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
All authors have declared no conflicts of interest.