1197P - Pathologic response and survival after cisplatin, pemetrexed, and bevacizumab followed by surgery for clinical stage II/IIIA non-squamous non-small...

Date 08 October 2016
Event ESMO 2016 Congress
Session Poster Display
Topics Anticancer Agents
Surgical Oncology
Non-Small Cell Lung Cancer
Biological Therapy
Radiation Oncology
Presenter Yasuhiro Tsutani
Citation Annals of Oncology (2016) 27 (6): 411-415. 10.1093/annonc/mdw382
Authors Y. Tsutani1, Y. Miyata1, K. Suzuki2, K. Takamochi2, F. Tanaka3, H. Nakayama4, Y. Yamashita5, M. Oda6, M. Tsuboi7, M. Okada1
  • 1Surgical Oncology, Hiroshima University, 734-8551 - Hiroshima/JP
  • 2General Thoracic Surgery, Juntendo University School of Medicine, 113-0033 - Tokyo/JP
  • 3Thoracic Surgery, University of Occupational and Environmental Health, Kitakyushu/JP
  • 4Thoracic Surgery, Kanagawa Cancer Center, Yokohama/JP
  • 5Thoracic Surgery, Kure Medical Center/Chugoku Cancer Center, Kure/JP
  • 6Thoracic Surgery, Kanazawa University, Kanazawa/JP
  • 7Thoracic Surgery & Oncology, National Cancer Center Hospital East, 277-8577 - Kashiwa/JP



Pathologic response after neoadjuvant therapy may be a surrogate marker of survival for lung cancer patients. The purpose of this study is to investigate the prognostic role of pathologic response after neoadjuvant chemotherapy with bevacizumab (BEV) in patients with clinical stage II/IIIA non-squamous non-small cell lung cancer (NSCLC).


In a phase II feasibility study of neoadjuvant chemotherapy with cisplatin (CDDP), pemetrexed (PEM), and BEV followed by surgery for resectable clinical stage II/IIIA non-squamous NSCLC (NAVAL study), the relationships between pathologic response and recurrence-free survival (RFS) or overall survival (OS) were analyzed. Less than 33% residual viable primary tumor after neoadjuvant chemotherapy was defined as pathologic response. None of study patient received postoperative adjuvant chemotherapy.


Twenty-five of 30 (83%) study patients underwent surgery after 3 cycles of neoadjuvant CDDP (75 mg/m2) + PEM (500 mg/m2) + BEV (15 mg/kg). Twenty-two (88%) and 3 (12%) patients underwent lobectomy and bilobectomy with systematic lymphadenectomy, respectively. Six (24%) patients were classified as pathologic responders, whereas 19 (76%) as non-responders. Three (12%) patients achieved pathologic complete response. Pathologic responders significantly correlated to RFS with 3-year RFS for pathologic responders of 100% versus 15.8% for non-responders (P = 0.002). Similar trend was observed in OS with 3-year OS for pathologic responders of 100% versus 63.2% for non-responders (P = 0.102).


Pathologic response can be a surrogate marker for survival in patients who underwent surgery after neoadjuvant CDDP + PEM + BEV. Additional treatment such as postoperative adjuvant chemotherapy may be needed for pathologic non-responders.

Clinical trial identification


Legal entity responsible for the study

Morihito Okada


Hiroshima University


All authors have declared no conflicts of interest.