Initial results of pulmonary resection after neoadjuvant nivolumab in patients with resectable non–small cell lung cancer Journal Article
| Authors: | Bott, M. J.; Yang, S. C.; Park, B. J.; Adusumilli, P. S.; Rusch, V. W.; Isbell, J. M.; Downey, R. J.; Brahmer, J. R.; Battafarano, R.; Bush, E.; Chaft, J.; Forde, P. M.; Jones, D. R.; Broderick, S. R. |
| Article Title: | Initial results of pulmonary resection after neoadjuvant nivolumab in patients with resectable non–small cell lung cancer |
| Abstract: | Objective: We conducted a phase I trial of neoadjuvant nivolumab, a monoclonal antibody to the programmed cell death protein 1 checkpoint receptor, in patients with resectable non–small cell lung cancer. We analyzed perioperative outcomes to assess the safety of this strategy. Methods: Patients with untreated stage I-IIIA non–small cell lung cancer underwent neoadjuvant therapy with 2 cycles of nivolumab (3 mg/kg), 4 and 2 weeks before resection. Patients underwent invasive mediastinal staging as indicated and post-treatment computed tomography. Primary study end points were safety and feasibility of neoadjuvant nivolumab followed by pulmonary resection. Data on additional surgical details were collected through chart review. Results: Of 22 patients enrolled, 20 underwent resection. One was unresectable; another had small cell histologic subtype. There were no delays to surgical resection. Median time from first treatment to surgery was 33 (range, 17-43) days. There were 15 lobectomies, 2 pneumonectomies, 1 bilobectomy, 1 sleeve lobectomy, and 1 wedge resection. Of 13 procedures attempted via a video-assisted thoracoscopic surgery or robotic approach, 7 (54%) required thoracotomy. Median operative time was 228 (range, 132-312) minutes; estimated blood loss was 100 (range, 25-1000) mL; length of hospital stay was 4 (range, 2-17) days. There was no operative mortality. Morbidity occurred in 10 of 20 patients (50%). The most common postoperative complication was atrial arrhythmia (6/20; 30%). Major pathologic response was identified in 9 of 20 patients (45%). Conclusions: Neoadjuvant therapy with nivolumab was not associated with unexpected perioperative morbidity or mortality. More than half of the video-assisted thoracoscopic surgery/robotic cases were converted to thoracotomy, often because of hilar inflammation and fibrosis. © 2018 The American Association for Thoracic Surgery |
| Keywords: | adult; clinical article; treatment response; aged; drug safety; cancer adjuvant therapy; cancer patient; cancer staging; computer assisted tomography; multiple cycle treatment; lung resection; thoracotomy; morbidity; surgical approach; lung embolism; postoperative complication; length of stay; lung adenocarcinoma; feasibility study; immunotherapy; heart infarction; operation duration; single drug dose; adenosquamous carcinoma; perioperative period; urine retention; heart atrium arrhythmia; video assisted thoracoscopic surgery; neoadjuvant; non small cell lung cancer; nsclc; pleura empyema; wedge resection; nivolumab; operative blood loss; human; male; female; priority journal; article; squamous cell lung carcinoma; robot assisted surgery; bronchus injury; immune checkpoint inhibition |
| Journal Title: | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 158 |
| Issue: | 1 |
| ISSN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2019-07-01 |
| Start Page: | 269 |
| End Page: | 275; discussion 275-276 |
| Language: | English |
| DOI: | 10.1016/j.jtcvs.2018.11.124 |
| PROVIDER: | scopus |
| PUBMED: | 30718052 |
| PMCID: | PMC6653596 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 July 2019 -- Source: Scopus |
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