Journal
ESMO OPEN
Volume 7, Issue 2, Pages -Publisher
ELSEVIER
DOI: 10.1016/j.esmoop.2022.100455
Keywords
operable stage III non-small-cell lung cancer; neoadjuvant therapy; surgery; long-term outcomes; prognostic factors
Categories
Funding
- AstraZeneca
- Swiss State Secretary for Education
- Research and Innovation (SERI)
- Swiss Cancer Research Foundation (SCS)
- Swiss Cancer League (SCL)
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In operable stage III non-small-cell lung cancer, neoadjuvant chemotherapy with cisplatin and docetaxel +/- neoadjuvant sequential radiotherapy has shown favorable long-term outcomes. Complete resection and pathological complete remission are important predictors of prognosis.
Background: Chemoradiotherapy with durvalumab consolidation has yielded excellent results in stage III non-small-cell lung cancer (NSCLC). Therefore, it is essential to identify patients who might benefit from a surgical approach. Material and methods: Data from 437 patients with operable stage III NSCLC enrolled in four consecutive Swiss Group for Clinical Cancer Research patients were treated with three cycles of induction chemotherapy (cisplatin/docetaxel), followed in some patients by neoadjuvant radiotherapy (44 Gy, 22 fractions) (16/00, 16/01, 16/08) and cetuximab (16/08). Results: With a median follow-up time of 9.3 years (range 8.5-10.3 years), 5- and 10-year overall survival (OS) rates were 37% and 25%, respectively. Overall, 342 patients (79%) underwent tumor resection, with a complete resection (R0) rate of 80%. Patients (n = 272, 63%) with R0 had significantly longer OS compared to patients who had surgery but incomplete resection (64.8 versus 19.2 months, P < 0.001). OS for patients who achieved pathological complete remission (pCR) (n = 66, 15%) was significantly better compared to resected patients without pCR (86.5 versus 37.0 months, P = 0.003). For patients with pCR, the 5- and 10-year event-free survival and OS rates were 45.7% [95% confidence interval (CI) 32.8% to 57.7%] and 28.1% (95% CI 15.2% to 42.6%), and 58.2% (95% CI 45.2% to 69.2%) and 45.0% (95% CI 31.5% to 57.6%), respectively. Conclusion: We report favorable long-term outcomes in patients with operable stage III NSCLC treated with neoadjuvant chemotherapy with cisplatin and docetaxel +/- neoadjuvant sequential radiotherapy from four prospective SAKK trials. Almost two-third of the patients underwent complete resection after neoadjuvant therapy. We confirm R0 resection and pCR as important predictors of outcome.
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