TY - JOUR
T1 - Transitioning to Neoadjuvant Therapy for Resectable Non-Small Cell Lung Cancer
T2 - Trends and Surgical Outcomes in a Regionalized Pulmonary Oncology Network
AU - Pilon, Yohann
AU - Rokah, Merav
AU - Seitlinger, Joseph
AU - Sepesi, Boris
AU - Rayes, Roni F.
AU - Cools-Lartigue, Jonathan
AU - Najmeh, Sara
AU - Sirois, Christian
AU - Mulder, David
AU - Ferri, Lorenzo
AU - Abdulkarim, Bassam
AU - Ezer, Nicole
AU - Fraser, Richard
AU - Camilleri-Broët, Sophie
AU - Fiset, Pierre Olivier
AU - Wong, Annick
AU - Sud, Shelly
AU - Langleben, Adrian
AU - Agulnik, Jason
AU - Pepe, Carmela
AU - Shieh, Benjamin
AU - Hirsh, Vera
AU - Ofiara, Linda
AU - Owen, Scott
AU - Spicer, Jonathan D.
N1 - Publisher Copyright:
© 2023
PY - 2024
Y1 - 2024
N2 - Background: Several regulatory agencies have approved the use of the neoadjuvant chemo-immunotherapy for resectable stage II and III of non-small cell lung cancer (NSCLC) and numerous trials investigating novel agents are underway. However, significant concerns exist around the feasibility and safety of offering curative surgery to patients treated within such pathways. The goal in this study was to evaluate the impact of a transition towards a large-scale neoadjuvant therapy program for NSCLC. Methods: Medical charts of patients with clinical stage II and III NSCLC who underwent resection from January 2015 to December 2020 were reviewed. The primary outcome was perioperative complication rate between neoadjuvant-treated versus upfront surgery patients. Multivariable logistic regression estimated occurrence of postoperative complications and overall survival was assessed as an exploratory secondary outcome by Kaplan–Meier and Cox-regression analyses. Results: Of the 428 patients included, 106 (24.8%) received neoadjuvant therapy and 322 (75.2%) upfront surgery. Frequency of minor and major postoperative complications was similar between groups (P = .22). Occurrence in postoperative complication was similar in both cohort (aOR = 1.31, 95% CI 0.73-2.34). Neoadjuvant therapy administration increased from 10% to 45% with a rise in targeted and immuno-therapies over time, accompanied by a reduced rate of preoperative radiation therapy use. 1-, 2-, and 5-year overall survival was higher in neoadjuvant therapy compared to upfront surgery patients (Log-Rank P = .017). Conclusions: No significant differences in perioperative outcomes and survival were observed in resectable NSCLC patients treated by neoadjuvant therapy versus upfront surgery. Transition to neoadjuvant therapy among resectable NSCLC patients is safe and feasible from a surgical perspective.
AB - Background: Several regulatory agencies have approved the use of the neoadjuvant chemo-immunotherapy for resectable stage II and III of non-small cell lung cancer (NSCLC) and numerous trials investigating novel agents are underway. However, significant concerns exist around the feasibility and safety of offering curative surgery to patients treated within such pathways. The goal in this study was to evaluate the impact of a transition towards a large-scale neoadjuvant therapy program for NSCLC. Methods: Medical charts of patients with clinical stage II and III NSCLC who underwent resection from January 2015 to December 2020 were reviewed. The primary outcome was perioperative complication rate between neoadjuvant-treated versus upfront surgery patients. Multivariable logistic regression estimated occurrence of postoperative complications and overall survival was assessed as an exploratory secondary outcome by Kaplan–Meier and Cox-regression analyses. Results: Of the 428 patients included, 106 (24.8%) received neoadjuvant therapy and 322 (75.2%) upfront surgery. Frequency of minor and major postoperative complications was similar between groups (P = .22). Occurrence in postoperative complication was similar in both cohort (aOR = 1.31, 95% CI 0.73-2.34). Neoadjuvant therapy administration increased from 10% to 45% with a rise in targeted and immuno-therapies over time, accompanied by a reduced rate of preoperative radiation therapy use. 1-, 2-, and 5-year overall survival was higher in neoadjuvant therapy compared to upfront surgery patients (Log-Rank P = .017). Conclusions: No significant differences in perioperative outcomes and survival were observed in resectable NSCLC patients treated by neoadjuvant therapy versus upfront surgery. Transition to neoadjuvant therapy among resectable NSCLC patients is safe and feasible from a surgical perspective.
KW - Locally advanced non-small cell lung cancer
KW - Perioperative outcomes
KW - Personalized medicine
KW - Preoperative therapies
KW - Thoracic oncology
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U2 - 10.1016/j.cllc.2023.12.005
DO - 10.1016/j.cllc.2023.12.005
M3 - Article
C2 - 38378398
AN - SCOPUS:85185576707
SN - 1525-7304
JO - Clinical Lung Cancer
JF - Clinical Lung Cancer
ER -