Neoadjuvant immunotherapy followed by surgery with curative intent in 35 patients with advanced NSCLC: the retrospective experiences of a multidisciplinary team

Dongjie Ma; Yuan Xu; Yingzhi Qin; Shanqing Li; Ji Li; Ying Jiang; Mengzhao Wang; Yan Xu; Jing Zhao; Minjiang Chen; Wuying Cheng; Ke Hu; Hongsheng Liu

doi:10.21037/atm-22-2271

Neoadjuvant immunotherapy followed by surgery with curative intent in 35 patients with advanced NSCLC: the retrospective experiences of a multidisciplinary team

Ann Transl Med. 2022 May;10(10):609. doi: 10.21037/atm-22-2271.

Authors

Dongjie Ma^#¹, Yuan Xu^#¹, Yingzhi Qin¹, Shanqing Li¹, Ji Li², Ying Jiang², Mengzhao Wang³, Yan Xu³, Jing Zhao³, Minjiang Chen³, Wuying Cheng⁴, Ke Hu⁵, Hongsheng Liu¹

Affiliations

¹ Department of Thoracic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
² Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
³ Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
⁴ Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.
⁵ Department of Radiotherapy, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China.

^# Contributed equally.

Abstract

Background: In recent years, neoadjuvant immunotherapy combined with chemotherapy has been used to treat locally advanced non-small cell lung cancer (NSCLC); however, no data are available to guide the selection of patients suitable for radical resection. In this paper, we report a clinical mode based on a multidisciplinary team (MDT).

Methods: We retrospectively analyzed the clinical data of patients with advanced NSCLC who were treated in our center between 26 December, 2019 and 1 October, 2021. These cases received an MDT assessment first. Eligible patients then received chemotherapy combined with personalized neoadjuvant immunotherapy. Adverse events were recorded. Chest computed tomography (CT) was performed every other cycle for tumor assessment. Radical resection was subsequently performed for potentially resectable tumors. Intraoperative conditions and surgical complications were recorded. The resected specimens were evaluated to determine the response to neoadjuvant therapy.

Results: The MDT team selected a total of 35 patients (squamous cell carcinoma: n=26, adenocarcinoma: n=8, adenosquamous carcinoma: n=1) for radical resection following neoadjuvant immunotherapy combined with chemotherapy. According to the Response Evaluation Criteria in Solid Tumors (RECIST) findings, 1 patient had complete remission, 27 had partial remission, 6 had progressive disease, and 1 had stable disease. All participants underwent radical resection, including video-assisted thoracoscopic surgery [VATS; 32 (91.4%)], sleeve resection [7 (20.0%)], and multilobar resection [7 (20.0%)]. A total of 17 patients (48.6%) achieved complete pathological remission, and 10 (28.6%) achieved major pathological remission. After surgery, the pathological grade was reduced in 33 patients (94.2%); the RECIST findings were unrelated to postoperative pathological remission (P=0.15).

Conclusions: The MDT mode helps to select suitable patients for radical resection and results in satisfactory pathological remission.

Keywords: Non-small cell lung cancer (NSCLC); multidisciplinary team (MDT); neoadjuvant immunotherapy.