Salvage surgery following downstaging of advanced non-small cell lung cancer by targeted therapy

Kuo Li, Xiaonian Cao, Bo Ai, Han Xiao, Quanfu Huang, Zheng Zhang, Qian Chu, Li Zhang, Xiaofang Dai, Yongde Liao, Kuo Li, Xiaonian Cao, Bo Ai, Han Xiao, Quanfu Huang, Zheng Zhang, Qian Chu, Li Zhang, Xiaofang Dai, Yongde Liao

Abstract

Background: Advanced non-small cell lung cancer (NSCLC) accounts for a high proportion of lung cancer cases. Targeted therapy improve the survival in these patients, but acquired drug resistance will inevitably occur. If tumor downstaging is achieved after targeted therapy, could surgical resection before drug resistance improve clinical benefits for patients with advanced NSCLC? Here, we conducted a clinical trial showing that for patients with advanced driver gene mutant NSCLC who did not progress after targeted therapy, salvage surgery (SS) could improve progression-free survival (PFS). Herein, we retrospectively reviewed our former clinical trial and thoracic cancer database in our medical institutions.

Methods: We identified patients with advanced driver gene mutant NSCLC treated with targeted therapy plus SS or targeted therapy alone in our former clinical trial and our thoracic cancer database from July 2016 to July 2019. PFS was compared between the targeted therapy plus SS group and the targeted therapy only group using the log-rank test.

Results: We identified 73 patients with driver gene mutant NSCLC who were treated with targeted therapy and 18 treated with targeted therapy plus SS.Among the 18 patients treated with targeted therapy plus SS, there were no obvious perioperative complications and deaths. Targeted therapy followed by SS resulted in a significantly longer PFS compared with targeted therapy alone (23.4 months VS 12.9 months, p = 0.0004).

Conclusions: Salvage surgery after tumor downstaging is a promising therapeutic strategy for some patients with advanced (stage IIIB-IV) NSCLC and may offer a new therapeutic option for multidisciplinary comprehensive treatment of lung cancer.

Keywords: advanced NSCLC; salvage surgery; targeted therapy.

Conflict of interest statement

None declared.

© 2021 The Authors. Thoracic Cancer published by China Lung Oncology Group and John Wiley & Sons Australia, Ltd.

Figures

FIGURE 1
FIGURE 1
Positron emission tomography‐computed tomography (PET‐ CT) before and after targeted therapy in Case 2
FIGURE 2
FIGURE 2
(a) The primary pulmonary lesion achieved a complete pathological response. (b) A major pathological response (MPR) was defined as the identification of 10% or less of residual viable tumor cells in the resected primary tumor
FIGURE 3
FIGURE 3
Progression‐free survival (PFS) between the targeted therapy plus SS group and the targeted therapy only group. The median PFS in the targeted therapy plus SS group: 23.4 months; targeted therapy only group: 12.9 months; (95% CI, 12.9–17.3.3; Log rank, p = 0.0004)
FIGURE 4
FIGURE 4
Progression‐free survival (PFS) between male and female patients in the targeted therapy plus SS group. PFS of male patients: 22.2 months; the PFS of female patients: 24.4 months; p = 0.71
FIGURE 5
FIGURE 5
Progression‐free survival (PFS) between smokers and never‐smokers in the targeted therapy plus SS group. PFS of smokers: 17.7 months; the PFS of nonsmokers: 23.6 months; p = 0.80
FIGURE 6
FIGURE 6
Progression‐free survival (PFS) among different mutation types. Exon 19 deletion: 22.2 months; L858R: 25.6 months; ALK‐rearrangement: 20.0 months; p = 0.69

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Source: PubMed

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