Pathologic response and survival after cisplatin, pemetrexed, and bevacizumab followed by surgery for clinical stage II/IIIA non-squamous non-small cell lung cancer

Date

08 Oct 2016

Session

Poster Display

Presenters

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

Author affiliations

  • 1 Surgical Oncology, Hiroshima University, 734-8551 - Hiroshima/JP
  • 2 General Thoracic Surgery, Juntendo University School of Medicine, 113-0033 - Tokyo/JP
  • 3 Thoracic Surgery, University of Occupational and Environmental Health, Kitakyushu/JP
  • 4 Thoracic Surgery, Kanagawa Cancer Center, Yokohama/JP
  • 5 Thoracic Surgery, Kure Medical Center/Chugoku Cancer Center, Kure/JP
  • 6 Thoracic Surgery, Kanazawa University, Kanazawa/JP
  • 7 Thoracic Surgery & Oncology, National Cancer Center Hospital East, 277-8577 - Kashiwa/JP
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Background

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).

Methods

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.

Results

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).

Conclusions

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

UMIN000004278

Legal entity responsible for the study

Morihito Okada

Funding

Hiroshima University

Disclosure

All authors have declared no conflicts of interest.

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