Postoperative survivin expression in stage III non-small cell lung cancer (NSCLC) patients treated with neoadjuvant chemoradiation.

Abstract

7034 Background: In a previous report, high pretreatment survivin was associated with poor prognosis and low pretreatment survivin was associated with pathological complete response (pCR) in stage III NSCLC patients treated with neoadjuvant chemoradiation (Fidler et al ASCO 2009). The objective of this study was to compare survivin expression in pretreatment tissue with expression in post-treatment in patients with residual tumor after neoadjuvant chemoradiation. Methods: Stage III patients who underwent neoadjuvant platinum based chemoradiation (40Gy) with sufficient pretreatment tissue available were identified. Patients with less than a pathological CR were selected for analysis. Tumors were stained for nuclear and cytoplasmic expression of suvivin (frequency 0-4 and intensity 0-4) by Immunohistochemistry (IHC) (Novus Biologicals). Data was analyzed using the McNemar's test. Results: 33 patients who underwent neoadjuvant chemoradiation had pretreatment tissue with adequate tumor specimens for analysis. 19 patients had available tumor remaining in pathological specimens after definitive resection. Patient characteristics: 10 females, median age 61.4; 11 adenocarcinoma, 6 squamous. For these 19 patients, median OS: 20.0 months, median time to recurrence: 11.7 months. Residual tumors had increased cytoplasmic survivin intensity compared with the same patients' pretreatment specimens (p=0.013). Conclusions: In this small sample size, residual tumor had increased cytoplasmic survivin expression compared with pretreatment tissue specimens suggesting that survivin may be a mechanism for resistance to chemoradiation. Adding agents that target survivin to chemoradiation is a reasonable strategy to improve outcomes in locally advanced NSCLC. These results require validation in a larger number of patients. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Lilly Lilly