Surgical outcomes after chemotherapy plus nivolumab and chemotherapy plus nivolumab and ipilimumab in patients with non–small cell lung cancer

Hope Feldman; Boris Sepesi; Cheuk H. Leung; Heather Lin; Annikka Weissferdt; Apar Pataer; William N. William; Garrett L. Walsh; David C. Rice; Jack A. Roth; Reza J. Mehran; Wayne L. Hofstetter; Mara B. Antonoff; Ravi Rajaram; Don L. Gibbons; J. Jack Lee; John V. Heymach; Ara A. Vaporciyan; Stephen G. Swisher; Tina Cascone

doi:10.1016/j.jtcvs.2023.09.073

Surgical outcomes after chemotherapy plus nivolumab and chemotherapy plus nivolumab and ipilimumab in patients with non–small cell lung cancer

Hope Feldman, Boris Sepesi, Cheuk H. Leung, Heather Lin, Annikka Weissferdt, Apar Pataer, William N. William, Garrett L. Walsh, David C. Rice, Jack A. Roth, Reza J. Mehran, Wayne L. Hofstetter, Mara B. Antonoff, Ravi Rajaram, Don L. Gibbons, J. Jack Lee, John V. Heymach, Ara A. Vaporciyan, Stephen G. Swisher, Tina Cascone

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Objective: Chemotherapy plus nivolumab is the standard of care neoadjuvant treatment for patients with resectable stage IB to IIIA non–small cell lung cancer. The influence of dual checkpoint blockade with chemotherapy on surgical outcomes remains unknown. We aimed to determine operative complexity and perioperative outcomes associated with neoadjuvant chemotherapy and nivolumab with or without ipilimumab. Methods: A total of 44 patients with stage IB (≥4 cm) to IIIA non–small cell lung cancer were treated on sequential platform arms of the NEOSTAR trial. A total of 22 patients were treated with nivolumab + chemotherapy, and 22 patients were treated with ipilimumab + nivolumab + chemotherapy. The safety of surgical resection after neoadjuvant therapy was estimated using 30-day complication rates. Operative reports and surgeons' narratives were evaluated to determine procedural complexity and operative conduct. Results: All 22 of 22 patients (100%) treated with nivolumab + chemotherapy underwent surgical resection: 20 R0 (90.9%), 17 (77.3%) lobectomies, 1 wedge resection, 2 segmentectomies, and 2 pneumonectomies. The majority, 21 of 22 (95%), were performed by thoracotomy. A total of 13 of 22 (59.1%) were rated as challenging resections. A total of 4 of 22 patients (18.2%) experienced grade 3 or greater Clavien-Dindo complication. A total of 20 of 22 patients (90.9%) treated with ipilimumab + nivolumab + chemotherapy underwent surgical resection: 19 R0 (95%), 18 (90%) lobectomies, 1 pneumonectomy, and 1 segmentectomy. A total of 16 of 20 (80%) resections were performed via thoracotomy, 3 of 20 (15%) via robotics, and 1 of 20 (5%) via thoracoscopy. A total of 9 of 20 (45%) resections were considered challenging. A total of 4 of 20 patients (20%) experienced grade 3 or greater Clavien-Dindo complication. Conclusions: Surgical resections are feasible and safe, with high rates of R0 after neoadjuvant chemotherapy and nivolumab with or without ipilimumab. Overall, approximately half of cases (22/42, 52.3%) were considered to be more challenging than a standard lobectomy.

Original language	English (US)
Pages (from-to)	1444-1453.e4
Journal	Journal of Thoracic and Cardiovascular Surgery
Volume	167
Issue number	4
DOIs	https://doi.org/10.1016/j.jtcvs.2023.09.073
State	Published - Apr 2024

Keywords

clinical trial
immunotherapy
NSCLC

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine

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10.1016/j.jtcvs.2023.09.073

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Feldman, H., Sepesi, B., Leung, C. H., Lin, H., Weissferdt, A., Pataer, A., William, W. N., Walsh, G. L., Rice, D. C., Roth, J. A., Mehran, R. J., Hofstetter, W. L., Antonoff, M. B., Rajaram, R., Gibbons, D. L., Lee, J. J., Heymach, J. V., Vaporciyan, A. A., Swisher, S. G., & Cascone, T. (2024). Surgical outcomes after chemotherapy plus nivolumab and chemotherapy plus nivolumab and ipilimumab in patients with non–small cell lung cancer. Journal of Thoracic and Cardiovascular Surgery, 167(4), 1444-1453.e4. https://doi.org/10.1016/j.jtcvs.2023.09.073

Feldman, H, Sepesi, B, Leung, CH , Lin, H , Weissferdt, A , Pataer, A, William, WN, Walsh, GL , Rice, DC, Roth, JA, Mehran, RJ , Hofstetter, WL , Antonoff, MB , Rajaram, R , Gibbons, DL , Lee, JJ , Heymach, JV , Vaporciyan, AA , Swisher, SG & Cascone, T 2024, 'Surgical outcomes after chemotherapy plus nivolumab and chemotherapy plus nivolumab and ipilimumab in patients with non–small cell lung cancer', Journal of Thoracic and Cardiovascular Surgery, vol. 167, no. 4, pp. 1444-1453.e4. https://doi.org/10.1016/j.jtcvs.2023.09.073

@article{3d0dfa4d351f48a08724c2c3e4399e39,

title = "Surgical outcomes after chemotherapy plus nivolumab and chemotherapy plus nivolumab and ipilimumab in patients with non–small cell lung cancer",

abstract = "Objective: Chemotherapy plus nivolumab is the standard of care neoadjuvant treatment for patients with resectable stage IB to IIIA non–small cell lung cancer. The influence of dual checkpoint blockade with chemotherapy on surgical outcomes remains unknown. We aimed to determine operative complexity and perioperative outcomes associated with neoadjuvant chemotherapy and nivolumab with or without ipilimumab. Methods: A total of 44 patients with stage IB (≥4 cm) to IIIA non–small cell lung cancer were treated on sequential platform arms of the NEOSTAR trial. A total of 22 patients were treated with nivolumab + chemotherapy, and 22 patients were treated with ipilimumab + nivolumab + chemotherapy. The safety of surgical resection after neoadjuvant therapy was estimated using 30-day complication rates. Operative reports and surgeons' narratives were evaluated to determine procedural complexity and operative conduct. Results: All 22 of 22 patients (100%) treated with nivolumab + chemotherapy underwent surgical resection: 20 R0 (90.9%), 17 (77.3%) lobectomies, 1 wedge resection, 2 segmentectomies, and 2 pneumonectomies. The majority, 21 of 22 (95%), were performed by thoracotomy. A total of 13 of 22 (59.1%) were rated as challenging resections. A total of 4 of 22 patients (18.2%) experienced grade 3 or greater Clavien-Dindo complication. A total of 20 of 22 patients (90.9%) treated with ipilimumab + nivolumab + chemotherapy underwent surgical resection: 19 R0 (95%), 18 (90%) lobectomies, 1 pneumonectomy, and 1 segmentectomy. A total of 16 of 20 (80%) resections were performed via thoracotomy, 3 of 20 (15%) via robotics, and 1 of 20 (5%) via thoracoscopy. A total of 9 of 20 (45%) resections were considered challenging. A total of 4 of 20 patients (20%) experienced grade 3 or greater Clavien-Dindo complication. Conclusions: Surgical resections are feasible and safe, with high rates of R0 after neoadjuvant chemotherapy and nivolumab with or without ipilimumab. Overall, approximately half of cases (22/42, 52.3%) were considered to be more challenging than a standard lobectomy.",

keywords = "clinical trial, immunotherapy, NSCLC",

author = "Hope Feldman and Boris Sepesi and Leung, {Cheuk H.} and Heather Lin and Annikka Weissferdt and Apar Pataer and William, {William N.} and Walsh, {Garrett L.} and Rice, {David C.} and Roth, {Jack A.} and Mehran, {Reza J.} and Hofstetter, {Wayne L.} and Antonoff, {Mara B.} and Ravi Rajaram and Gibbons, {Don L.} and Lee, {J. Jack} and Heymach, {John V.} and Vaporciyan, {Ara A.} and Swisher, {Stephen G.} and Tina Cascone",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2024",

month = apr,

doi = "10.1016/j.jtcvs.2023.09.073",

language = "English (US)",

volume = "167",

pages = "1444--1453.e4",

journal = "Journal of Thoracic and Cardiovascular Surgery",

issn = "0022-5223",

publisher = "Mosby Inc.",

number = "4",

}

TY - JOUR

T1 - Surgical outcomes after chemotherapy plus nivolumab and chemotherapy plus nivolumab and ipilimumab in patients with non–small cell lung cancer

AU - Feldman, Hope

AU - Sepesi, Boris

AU - Leung, Cheuk H.

AU - Lin, Heather

AU - Weissferdt, Annikka

AU - Pataer, Apar

AU - William, William N.

AU - Walsh, Garrett L.

AU - Rice, David C.

AU - Roth, Jack A.

AU - Mehran, Reza J.

AU - Hofstetter, Wayne L.

AU - Antonoff, Mara B.

AU - Rajaram, Ravi

AU - Gibbons, Don L.

AU - Lee, J. Jack

AU - Heymach, John V.

AU - Vaporciyan, Ara A.

AU - Swisher, Stephen G.

AU - Cascone, Tina

PY - 2024/4

Y1 - 2024/4

N2 - Objective: Chemotherapy plus nivolumab is the standard of care neoadjuvant treatment for patients with resectable stage IB to IIIA non–small cell lung cancer. The influence of dual checkpoint blockade with chemotherapy on surgical outcomes remains unknown. We aimed to determine operative complexity and perioperative outcomes associated with neoadjuvant chemotherapy and nivolumab with or without ipilimumab. Methods: A total of 44 patients with stage IB (≥4 cm) to IIIA non–small cell lung cancer were treated on sequential platform arms of the NEOSTAR trial. A total of 22 patients were treated with nivolumab + chemotherapy, and 22 patients were treated with ipilimumab + nivolumab + chemotherapy. The safety of surgical resection after neoadjuvant therapy was estimated using 30-day complication rates. Operative reports and surgeons' narratives were evaluated to determine procedural complexity and operative conduct. Results: All 22 of 22 patients (100%) treated with nivolumab + chemotherapy underwent surgical resection: 20 R0 (90.9%), 17 (77.3%) lobectomies, 1 wedge resection, 2 segmentectomies, and 2 pneumonectomies. The majority, 21 of 22 (95%), were performed by thoracotomy. A total of 13 of 22 (59.1%) were rated as challenging resections. A total of 4 of 22 patients (18.2%) experienced grade 3 or greater Clavien-Dindo complication. A total of 20 of 22 patients (90.9%) treated with ipilimumab + nivolumab + chemotherapy underwent surgical resection: 19 R0 (95%), 18 (90%) lobectomies, 1 pneumonectomy, and 1 segmentectomy. A total of 16 of 20 (80%) resections were performed via thoracotomy, 3 of 20 (15%) via robotics, and 1 of 20 (5%) via thoracoscopy. A total of 9 of 20 (45%) resections were considered challenging. A total of 4 of 20 patients (20%) experienced grade 3 or greater Clavien-Dindo complication. Conclusions: Surgical resections are feasible and safe, with high rates of R0 after neoadjuvant chemotherapy and nivolumab with or without ipilimumab. Overall, approximately half of cases (22/42, 52.3%) were considered to be more challenging than a standard lobectomy.

AB - Objective: Chemotherapy plus nivolumab is the standard of care neoadjuvant treatment for patients with resectable stage IB to IIIA non–small cell lung cancer. The influence of dual checkpoint blockade with chemotherapy on surgical outcomes remains unknown. We aimed to determine operative complexity and perioperative outcomes associated with neoadjuvant chemotherapy and nivolumab with or without ipilimumab. Methods: A total of 44 patients with stage IB (≥4 cm) to IIIA non–small cell lung cancer were treated on sequential platform arms of the NEOSTAR trial. A total of 22 patients were treated with nivolumab + chemotherapy, and 22 patients were treated with ipilimumab + nivolumab + chemotherapy. The safety of surgical resection after neoadjuvant therapy was estimated using 30-day complication rates. Operative reports and surgeons' narratives were evaluated to determine procedural complexity and operative conduct. Results: All 22 of 22 patients (100%) treated with nivolumab + chemotherapy underwent surgical resection: 20 R0 (90.9%), 17 (77.3%) lobectomies, 1 wedge resection, 2 segmentectomies, and 2 pneumonectomies. The majority, 21 of 22 (95%), were performed by thoracotomy. A total of 13 of 22 (59.1%) were rated as challenging resections. A total of 4 of 22 patients (18.2%) experienced grade 3 or greater Clavien-Dindo complication. A total of 20 of 22 patients (90.9%) treated with ipilimumab + nivolumab + chemotherapy underwent surgical resection: 19 R0 (95%), 18 (90%) lobectomies, 1 pneumonectomy, and 1 segmentectomy. A total of 16 of 20 (80%) resections were performed via thoracotomy, 3 of 20 (15%) via robotics, and 1 of 20 (5%) via thoracoscopy. A total of 9 of 20 (45%) resections were considered challenging. A total of 4 of 20 patients (20%) experienced grade 3 or greater Clavien-Dindo complication. Conclusions: Surgical resections are feasible and safe, with high rates of R0 after neoadjuvant chemotherapy and nivolumab with or without ipilimumab. Overall, approximately half of cases (22/42, 52.3%) were considered to be more challenging than a standard lobectomy.

KW - clinical trial

KW - immunotherapy

KW - NSCLC

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U2 - 10.1016/j.jtcvs.2023.09.073

DO - 10.1016/j.jtcvs.2023.09.073

M3 - Article

C2 - 37816395

AN - SCOPUS:85176455214

SN - 0022-5223

VL - 167

SP - 1444-1453.e4

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

IS - 4

ER -

Surgical outcomes after chemotherapy plus nivolumab and chemotherapy plus nivolumab and ipilimumab in patients with non–small cell lung cancer

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