Abstract 92P
Background
Development of immunotherapy/molecular targeted therapy has significantly increased survival/QoL in advanced stages NSCLC. Aim: to analyze outcome predictors, surrogate outcomes, and PROMs after neoadjuvant immunotherapy for initially unresectable NSCLC.
Methods
Initially unresectable NSCLC (2014–2021) who received immunotherapy ± platinum-based chemo and/or radiotherapy evaluated after response (reduction of primary tumor and/or mediastinal lymphadenopathy/control of distant metastatic disease underwent surgical resection). PROMs were recorded using EORTC QLQ-29.
Results
19 underwent salvage surgery after ICI. 14 had partial response (73.6%), 5 stable diseases. Diagnosis was achieved by EBUS in 8 (42.1%), FNAB in 7 (36.8%), metastasis biopsy in 4 (21.0%). 11 (57.9%) were treated with neoadjuvant platinum-based chemo before or with ICI, 1 (5.2%) pemetrexed before ICI, 5 (26.3%) radiotherapy for metastatic control. 3 (15.7%) had ICI adverse effects. Radiotherapy was never used preoperatively for pulmonary/mediastinal disease. 7 (36.8%) received adjuvant therapy (5 [26.3%] pembrolizumab, 1 [5.2%] pemetrexed, 1 [5.2%] pemetrexed + pembrolizumab). 4 (21.0%) had local relapse (no systemic relapse). Median OS was 19 months (range: 2–57.4). At 2 months, 94.7% were alive (6 months: 89.5%; 31 months: 79.5%). 2 (10.5%) had local recurrence. 2 (10.5%) died due to recurrence, 1 (5.2%) to COVID. 4 (21.0%) relapsed (median DFS: 5.3 months [range: 2.2–13.0]). PROMs were reviewed retrospectively at 30 days/1 year with significant decrease in coughing, side effects of treatment, surgery-related problems.
Table: 92PData as No (%), median (range), mean ± SD
| Age | 66 (47–76) | ||
|---|---|---|---|
| M/F | 8.5 | ||
| AdenocarcinomaSquamous cell Other | 11 (57.9)5 (26.3) 3 (15.6) | ||
| Clinical StageIAIIBIIIAIIIBIIICIVAIVB | Before ICI3 (15.7)4 (21.0)3 (15.7)8 (42.1)1 (5.2) | After ICI4 (21.0)3 (15.7)2 (10.5)3 (15.7)7 (36.8) | |
| PembrolizumabNivolumabAtezolizumab | 14 (73.6)3 (15.7)2 (10.5) | ||
| Lobectomy Pneumonectomy Other | 15 (78.9)2 (10.5)2 (10.5) | ||
| Pathological response Complete Major | 7 (36.8)3 (15.7) | ||
| EORTC QLQ-29 | 30 d | 1 y | p-value |
| Coughing | 18.8 ± 15.5 | 5.5 ± 10.2 | 0.19 |
| Shortness of breath | 11.1 ± 11.8 | 8.1 ± 9.8 | 0.84 |
| Side effects of treatment | 10.5 ± 6.5 | 7.7 ± 4.4 | 0.91 |
| Fear of progression | 13.3 ± 16.9 | 6.6 ± 13.8 | 0.40 |
| Surgery related problems | 10.2 ± 9.4 | 4.0 ± 6.0 | 0.53 |
Conclusions
Radical surgical resections following definitive immunotherapy/immune-chemotherapy in selected initially unresectable NSCLC are feasible and safe (low surgical-related mortality and morbidity). Symptoms and surgery-related outcomes were lower with higher QoL due to a selected group of highly motivated patients.
Legal entity responsible for the study
The authors.
Funding
Ministero della Salute.
Disclosure
All authors have declared no conflicts of interest.