Journal Article Ahead of print
PubMed: 42872517 DOI: 10.1002/ijc.70789
Real-World Experience With Multimodal Treatment of Resectable Stage II-III Non-Small Cell Lung Cancer: A Single Institutional Analysis.
Int J Cancer
Authors: Raffaella Griffo, Benedikt Niedermaier, Laura V Klotz, Marc Schneider, Michael Allgäuer, Marc Kriegsmann, Romina M Roesch, Lena Brendel, Henrike Deissner, Farastuk Bozorgmehr, Petros Christopoulos, Michael Thomas, Hauke Winter, Martin E Eichhorn, Florian Eichhorn
Affiliations
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
- Division of Systems Biology of Signal Transduction, German Cancer Research Center (DKFZ), DKFZ-ZMBH Alliance, Heidelberg, Germany.
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
- Department of Thoracic Surgery, Thoraxklinik, University of Heidelberg, Heidelberg, Germany. Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
- Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research (DZL), Heidelberg, Germany. Translational Research Unit, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
- Department of Pathology, University of Heidelberg, Heidelberg, Germany.
- Department of Thoracic Oncology, Thoraxklinik, University of Heidelberg, Heidelberg, Germany.
Abstract
Neoadjuvant therapy has recently become an integral component of multimodal treatment for resectable lung cancer. However, real-world data on perioperative morbidity and treatment adherence remain limited. This study aimed to assess the feasibility and safety of different neoadjuvant treatment approaches applied within daily clinical routine. We retrospectively analyzed patients with resectable stage II-III non-small cell lung cancer undergoing either neoadjuvant chemoimmunotherapy or chemotherapy/chemoradiotherapy followed by curative surgical resection. Treatment groups were compared with respect to perioperative outcomes, radiologic and pathologic downstaging, and pathologic response. A total of 143 patients met the inclusion criteria, of whom 46 (32.2%) received chemoimmunotherapy and 97 (67.8%) were treated with chemotherapy prior to surgery. Adverse events leading to treatment discontinuation occurred in only two patients in the chemoimmunotherapy group and four patients in the chemotherapy group. Chemoimmunotherapy was associated with significantly higher rates of pathologic complete response (37.0% vs. 4.1%) and more pronounced nodal downstaging, with a higher proportion of patients achieving ypN0 status (76.1% vs. 34.0%). High tumoral PD-L1 expression (≥ 50%) and squamous cell carcinoma histology were independently associated with pathologic complete response. Real-world treatment with neoadjuvant chemoimmunotherapy was feasible and resulted in improved response rates compared with chemotherapy, without increasing perioperative morbidity. Histology and high PD-L1 expression may serve as predictors for complete pathologic response, although the predictive value of PD-L1 requires confirmation in larger cohorts with more complete biomarker data.
MeSH
Cells, Lung, Neoplasms, Carcinoma, Non-Small-Cell Lung, Drug Therapy, Immunotherapy, Combined Modality Therapy, Lung Neoplasms, Small Cell Lung Carcinoma, Neoadjuvant Therapy, Morbidity, Therapeutics, Chemotherapy