Real-world clinical outcomes of neoadjuvant immunotherapy combined with chemotherapy in resectable non-small cell lung cancer
Menée dans un contexte de vie réelle à partir de données portant sur 76 patients atteints d'un cancer du poumon non à petites cellules résécable (durée médiane de suivi : 12,2 mois), cette étude observationnelle évalue l'efficacité, du point de vue de la réponse pathologique majeure, et la toxicité d'une immunothérapie néoadjuvante (à base de pembrolizumab ou de nivolumab) en combinaison avec une chimiothérapie
Objectives : Early stage non-small cell lung cancer (NSCLC) patients who undergo complete resection continue to demonstrate high risk of recurrence and death. The advent of the neoadjuvant regimen has brought new hope for these patients. The present study aims to further demonstrate the efficacy of neoadjuvant chemoimmunotherapy. Materials and Methods : A real-world observational study was conducted concerning patients who received neoadjuvant pembrolizumab or nivolumab combined with chemotherapy between January 2018 and October2020 in Shanghai Pulmonary Hospital. The primary endpoint was major pathologic response(MPR), and the secondary endpoints were objective response rate (ORR), pathologic complete response (pCR), disease-free survival (DFS) and toxicity. Results : A total of 76 patients were analyzed and divided into the pembrolizumab (n=42) and nivolumab groups (n=34) with a median follow-up time of 12.2 months. Most patients(92%) had stage III disease, with 41 (54%) and 29 (38%) patients initially diagnosedclinical stage IIIA and IIIB, respectively. Fifty (66%), 21 (28%) and 5 (6%) patientsreceived two, three and four cycles of neoadjuvant treatment, separately, achievingan ORR of 75%. None of them needed a reduced initial dose or delay due to intolerableadverse events. Forty-nine (64%) and 28 (37%) patients achieved MPR and pCR, respectively.RNA sequencing showed that MPR associated with increased infiltration of cytotoxicimmune cells with tertiary lymphoid structures (TLSs). Histological evaluation highlightedthe localization of B cells within TLSs. Forty-two (69%) patients with clinicallyN2 disease at baseline were downstaged to pathological N0 (39 patients) or N1 (3 patients).One-year-PFS rate of stage III patients was 91%. No difference in baseline characteristicsand treatment outcomes was observed between 2 groups. Conclusion : The feasibility of neoadjuvant chemoimmunotherapy for resectable NSCLC was furthervalidated, with a high MPR rate and manageable adverse events.
Lung Cancer 2022