Feasibility of Surgical Resection After Induction Epidermal Growth Factor Receptor–Tyrosine Kinase Inhibitor Therapy for N2 Lung Adenocarcinomas

Abstract

Prognosis of patients with stage IIIA-N2 lung adenocarcinoma is still not optimistic. The aim of this study was to evaluate safety, feasibility, and outcomes of surgery after induction epidermal growth factor receptor-tyrosine kinase inhibitor therapy in a clinical trial setting. Fourteen patients with IIIA-N2 lung adenocarcinoma and epidermal growth factor receptor mutation received erlotinib induction followed by surgery in a phase II clinical trial. Perioperative outcomes and survival results were compared with a control group of 15 patients receiving neoadjuvant chemotherapy during the same time period. Thirteen patients showed partial response toinduction, whereas 16 patients remained stable. Serum carcinoembryonic antigen level in the erlotinib group was significantly higher than in the chemotherapy groupbefore treatment but was reduced to similar levels after induction. Operation time, blood loss, resection extents, complete resection rates, postoperative drainage, complication rates, and length of hospital stay were allcomparable between the 2 groups. Thoracoscopic resection was accomplished in 78.6% of patients in theerlotinib group and 80.0% of patients in the chemotherapy group (P= .924) but was higher in patientswho responded to induction than those who did not (92.3% vs 68.8%, P= .119). A resection extent greater than lobectomy and incomplete resections wereonly seen in stable disease after induction. Nosignificant difference was detected in 1-year and 3-yearoverall or disease-free survivals between the 2groups. Pulmonary resection is safe and feasible after induction treatment with erlotinib for stage IIIA-N2 lung adenocarcinomas. Better surgical and oncologic outcomes may be expected in patients who respond to effective induction therapies.