Transitioning to Neoadjuvant Therapy for Resectable Non-Small Cell Lung Cancer: Trends and Surgical Outcomes in a Regionalized Pulmonary Oncology Network

• Published in: Clinical lung cancer 2024-05, Vol.25 (3), p.e133-e144.e4
• Main Authors: Pilon, Yohann, Rokah, Merav, Seitlinger, Joseph, Sepesi, Boris, Rayes, Roni F., Cools-Lartigue, Jonathan, Najmeh, Sara, Sirois, Christian, Mulder, David, Ferri, Lorenzo, Abdulkarim, Bassam, Ezer, Nicole, Fraser, Richard, Camilleri-Broët, Sophie, Fiset, Pierre-Olivier, Wong, Annick, Sud, Shelly, Langleben, Adrian, Agulnik, Jason, Pepe, Carmela, Shieh, Benjamin, Hirsh, Vera, Ofiara, Linda, Owen, Scott, Spicer, Jonathan D.
• Format: Article
• Language: English
• Subjects: Aged; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - therapy; Female; Follow-Up Studies; Humans; Locally advanced non-small cell lung cancer; Lung Neoplasms - drug therapy; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Middle Aged; Neoadjuvant Therapy - methods; Neoplasm Staging; Perioperative outcomes; Personalized medicine; Pneumonectomy; Postoperative Complications - epidemiology; Preoperative therapies; Retrospective Studies; Survival Rate; Thoracic oncology; Treatment Outcome
• ISSN: 1525-7304; 1938-0690
• DOI: 10.1016/j.cllc.2023.12.005

•Large-scale neoadjuvant therapy program for non-small cell lung cancer (NSCLC) is feasible.•Perioperative outcomes are similar in upfront surgery vs neoadjuvant in NSCLC.•Surgery is safe among neoadjuvant-treated resectable NSCLC. Several regulatory agencies have approved the use of the neoadjuvant chemo-immunotherapy for resectable stage II and III of non-small cell lung cancer (NSCLC) and numerous trials investigating novel agents are underway. However, significant concerns exist around the feasibility and safety of offering curative surgery to patients treated within such pathways. The goal in this study was to evaluate the impact of a transition towards a large-scale neoadjuvant therapy program for NSCLC. Medical charts of patients with clinical stage II and III NSCLC who underwent resection from January 2015 to December 2020 were reviewed. The primary outcome was perioperative complication rate between neoadjuvant-treated versus upfront surgery patients. Multivariable logistic regression estimated occurrence of postoperative complications and overall survival was assessed as an exploratory secondary outcome by Kaplan–Meier and Cox-regression analyses. Of the 428 patients included, 106 (24.8%) received neoadjuvant therapy and 322 (75.2%) upfront surgery. Frequency of minor and major postoperative complications was similar between groups (P = .22). Occurrence in postoperative complication was similar in both cohort (aOR = 1.31, 95% CI 0.73-2.34). Neoadjuvant therapy administration increased from 10% to 45% with a rise in targeted and immuno-therapies over time, accompanied by a reduced rate of preoperative radiation therapy use. 1-, 2-, and 5-year overall survival was higher in neoadjuvant therapy compared to upfront surgery patients (Log-Rank P = .017). No significant differences in perioperative outcomes and survival were observed in resectable NSCLC patients treated by neoadjuvant therapy versus upfront surgery. Transition to neoadjuvant therapy among resectable NSCLC patients is safe and feasible from a surgical perspective. Of all 428 resectable stage II and III NSCLC patients included in this study, 25% received neoadjuvant therapy. Perioperative outcomes and 5-year overall survival were similar between patients having received neoadjuvant therapy versus upfront surgery. Establishing a neoadjuvant therapy program for NSCLC is feasible and safe from a surgical perspective.