Clinicopathologic outcomes of preoperative targeted therapy in patients with clinical stage I to III non–small cell lung cancer Conference Paper
| Authors: | Lengel, H. B.; Zheng, J.; Tan, K. S.; Liu, C. C.; Park, B. J.; Rocco, G.; Adusumilli, P. S.; Molena, D.; Yu, H. A.; Riely, G. J.; Bains, M. S.; Rusch, V. W.; Kris, M. G.; Chaft, J. E.; Li, B. T.; Isbell, J. M.; Jones, D. R. |
| Title: | Clinicopathologic outcomes of preoperative targeted therapy in patients with clinical stage I to III non–small cell lung cancer |
| Conference Title: | 103th Annual Meeting of the American Association for Thoracic Surgery (AATS) |
| Abstract: | Objective: Targeted therapy improves outcomes in patients with advanced-stage non–small cell lung cancer (NSCLC) and in the adjuvant setting, but data on its use before surgery are limited. We sought to investigate the safety and feasibility of preoperative targeted therapy in patients with operable NSCLC. Methods: We retrospectively reviewed 51 patients with clinical stage I to III NSCLC who received targeted therapy, alone or in combination with chemotherapy, before surgical resection with curative intent, treated from 2004 to 2021. The primary outcome was the safety and feasibility of preoperative targeted therapy; secondary outcomes included objective response rate, major pathologic response (defined as ≤10% viable tumor) rate, recurrence-free survival (RFS), and overall survival. Results: Of the 51 patients included, 46 had an activating epidermal growth factor receptor gene alteration and 5 had an anaplastic lymphoma kinase fusion. Overall, 37 of 46 evaluable patients experienced at least 1 adverse event before surgery; however, only 3 patients experienced a grade 3 or 4 event. The objective response rate was 38% (17/45) for all evaluable patients and 44% (14/32) for patients with clinical stage II or III disease. The major pathologic response rate was 20% (9/44); 2 patients had a complete pathologic response. Median RFS was 3.8 years (95% CI, 2.8 to not reached). Targeted therapy alone was associated with better RFS than combination therapy (P = .009) in patients with clinical stage II or III disease. Conclusions: Preoperative targeted therapy was well tolerated and associated with good outcomes, with or without induction chemotherapy. In addition, radiographic response and pathologic response were strongly correlated. © 2022 The American Association for Thoracic Surgery |
| Keywords: | adult; cancer chemotherapy; controlled study; human tissue; treatment response; aged; primary tumor; retrospective studies; gene mutation; major clinical study; overall survival; exon; fatigue; erlotinib; multimodality cancer therapy; skin toxicity; systemic therapy; treatment duration; conference paper; cancer patient; combined modality therapy; neoadjuvant therapy; cancer staging; follow up; neoplasm staging; preoperative evaluation; edema; anemia; gastrointestinal symptom; lung lobectomy; mucosa inflammation; stomatitis; carcinoma, non-small-cell lung; lung neoplasms; pneumonectomy; epidermal growth factor receptor; cohort analysis; surgical approach; retrospective study; distant metastasis; protein tyrosine kinase inhibitor; arthralgia; coughing; dyspnea; postoperative complication; lung tumor; lung adenocarcinoma; fluorescence in situ hybridization; patient safety; surgical infection; gefitinib; gene fusion; atelectasis; targeted therapy; muscle disease; preoperative treatment; epistaxis; atrial fibrillation; induction chemotherapy; electrolyte disturbance; paronychia; mediastinum lymph node; recurrence free survival; non small cell lung cancer; anaplastic lymphoma kinase; molecularly targeted therapy; adverse event; clinical outcome; wedge resection; chylothorax; crizotinib; open surgery; response evaluation criteria in solid tumors; Common Terminology Criteria for Adverse Events; high throughput sequencing; humans; human; male; female; alectinib; mean survival time; x-ray computed tomography; osimertinib; non–small cell lung cancer; positron emission tomography-computed tomography; anaplastic lymphoma kinase tyrosine kinase receptor; air leak syndrome |
| Journal Title | Journal of Thoracic and Cardiovascular Surgery |
| Volume: | 165 |
| Issue: | 5 |
| Conference Dates: | 2022 May 14-17 |
| Conference Location: | Boston, MA |
| ISBN: | 0022-5223 |
| Publisher: | Mosby Elsevier |
| Date Published: | 2023-05-01 |
| Start Page: | 1682 |
| End Page: | 1693.e3 |
| Language: | English |
| DOI: | 10.1016/j.jtcvs.2022.10.056 |
| PUBMED: | 36528430 |
| PROVIDER: | scopus |
| PMCID: | PMC10085825 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Corresponding author is MSK author: David R. Jones -- Source: Scopus |
