We previously reported that neoadjuvant cisplatin, pemetrexed, and bevacizumab followed by surgery is safe and feasible in patients with clinical stage II/IIIA non-squamous non-small cell lung cancer (NSCLC) (NAVAL study). The purpose of this study is to evaluate survival results, which are secondary endpoints of NAVAL study.
In a phase II feasibility study of neoadjuvant chemotherapy with cisplatin (75 mg/m2), pemetrexed (500 mg/m2), and bevacizumab (15 mg/kg) followed by surgery for resectable clinical stage II/IIIA non-squamous NSCLC, progression-free survival (PFS) and overall survival (OS) were analyzed. Patients who had less than 33% residual viable primary tumor after neoadjuvant chemotherapy were defined as pathologic responders. Others were defined as non-responders.
Among all 30 patients, 25 underwent surgical resection after 3 cycle of neoadjuvant chemotherapy with bevacizumab, and 3 underwent off protocol surgical resection. Two-year PFS rate and 5-year PFS rate were 41.5% and 34.6%, respectively. Two-year OS rate and 5-year OS rate were 70.0% and 60.0%, respectively. Six (20%) patients were classified as pathologic responders, whereas 24 (80%) as non-responders. There was significant difference in PFS between pathologic responders (5-year PFS rate, 100%) and non-responders (5-year PFS rate, 17.5%; P = 0.002). Also, there was significant difference in OS between pathologic responders (5-year OS rate, 100%) and non-responders (5-year OS rate, 43.5%; P = 0.006).
Neoadjuvant cisplatin, pemetrexed, and bevacizumab followed by surgery is effective for clinical stage II/IIIA non-squamous NSCLC. Long-term survival after surgery is expected for pathologic responders, whereas additional therapy will be needed for non-responders.
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All authors have declared no conflicts of interest.