Abstract 155P
Background
The use of immune checkpoint inhibitors (ICI) in a neoadjuvant or perioperative treatment concept emerges as a new standard for patients with resectable stage III NSCLC. There are however concerns about patients who cannot undergo definitive surgery after neoadjuvant treatment.
Methods
Data from 499 patients included in the five Swiss Group for Clinical Cancer Research (SAKK) trials 16/96, 16/00, 16/01, 16/08, and 16/14 were pooled and outcomes analyzed. These trials were designed for resectable stage III NSCLC. Preoperative treatment consisted of three cycles induction chemotherapy (cisplatin/docetaxel), followed in some patients by neoadjuvant radiotherapy (44 Gy, 22 fractions) (16/00, 16/01, 16/08) and cetuximab (16/08), or durvalumab (16/14). Patients in SAKK 16/14 also had adjuvant durvalumab. Here, we report a retrospective analysis of outcomes in patients who did or did not have definitive surgery.
Results
Of 499 patients (N=431 in pre-ICI SAKK trials; N=68 in SAKK 16/14), 102 patients (20.4%) did not have definitive surgery. Cancellation of surgery occurred in a similar proportion of patients with or without neoadjuvant ICI (19% vs. 21%, p=0.9), but R0 resection was achieved in more patients (93% vs. 80%, p=0.024) after neoadjuvant ICI in SAKK 16/14. In the pre-ICI trials (median follow-up: 9.5 years) the 3- and 5-year overall survival (OS) rates were 45% and 37%, while in SAKK 16/14 (mFU: 4.5y) the 3-y OS rate was 70%. The median OS (months) and 3-y OS rate were longer/higher in patients who had definitive surgery compared to those who did not: 43.4 vs. 9.0 and 54% vs. 10% (pre-ICI trials); and NR (67.2-NR) vs. 26.8 and 78% vs. 32% (SAKK 16/14). Reasons for not undergoing definitive surgery by trial and outcomes by subsequent treatment will be presented at the meeting.
Conclusions
The proportion of patients with definitive surgery was similar in the pre-ICI and SAKK 16/14 trials, but the R0 resection rate was significantly higher in SAKK 16/14. Prognosis in patients without definitive surgery appears to have improved in the ICI-era.
Legal entity responsible for the study
Swiss Group for Clinical Cancer Research (SAKK).
Funding
Funding directed to David König.
Disclosure
S. Cardoso Almeida: Financial Interests, Institutional, Other, Support for attending meetings and/or travel: Janssen-Cilag, Sanofi, BeiGene. T. Finazzi: Financial Interests, Institutional, Speaker’s Bureau: AstraZeneca; Financial Interests, Institutional, Other, Support for attending meetings and/or travel: AstraZeneca, Astellas Pharma, Debiopharm. I. Opitz: Financial Interests, Institutional, Other: Roche, Medtronic; Financial Interests, Institutional, Speaker’s Bureau: AstraZeneca, Roche; Financial Interests, Institutional, Advisory Board: AstraZeneca, MSD, Medtronic, Bristol Myers Squibb; Financial Interests, Institutional, Other, Proctorship: Intuitive. M.T. Mark: Financial Interests, Institutional, Advisory Role, Consulting fees: Amgen, AstraZeneca, Bristol Myers Squibb, MSD, Pfizer, Takeda, Roche; Financial Interests, Institutional, Other, Support for attending meetings and/or travel: AstraZeneca, Roche, Takeda. A. Addeo: Financial Interests, Institutional, Speaker’s Bureau: AstraZeneca, Eli Lilly, Amgen; Financial Interests, Institutional, Sponsor/Funding: AstraZeneca; Financial Interests, Institutional, Advisory Role: Bristol Myers Squibb, AstraZeneca, Roche, Astellas, Novartis, MSD, Pfizer, Eli Lilly, Amgen, Merck. L.A. Mauti: Financial Interests, Personal, Advisory Board: Takeda, Bristol Myers Squibb, MSD, Merck, Sanofi, Novartis, AstraZeneca, Pfizer, Regeneron; Financial Interests, Personal, Advisory Role: Daiichi Sankyo, Sanofi; Financial Interests, Personal, Invited Speaker: Amgen; Financial Interests, Personal, Other, Support for attending meetings and/or travel: AstraZeneca, Roche, Sanofi; Financial Interests, Personal, Sponsor/Funding: Gilead; Financial Interests, Personal and Institutional, Sponsor/Funding: AstraZeneca. S.I. Rothschild: Financial Interests, Personal and Institutional, Research Grant: AstraZeneca, Merck Serono, Roche Pharma, Amgen; Financial Interests, Institutional, Advisory Role: Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Eli Lilly, Janssen, Merck, MSD, Novartis, Otsuka, Pfizer, PharmaMar, Roche Pharma, Roche Diagnostics, Sanofi Aventis, Takeda; Financial Interests, Institutional, Speaker’s Bureau: Roche Pharma, Bristol Myers Squibb, AstraZeneca, Amgen, MSD, Novartis, Roche Diagnostics, Takeda; Financial Interests, Institutional, Expert Testimony: Roche, AstraZeneca, Bristol Myer Squibb; Financial Interests, Institutional, Other, Support for attending meetings and/or travel: Roche Pharma, Eli Lilly, Bristol Myers Squibb, Amgen, AstraZeneca, MSD; Financial Interests, Institutional, Advisory Board: Roche; Non-Financial Interests, Personal and Institutional, Member, Vice President: Swiss Group for Clinical Cancer Research (SAKK); Non-Financial Interests, Personal and Institutional, Member, Elected member: Swiss Federal Drug Commission (Federal Health Office). M. Pless: Financial Interests, Institutional, Advisory Role: AbbVie, AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Roche, Takeda, Eisai Pharma, MSD, Novartis, Pfizer, Merck; Financial Interests, Institutional, Speaker’s Bureau: Janssen, Bayer, Nestle, Sanofi, Amgen; Financial Interests, Institutional, Other, Support for attending meetings and/or travel: AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Roche, Takeda, Vifor. D. König: Financial Interests, Institutional, Funding: Geistlich-Stucki Stiftung; Financial Interests, Institutional, Advisory Role: AstraZeneca, MSD, Novartis; Financial Interests, Institutional, Speaker’s Bureau: Amgen, Sanofi, Swiss Oncology in Motion, Mirati; Financial Interests, Institutional, Other, Support for attending meetings and/or travel: Sanofi, Amgen, Roche; Financial Interests, Institutional, Advisory Board: AstraZeneca, Merck, MSD, PharmaMar, Bristol Myers Squibb. All other authors have declared no conflicts of interest.