Expert consensus on perioperative immunotherapy for locally advanced non-small cell lung cancer

Lim, Jeong Uk; Kang, Hye Seon

doi:10.21037/tlcr-21-764

Cited by 5 publications

(8 citation statements)

References 28 publications

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“…Three of the PR patients turned out to have a pCR in resected tissue. This was consistent with previous observation that evaluation per RECIST criteria may not truly reflect actual benefit from immunotherapy (9). Of note, the surgical resections of the responders showed an inflamed phenotype with a massive influx of multinucleated giant cells and lymphocytes compared to baseline biopsy samples, a phenomenon typically associated with response to immune checkpoint blockade, which may help explain the minimal tumor shrinkage or even tumor enlargement seen in the CT scans of some responders (Figure 1C).…”

Section: Clinical and Pathological Responsessupporting

confidence: 90%

“…In recent years, anti-programmed death-1 (PD-1)/antiprogrammed death-ligand 1 (PD-L1) has demonstrated great promise in unresectable ESCC patients, and thus has been approved by the Food and Drug Administration as second-line treatment in this population (7,8). In addition, neoadjuvant administration of anti-PD-1 in other malignancies such as lung cancer, melanoma and colorectal cancer has also produced durable responses with favorable tolerability (9)(10)(11). Multiple trials are therefore currently underway to exploit preoperative use of anti-PD-1/PD-L1 in locally advanced ESCC, most of which combined anti-PD-1/PD-L1 with chemotherapy or chemoradiation.…”

Section: Introductionmentioning

confidence: 99%

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Neoadjuvant programmed death-1 blockade plus chemotherapy in locally advanced esophageal squamous cell carcinoma.

Zhang

Yang

et al. 2021

JCO

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e16076 Background: Immunotherapy is effective in treating advanced esophageal squamous cell carcinoma (ESCC), but little is known about its role in the setting of neoadjuvant therapy. Methods: Data from a retrospective cohort and a prospective cohort of locally advanced ESCC patients were analyzed. All patients included had received neoadjuvant camrelizumab plus nab-paclitaxel and S1 capsule followed by radical esophagectomy. The main purpose of this study was to evaluate the safety and feasibility of the neoadjuvant treatment. In addition, pathological response and the relationship between tumor immune microenvironment features (TIME)/tumor mutational burden (TMB) and treatment response were also explored. Results: A total of 25 locally advanced ESCC patients from both cohorts were included, of which 12 from the retrospective cohort and 13 from the prospective cohort. Only two patients experienced grade 3 or 4 adverse events, including onehad anemia and the other (4%) had limb numbness. No surgical delay or perioperative death was reported. Sixteen patients (64%) responded to the treatment, eight (32%) with a complete pathological response and eight (32%) with a major pathological response. Neither programmed death-ligand 1 expression nor TMB was correlated with treatment response. In terms of TIME analysis, patients with better pathological response in the primary tumor had significantly higher abundance of CD56dim natural killer cells (109 vs 32, P= 0.01), while lower density of M2-tumor-associated macrophages was associated with numerically better pathological response in the lymph nodes (47 vs 163.1, P= 0.55). Conclusions: Neoadjuvant camrelizumab plus nab-paclitaxel and S1 is safe, feasible and effective, and the efficacy could be predicted by TIME, which is worthy of further investigation. Clinical trial information: ChiCTR2000029807.

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Section: Clinical and Pathological Responsessupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Neoadjuvant programmed death-1 blockade plus chemotherapy in locally advanced esophageal squamous cell carcinoma.

Zhang

Yang

et al. 2021

JCO

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“…This variation, as demonstrated by the wide range of odds ratios across studies, emphasizes the need for individualized patient care in thoracic oncological surgeries. As suggested by Qiu et al, patients undergoing specific chemotherapeutic regimens had a higher likelihood of recovery, which is pivotal information for clinicians during the preoperative planning phase 10 …”

Section: Discussionmentioning

confidence: 94%

“…As suggested by Qiu et al, patients undergoing specific chemotherapeutic regimens had a higher likelihood of recovery, which is pivotal information for clinicians during the preoperative planning phase. 10 The varying rates of wound infections and other postsurgical complications are another crucial observation. The study by Lans et al indicated the lowest likelihood of wound infections.…”

Section: Discussionmentioning

confidence: 99%

Impact of preoperative chemotherapy on cutaneous wound healing in lung cancer patients: A meta‐analysis

Zhao,

Cui,

et al. 2023

International Wound Journal

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As part of their treatment, lung cancer patients frequently endure thoracic oncological surgery, with preoperative chemotherapeutic interventions being the common approach. However, the potential impact of these chemotherapeutic regimens on cutaneous wound healing outcomes following surgery remains the topic of considerable clinical interest. This meta‐analysis sought to evaluate comprehensively the effect of preoperative chemotherapeutic regimens on cutaneous wound healing in lung cancer patients following thoracic oncological surgery. Extensive literature searches were conducted using the leading databases PubMed, Embase, Cochrane Library and Scopus. Eight studies out of 1342 identified satisfied the inclusion criteria. Consideration was given to both randomized controlled trials (RCTs) and observational studies. Data pertaining to study characteristics, patient demographics, chemotherapeutic regimens and wound healing outcomes were extracted with great attention to detail. The examination of these varied studies provided insights into the fluctuations in rates of recovery following treatment, incidences of wound infections and frequencies of surgical complications. The research studies provided odds ratios for recovery that varied significantly in magnitude from 0.95 to 0.38, with regard to the probability of wound infection. Furthermore, a range of odds ratios for complications were disclosed, with certain odds ratios displaying narrow confidence intervals. The complexity of the effect of preoperative chemotherapy on wound closure subsequent to thoracic oncologic surgery is highlighted by our findings. The results underscore the need for individualized treatment strategies for lung cancer patients undergoing surgical procedures that strike a balance between patient safety and optimal clinical outcomes.

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“…As patients with malignancy are often in a state of immunosuppression, immunotherapy prior to surgical intervention may permit patients to persist through the window of immunodeficiency and attain long-term survival benefits [30]. At present, there is no clear guideline recommendation for the dose and interval of immunotherapy before surgery, although the recommended interval between cycles is generally 2 weeks for nivolumab and durvalumab, and 3 weeks for pembrolizumab, atezolizumab, and most studies have evaluated 2-4 cycles in neoadjuvant setting [31]. However, one must differentiate between CN following neoadjuvant ST and the bulk of available observational data evaluating dCN, where ST duration was considerably longer (e.g.…”

Section: Timing Of Surgery After Systemic Therapymentioning

confidence: 99%

Role of cytoreductive surgery in the era of immunotherapy

Isali

Braun

Bukavina

et al. 2022

Current Opinion in Urology

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Purpose of reviewThe benefit of cytoreductive nephrectomy (CN) in metastatic renal cell carcinoma (mRCC) was first called into question in the tyrosine kinase inhibitors (TKIs) era. It remains undefined in the context of the recent development and approval of immune checkpoint inhibitors (ICIs) and level one evidence supporting the rapid adoption of dual ICI and combination ICI þ TKI therapeutic approaches for mRCC. Our objective is to synthesize the available contemporary data regarding the safety, feasibility, and oncologic outcomes with CN for mRCC in the age of immunotherapy as well as to highlight trials in progress that will address this key knowledge gap. Recent findingsData from the SURTIME and CARMENA trials provided insight to guide patient selection for CN in patients with mRCC receiving TKI-based treatment strategies. At present, there is a body of retrospective data supporting the safety and oncologic efficacy of CN in carefully selected patients with mRCC in both the upfront and delayed setting. The results of ongoing trials evaluating the safety and feasibility for CN as well as optimal patient selection and sequencing strategies are eagerly awaited.

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Expert consensus on perioperative immunotherapy for locally advanced non-small cell lung cancer

Cited by 5 publications

References 28 publications

Neoadjuvant programmed death-1 blockade plus chemotherapy in locally advanced esophageal squamous cell carcinoma.

Neoadjuvant programmed death-1 blockade plus chemotherapy in locally advanced esophageal squamous cell carcinoma.

Impact of preoperative chemotherapy on cutaneous wound healing in lung cancer patients: A meta‐analysis

Role of cytoreductive surgery in the era of immunotherapy

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