Salvage Surgery After Immune Checkpoint Inhibitors for Advanced Non-Small Cell Lung Cancer: Potential Association Between Immune-Related Adverse Events and Longer Survival

Abstract

•The emergence of immune checkpoint inhibitors (ICIs) has improved the long-term survival outcomes in patients with advanced non-small cell lung cancer (NSCLC). However, the indications and long-term outcomes of salvage surgery for localized and residual diseases in patients with NSCLC treated with ICIs remain unknown. Herein, we present the long-term survival outcomes of 4 patients who underwent salvage surgery for residual lesions after ICIs. Three (75%) patients discontinued ICIs due to immune-related adverse events despite good responses, and underwent salvage surgery, achieving 12 to 35 months of postoperative survival (50-80 months from initial diagnoses). Despite definitive chemoradiotherapy and atezolizumab, the other (25%) patient who underwent salvage surgery due to disease progression had multiple recurrences after 8 months and died at 18 months postoperatively. Salvage surgery after good responses to ICIs for NSCLC may be associated with favorable long-term survival in selected patients, and its role should be further investigated. •The emergence of immune checkpoint inhibitors (ICIs) has improved the long-term survival outcomes in patients with advanced non-small cell lung cancer (NSCLC). However, the indications and long-term outcomes of salvage surgery for localized and residual diseases in patients with NSCLC treated with ICIs remain unknown. Herein, we present the long-term survival outcomes of 4 patients who underwent salvage surgery for residual lesions after ICIs. Three (75%) patients discontinued ICIs due to immune-related adverse events despite good responses, and underwent salvage surgery, achieving 12 to 35 months of postoperative survival (50-80 months from initial diagnoses). Despite definitive chemoradiotherapy and atezolizumab, the other (25%) patient who underwent salvage surgery due to disease progression had multiple recurrences after 8 months and died at 18 months postoperatively. Salvage surgery after good responses to ICIs for NSCLC may be associated with favorable long-term survival in selected patients, and its role should be further investigated.