IASLC multidisciplinary recommendations for pathologic assessment of lung cancer resection specimens after neoadjuvant therapy Journal Article


Authors: Travis, W. D.; Dacic, S.; Wistuba, I.; Sholl, L.; Adusumilli, P.; Bubendorf, L.; Bunn, P.; Cascone, T.; Chaft, J.; Chen, G.; Chou, T. Y.; Cooper, W.; Erasmus, J. J.; Ferreira, C. G.; Goo, J. M.; Heymach, J.; Hirsch, F. R.; Horinouchi, H.; Kerr, K.; Kris, M.; Jain, D.; Kim, Y. T.; Lopez-Rios, F.; Lu, S.; Mitsudomi, T.; Moreira, A.; Motoi, N.; Nicholson, A. G.; Oliveira, R.; Papotti, M.; Pastorino, U.; Paz-Ares, L.; Pelosi, G.; Poleri, C.; Provencio, M.; Roden, A. C.; Scagliotti, G.; Swisher, S. G.; Thunnissen, E.; Tsao, M. S.; Vansteenkiste, J.; Weder, W.; Yatabe, Y.
Article Title: IASLC multidisciplinary recommendations for pathologic assessment of lung cancer resection specimens after neoadjuvant therapy
Abstract: Currently, there is no established guidance on how to process and evaluate resected lung cancer specimens after neoadjuvant therapy in the setting of clinical trials and clinical practice. There is also a lack of precise definitions on the degree of pathologic response, including major pathologic response or complete pathologic response. For other cancers such as osteosarcoma and colorectal, breast, and esophageal carcinomas, there have been multiple studies investigating pathologic assessment of the effects of neoadjuvant therapy, including some detailed recommendations on how to handle these specimens. A comprehensive mapping approach to gross and histologic processing of osteosarcomas after induction therapy has been used for over 40 years. The purpose of this article is to outline detailed recommendations on how to process lung cancer resection specimens and to define pathologic response, including major pathologic response or complete pathologic response after neoadjuvant therapy. A standardized approach is recommended to assess the percentages of (1) viable tumor, (2) necrosis, and (3) stroma (including inflammation and fibrosis) with a total adding up to 100%. This is recommended for all systemic therapies, including chemotherapy, chemoradiation, molecular-targeted therapy, immunotherapy, or any future novel therapies yet to be discovered, whether administered alone or in combination. Specific issues may differ for certain therapies such as immunotherapy, but the grossing process should be similar, and the histologic evaluation should contain these basic elements. Standard pathologic response assessment should allow for comparisons between different therapies and correlations with disease-free survival and overall survival in ongoing and future trials. The International Association for the Study of Lung Cancer has an effort to collect such data from existing and future clinical trials. These recommendations are intended as guidance for clinical trials, although it is hoped they can be viewed as suggestion for good clinical practice outside of clinical trials, to improve consistency of pathologic assessment of treatment response. © 2020
Keywords: cancer chemotherapy; treatment response; overall survival; histopathology; review; cancer combination chemotherapy; drug efficacy; monotherapy; cancer adjuvant therapy; disease free survival; preoperative care; neoadjuvant therapy; cancer staging; positron emission tomography; lymph node metastasis; antineoplastic agent; ipilimumab; cancer immunotherapy; computer assisted tomography; multiple cycle treatment; lung lobectomy; lung resection; inflammation; lung cancer; practice guideline; pathology; lung adenocarcinoma; specimen handling; drug response; medical society; interdisciplinary communication; platinum complex; lung fibrosis; pathologist; predictive value; chemoradiotherapy; epidermal growth factor receptor kinase inhibitor; non small cell lung cancer; molecularly targeted therapy; tumor necrosis; resection specimens; cancer prognosis; nivolumab; human; priority journal; squamous cell lung carcinoma; anaplastic lymphoma kinase inhibitor; atezolizumab; thoracic surgeon; specimen processing
Journal Title: Journal of Thoracic Oncology
Volume: 15
Issue: 5
ISSN: 1556-0864
Publisher: Elsevier Inc.  
Date Published: 2020-05-01
Start Page: 709
End Page: 740
Language: English
DOI: 10.1016/j.jtho.2020.01.005
PUBMED: 32004713
PROVIDER: scopus
DOI/URL:
Notes: Review -- Export Date: 1 June 2020 -- Source: Scopus
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MSK Authors
  1. Jamie Erin Chaft
    162 Chaft
  2. William D Travis
    606 Travis
  3. Mark Kris
    713 Kris