Zhai Hengyu, Li Wenhai, Jiang Kun, Zhi Yanan, Yang Zhao
Department of Thoracic Surgery, Xi'an International Medical Center Hospital, Xi'an, Shaanxi, 710000, People's Republic of China.
Cancer Manag Res. 2022 Feb 9;14:515-524. doi: 10.2147/CMAR.S344343. eCollection 2022.
Patients with locally advanced (stage III) non-small cell lung cancer (NSCLC) demonstrate broad anatomic heterogeneity with modest survival benefits. Immune checkpoint inhibitors (ICIs) have shown survival benefit in metastatic NSCLC. We conducted this study to evaluate the efficacy and safety of neoadjuvant nivolumab in combination with chemotherapy in the treatment of this population.
We retrospectively evaluated patients with locally advanced NSCLC receiving neoadjuvant nivolumab and chemotherapy (paclitaxel with carboplatin) followed by surgery at our institution from January 2019 to January 2020.
A total of 46 eligible patients, 26 males, and 20 females were diagnosed with NSCLC in a stage IIIA (30 cases) and IIIB (16 cases) to receive neoadjuvant treatment. The treatment was well tolerated with just 7 (15.2%) typical immune-related adverse events (hyperthyroidism, hyperglycemia, and rash) recorded. A total of 45 patients underwent surgical resection, and 43 (95.6%) of them achieved a R0 resection. No major surgical complications were observed. There was a complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) in 2 (4.3%), 26 (56.5%), 17 (37.0%), 6 (26.1%), and 1 (2.2%) patients. Eight patients resulted in a major pathological response (MPR) (17.4%) and 24 patients had a pathological complete response (pCR) (52.2%). At the time of data cutoff (June 1, 2021), the median follow-up period was 15.5 months (IQR 3.9-29) and 27 (60%) of 45 patients who had tumor resection were progression free. At 24 months, progression-free survival was 45.8% and overall survival was 79.9%.
Nivolumab plus paclitaxel and carboplatin could be a potential neoadjuvant regimen for patients with locally advanced NSCLC, rendering a potentially lethal disease to one that is curable.
局部晚期（III期）非小细胞肺癌（NSCLC）患者表现出广泛的解剖学异质性，生存获益有限。免疫检查点抑制剂（ICI）已在转移性NSCLC中显示出生存获益。我们开展本研究以评估新辅助纳武利尤单抗联合化疗治疗该人群的疗效和安全性。
我们回顾性评估了2019年1月至2020年1月在我院接受新辅助纳武利尤单抗和化疗（紫杉醇联合卡铂）随后接受手术的局部晚期NSCLC患者。
共有46例符合条件的患者，其中26例男性和20例女性被诊断为IIIA期（30例）和IIIB期（16例）NSCLC并接受新辅助治疗。治疗耐受性良好，仅记录到7例（15.2%）典型的免疫相关不良事件（甲状腺功能亢进、高血糖和皮疹）。共有45例患者接受了手术切除，其中43例（95.6%）实现了R0切除。未观察到重大手术并发症。2例（4.3%）患者出现完全缓解（CR），26例（56.5%）患者出现部分缓解（PR），17例（37.0%）患者疾病稳定（SD），6例（13.0%）患者疾病进展（PD），1例（2.2%）患者疾病进展。8例患者出现主要病理缓解（MPR）（17.4%），24例患者出现病理完全缓解（pCR）（52.2%）。在数据截止时（2021年6月），中位随访期为15.5个月（IQR 3.9 - 29），45例接受肿瘤切除的患者中有27例（60%）无疾病进展。在24个月时，无进展生存率为45.8%，总生存率为79.9%。
纳武利尤单抗联合紫杉醇和卡铂可能是局部晚期NSCLC患者的一种潜在新辅助方案，可将一种潜在致命疾病转变为可治愈疾病。
