Neoadjuvant immune checkpoint inhibitor plus chemotherapy in rare tracheal tumors

Abstract

Dear Editor, Primary malignant tumors of the trachea account for 0.01%-0.4% of all cancer cases [1]. Due to their locally aggressive growth, surgical resection including carinal resection and airway reconstruction was most frequently applied for these diseases [2]. However, tracheal surgery is technically challenging and is associated with high rates of operative morbidity and mortality. Effective neoadjuvant treatment is expected to reduce the tumor load and lessen the extent of resecting primary tracheal tumors. However, evidence regarding neoadjuvant treatment for tracheal tumors remains relatively scarce and platinumbased doublet chemotherapy remains the standard in this setting. Immune checkpoint inhibitors are a promising approach to neoadjuvant treatment. A phase II clinical trial (NADIM[3]) evaluated nivolumab with paclitaxel plus carboplatin as neoadjuvant regiment for resectable stage IIIA non-small cell lung cancer. The major pathological response rate was 83%, and the pathological complete response rate was 63% [3]. The updated results of the phase III trial (Checkmate 816) showed that neoadjuvant nivolumab in combination with platinum-based chemotherapy could significantly improve pathological complete response rate compared to chemotherapy alone (24.0% vs. 2.2%, odds ratio = 13.94, 99% confidence interval [CI] = 3.49-55.75) [4]. Hence, to deepen our understanding on the treatment of primary tracheal tumors, we report the application of neoadjuvant immunochemotherapy in two rare tracheal tumor cases.Case 1: A 57-year-old woman presented with a gradually worsening cough for 2 weeks. She had no history of cardiothoracic operation or tuberculosis. Chest computerized tomography (CT) revealed a rounded, solid nodule measuring approximately 1.1 cm in diameter, located at the opening of the right main bronchus, with no clear boundary. 18F-FDG positron emission tomography-computed

Prognostic factors and constructing a nomogram in tracheal cancer patients treated with surgical intervention: A study based on SEER database

“…However, there have been successful cases in which this approach was employed. [ 25 , 26 ] Interestingly, in our study, for patients who underwent surgical treatment, chemotherapy and radiotherapy were not included as independent prognostic factors in the multivariate Cox regression analysis. Although chemotherapy was found to have a statistically significant difference in the univariate Cox regression analysis, it did not demonstrate an obvious difference in the multivariate Cox regression analysis.…”

Trachealtumoren

“…Lokal ist die Operabilität dann gegeben, wenn eine R0-Resektion und Rekonstruktion der trachealen Kontinuität technisch und spannungsfrei möglich sind. Trachearesektionen nach neoadjuvanter Therapie sind in Einzelfällen beschrieben und technisch anspruchsvoll [25]. In der lokal inoperablen und/oder metastasierten Situation kommen praktisch ausschließlich Techniken der interventionellen Bronchoskopie und/oder Strahlentherapie zum Einsatz, die ihren Stellenwert auch in der Palliation bei weit fortgeschrittener Erkrankung haben.…”

LAG3-PD1 or CTLA4-PD1 Inhibition in Advanced Melanoma: Indirect Cross Comparisons of the CheckMate-067 and RELATIVITY-047 Trials

“…However, in the past few decades, targeted therapy and immunotherapy have transformed tremendously the chances of patient’s survival [ 2 , 3 , 4 , 5 ]. Checkpoint inhibitors that block programmed cell death 1 (PD-1) and cytotoxic T-lymphocyte antigen 4 (CTLA-4) pathways hold the most promise [ 6 ]. Evidence from two randomized trials established dual CTLA4-PD1 inhibitors (nivolumab–ipilimumab) as the standard of care for previously untreated advanced melanoma [ 2 , 7 ].…”