Integrated intErventional bronchoscopy in the treatment of locally adVanced non-small lung cancER with central Malignant airway Obstructions: a multicentric REtrospective study (EVERMORE)

Alessandro Marchioni,Roberto Piro,Massimo Dominici,Giulia Bruzzi,Nicola Facciolongo,Sofia Taddei,Roberto Tonelli,Fausto Barbieri,Dario Andrisani,Riccardo Fantini,Eleonora Casalini,Alessandro Andreani,Filippo Gozzi,Mario Bavieri,Luca Tabbì,Ivana Castaniere,Gaia Cappiello ,Enrico Clini,Francesco De Falco ,E Meschiari

doi:10.1016/j.lungcan.2020.07.032

Abstract

ObjectivesDespite new therapeutic perspectives, the presence of central airways occlusion (CAO) in patients with locally advanced non-small cell lung cancer (NSCLC) is associated with poor survival. There is no clear evidence on the clinical impact of interventional bronchoscopy as a part of an integrated treatment to cure these patients. Materials and methodsThis retrospective cohort study was conducted in two teaching hospitals over a 10 years period (January 2010-January 2020) comparing patients with NSCLC at stage IIIB and CAO at disease onset treated with chemotherapy/radiotherapy (standard therapy-ST) with those receiving interventional bronchoscopy plus ST (integrated treatment-IT). Primary outcome was 1-year survival. The onset of respiratory events, symptoms-free interval, hospitalization, need for palliation, and overall mortality served as secondary outcomes. ResultsA total of 100 patients were included, 60 in the IT and 40 in the ST group. Unadjusted Kaplan-Meier estimates showed greater effect of IT compared to ST on 1-year survival (HR = 2.1 95%CI[1.1-4.8], p = 0.003). IT showed a significantly higher survival gain over ST in those patients showing KRAS mutation (7.6 VS 0.8 months,<0.0001), a lumen occlusion >65% (6.6 VS 2.9 months,<0.001), and lacking the involvement of left bronchus (7 VS 2.3 months,<0.0001). Compared to ST, IT also showed a favorable difference in terms of new hospitalizations (p = 0.03), symptom-free interval (p = 0.02), and onset of atelectasis (p = 0.01). ConclusionsIn patients with NSCLC stage IIIB and CAO, additional interventional bronchoscopy might impact on 1-year survival. Genetic and anatomic phenotyping might allow identifying those patients who may gain life expectancy from the endoscopic intervention.

Highlights

Stage III locally advanced non-small cell lung cancer (NSCLC) is a heterogeneous condition affecting about one-third of the overall patients (1)
Materials and methods This retrospective cohort study was conducted in two teaching hospitals over a 10 years period (January 2010-January 2020) comparing patients with NSCLC at stage IIIB and central airway obstruction (CAO) at disease onset treated with chemotherapy/radiotherapy with those receiving interventional bronchoscopy plus ST
The main purpose of this study is to evaluate the clinical impact of interventional bronchoscopy plus chemotherapy/radiotherapy compared with chemotherapy/radiotherapy alone in the management of patients with stage IIIB NSCLC with CAO

Summary

Introduction

Stage III locally advanced non-small cell lung cancer (NSCLC) is a heterogeneous condition affecting about one-third of the overall patients (1). It has been shown that durvalumab significantly prolonged progression-free and overall survival, as compared with placebo, among patients with unresectable stage III NSCLC after concurrent chemoradiotherapy (2-3) Despite this new therapeutic perspective, a group of patients with locally advanced NSCLC already presents at diagnosis with an occlusion of the central airways which can result in worse life expectancy. The main purpose of this study is to evaluate the clinical impact of interventional bronchoscopy plus chemotherapy/radiotherapy (integrated treatment) compared with chemotherapy/radiotherapy alone (standard therapy) in the management of patients with stage IIIB NSCLC with CAO

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