Abstract
The addition of radiotherapy in neoadjuvant chemotherapy did not improve event-free or overall survival in resectable non-small cell lung carcinoma (NSCLC). Neoadjuvant immunotherapy produced major pathologic response(MPR) rate of up to 45%. The potential synergy between radiotherapy and immunotherapy has been described in several studies. We reported outcomes of three cases of stage III/N2 NSCLC treated with neoadjuvant immunotherapy and stereotactic body radiation therapy (SBRT) in a single center. This explanatory trial included treatment-naive patients with stage III resectable NSCLC who received two doses of the programmed cell death protein 1 (PD-1) inhibitor toripalimab after 1 week of receiving SBRT for lung lesions. Thereafter, surgery was planned 4–6 weeks after the second dose. The primary endpoints were safety and feasibility, while the secondary endpoint was the pathologic response rate. Toripalimab combined with SBRT as a neoadjuvant treatment had well-tolerable side effects and did not lead to a delay in surgery. Among the included patients, one achieved pathologic complete response (PCR), one achieved MPR, and one with 20% residual tumor did not achieve MPR. There were few side effects of toripalimab combined with SBRT as a neoadjuvant treatment, and the treatment did not cause a delay in surgery. This study preliminarily explored the outcomes of a new neoadjuvant treatment.
Highlights
Effective treatments are needed for patients with stage III nonsmall cell lung carcinoma (NSCLC), which has a 5-year survival rate ranging from 13% to 36%, with most patients having postsurgical tumor relapse [1]
The present study showed that neoadjuvant stereotactic body radiation therapy (SBRT) combined with immunotherapy was safe in three patients with stage III NSCLC
4) The out-offield effect was increased from 10% in conventional radiotherapy to 38% in SBRT combined with immunotherapy [22]
Summary
Effective treatments are needed for patients with stage III NSCLC, which has a 5-year survival rate ranging from 13% to 36%, with most patients having postsurgical tumor relapse [1]. Equivalent dose (BED) was 100 Gy. Computed tomographic (CT) scans after two cycles of toripalimab showed tumor partial response(PR), with a significant decrease in the left lung mass (Figures 2B, C). Histologic analysis of the resected lung and lymph nodes showed an absence of viable tumor cells in addition to pulmonary necrosis and fibrosis (Figures 1C, D). The short diameter of the subcarinal lymph node was 1.0cm and the biopsy by endobronchial ultrasound-guided transbronchial needle aspiration biopsy showed a small number of tumor cells This patient was administered SBRT at the left lower lung lesion (50Gy/5fractions) and two cycles of toripalimab. CT scans after two cycles of toripalimab showed a minor response (left lower lung lesion decreased by 29%) (Figure 4). The patient is currently on maintenance immunotherapy for four cycle, and Grade 3 or above adverse reactions were not observed
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