NEOADJUVANT IMMUNOTHERAPY FOLLOWED BY CURATIVE INTENT SURGERY IN 29 PATIENTS WITH INITIALLY DEEMED UNRESECTABLE NON-SMALL CELL LUNG CANCER

Abstract

TYPE: Abstract TOPIC: Lung Cancer PURPOSE: This retrospective, single center, observational study aims to estimate the effect of neoadjuvant immunotherapy on treatment outcomes in patients with unresectable NSCLC. METHODS: Patients with initially deemed unresectable NSCLC but showed response to neoadjuvant immunotherapy and underwent surgery were retrospectively analyzed. RESULTS: (1) 29 patients (21 squamous cell carcinoma,7 adenocarcinoma and 1 adenosquamous carcinoma) were analyzed. 16 patients (55%) presented in stage IIIA, 10 (34%) in stage IIIB, 1 in stage IIIC and 2 in stage IA. (2) The PC+K therapy was the mostly widely adopted (21 patients, 72%). The median duration of immunotherapy was 64 days. The median immunotherapy-surgery interval was 40 days. Preoperative TRAE/irAE was observed in 5 patients. (3) 22 (76%) patients achieved PR, 6 (24%) achieved SD in preoperative imaging evaluation. The median reduction of the maximum cross-sectional area was 57.6%. (4) 6 patients received sleeve resection. No pneumonectomy was peformed. Perioperative complications occur in 3 patients. (5) Reduction in TNM stage occur in 25 (86%) patients. The CPR and MRP were 41% and 28%, respectively. Patients with squamous cell carcinomas got a significantly higher reduction rates (95%). 19 out of 21 (90%) patients with suspicious lymph node metastasis achieved reduction in stage. The stage reduction between imaging evaluation and histology was irrelevant (P=0.89). CONCLUSIONS: Patients with initially deemed unresectable NSCLC showed favourable clinical response to induction immunotherapy. CLINICAL IMPLICATIONS: Immunotherapy could be a promising new option for neoadjuvant therapy. It opens the door to radical surgery for patients with initially deemed unresectable NSCLC. DISCLOSURE: Nothing to declare. KEYWORD: immunotherapy