Lung Cancer Surgery after Treatment with Anti-PD1/PD-L1 Immunotherapy for Non-Small-Cell Lung Cancer: A Case—Cohort Study

Background: Immune checkpoint inhibitors (ICIs) are the standard of care for non-resectable non-small-cell lung cancer and are under investigation for resectable disease. Some authors have reported difficulties during lung surgery following ICI treatment. This retrospective study investigated the pe...

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Published in:Cancers 2021-09, Vol.13 (19), p.4915
Main Authors: El Husseini, Kinan, Piton, Nicolas, De Marchi, Marielle, Grégoire, Antoine, Vion, Roman, Blavier, Pierre, Thiberville, Luc, Baste, Jean-Marc, Guisier, Florian
Format: Article
Language:English
Subjects:
Cancer surgery
Cancer therapies
Chemotherapy
Cohort analysis
Data collection
Fibrosis
Immune checkpoint inhibitors
Immunotherapy
Inflammation
Lung cancer
Medical prognosis
Metastasis
Morbidity
Mortality
Non-small cell lung carcinoma
Patients
PD-1 protein
PD-L1 protein
Pembrolizumab
Population
Software
Surgery
Surgical outcomes
Thoracic surgery
Tumors
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Summary:Background: Immune checkpoint inhibitors (ICIs) are the standard of care for non-resectable non-small-cell lung cancer and are under investigation for resectable disease. Some authors have reported difficulties during lung surgery following ICI treatment. This retrospective study investigated the perioperative outcomes of lung resection in patients with preoperative ICI. Methods: Patients with major lung resection after receiving ICIs were included as cases and were compared to patients who received preoperative chemotherapy without ICI. Surgical, clinical, and imaging data were collected. Results: A total of 25 patients were included in the ICI group, and 34 were included in the control group. The ICI patients received five (2–18) infusions of ICI (80% with pembrolizumab). Indications for surgery varied widely across groups (p < 0.01). Major pathological response was achieved in 44% of ICI patients and 23.5% of the control group (p = 0.049). Surgery reports showed a higher rate of tissue fibrosis/inflammation in the ICI group (p < 0.01), mostly in centrally located tumours (7/13, 53.8% vs. 3/11, 27.3% of distal tumours, p = 0.24), with no difference in operating time (p = 0.81) nor more conversions (p = 0.46) or perioperative complications (p = 0.94). There was no 90-day mortality. Disease-free survival was higher in the ICI group (HR = 0.30 (0.13–0.71), p = 0.02). Conclusions: This study further supports the safety and feasibility of lung resection in patients following preoperative treatment with ICI.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers13194915