Neoadjuvant Chemo-Immunotherapy for Early-Stage Non–Small Cell Lung Cancer

JAMA Network Open, Journal Year: 2024, Volume and Issue: 7(4), P. e246837 - e246837

Published: April 16, 2024

Importance Randomized clinical trials (RCTs) with neoadjuvant immune checkpoint inhibitors (ICIs) plus chemotherapy (ICI-chemotherapy) for patients early-stage non–small cell lung cancer (NSCLC) have reported consistent associations event-free survival (EFS) and pathologic complete response (pCR) pending longer follow-up overall data. Objective To assess the pooled benefit of ICI-chemotherapy in 2-year EFS pCR among NSCLC examine impact clinical, pathologic, treatment-related factors. Data Sources Full-text articles abstracts English were searched EMBASE, PubMed, Cochrane Central Register Controlled Trials, Database Systematic Reviews through November 1, 2023, oncology conference proceedings from January 2008, to 2023. Study Selection Phase 2 or 3 RCTs without adjuvant ICIs vs alone placebo observation previously untreated staged IB IIIB included. Extraction Synthesis extraction prespecified data elements was performed by reviewers using a structured abstraction electronic form. A random-effects model used meta-analysis. The meta-analysis followed Preferred Reporting Items Meta-Analyses guideline. Main Outcomes Measures Two-year outcomes interest who received (experimental arm) (control arm). Aggregated hazard ratios (HRs) time-to-event (2-year EFS) risk (RRs) dichotomous their respective 95% CIs calculated. Results Eight 3387 included, some concerns bias as assessed Collaboration method, mainly related measurements. Neoadjuvant associated improved (HR, 0.57; CI, 0.50-0.66; P < .001) increased rate (RR, 5.58; 4.27-7.29; experimental control treatment arms. This association not significantly modified main patient characteristics; tumor- factors, including tumor programmed death ligand 1 (PD-L1) status; type platinum-compound chemotherapy; number cycles ICI-chemotherapy; addition ICIs. Patients whose cells negative PD-L1 at higher relapse 0.75; 0.62-0.91) than those low 0.61; 0.37-0.71) high 0.40; 0.27-0.58) ( = .005). Conclusions Relevance In this systematic review NSCLC, platinum-based meaningful improvement pCR.

Language: Английский

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The Next Chapter in Immunotherapy and Radiation Combination Therapy: Cancer-Specific Perspectives

International Journal of Radiation Oncology*Biology*Physics, Journal Year: 2024, Volume and Issue: 118(5), P. 1404 - 1421

Published: Jan. 5, 2024

Language: Английский

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Systematic review and meta-analysis of immune checkpoint inhibitors as single agent or in combination with chemotherapy in early-stage non-small cell lung cancer: Impact of clinicopathological factors and indirect comparison between treatment strategies

European Journal of Cancer, Journal Year: 2023, Volume and Issue: 195, P. 113404 - 113404

Published: Oct. 27, 2023

Language: Английский

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Non-invasive multimodal CT deep learning biomarker to predict pathological complete response of non-small cell lung cancer following neoadjuvant immunochemotherapy: a multicenter study

Journal for ImmunoTherapy of Cancer, Journal Year: 2024, Volume and Issue: 12(9), P. e009348 - e009348

Published: Sept. 1, 2024

Objectives Although neoadjuvant immunochemotherapy has been widely applied in non-small cell lung cancer (NSCLC), predicting treatment response remains a challenge. We used pretreatment multimodal CT to explore deep learning-based image biomarkers. Methods This study retrospectively obtained non-contrast enhanced and contrast enhancedbubu scans of patients with NSCLC who underwent surgery after receiving at multiple centers between August 2019 February 2023. Deep learning features were extracted from both construct the predictive models (LUNAI-uCT model LUNAI-eCT model), respectively. After feature fusion these two types features, fused (LUNAI-fCT model) was constructed. The performance evaluated using area under receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, positive value, negative value. SHapley Additive exPlanations analysis quantify impact imaging on prediction. To gain insights into how our makes predictions, we employed Gradient-weighted Class Activation Mapping generate saliency heatmaps. Results training validation datasets included 113 Center A 8:2 ratio, test dataset 112 (Center B n=73, C n=20, D n=19). In dataset, LUNAI-uCT, LUNAI-eCT, LUNAI-fCT achieved AUCs 0.762 (95% CI 0.654 0.791), 0.797 0.724 0.844), 0.866 0.821 0.883), Conclusions By extracting CT, constructed as an biomarker, which can non-invasively predict pathological complete for NSCLC.

Language: Английский

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Is neoadjuvant immunotherapy necessary in patients with programmed death ligand 1 expression-negative resectable non-small cell lung cancer? A systematic review and meta-analysis

Lung Cancer, Journal Year: 2024, Volume and Issue: 191, P. 107799 - 107799

Published: April 23, 2024

Language: Английский

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Single‐arm interventional versus observational studies for assessing efficacy: A meta‐epidemiological study

Cochrane Evidence Synthesis and Methods, Journal Year: 2025, Volume and Issue: 3(1)

Published: Jan. 1, 2025

Abstract Introduction Interventional single‐arm trials (SATs) are increasingly being used as evidence, despite a lack of agreement on their validity and where they should sit in the hierarchy evidence. We conducted meta‐epidemiological study to investigate whether there systematic differences outcomes levels between‐study heterogeneity for SATs compared with observational counterpart, cohort studies. Methods identified reviews (SRs) pharmacological interventions, published 2023, that included both interventional For each SR, subgroup meta‐analysis dichotomous was studies assess effect sizes, between group differences. In sensitivity analysis, clinically heterogeneous primary were removed analyses re‐run. Results 66 SRs contained studies, which 13 reported meta‐analyses efficacy outcomes. There no overall risk difference (risk difference: −0.020, 95% CI: −0.092 0.052, p = 0.59). tendency higher but significant −0.071, −0.161, 0.019, 0.12). high within (median; range I 2 : 54.8; 11.3–91.0) cohorts 77.2; 0–94.7) remained analysis. Conclusion do not appear be outcome further research is recommended confirm this finding. Levels designs, even after attempts reduce clinical heterogeneity. Because had potentially been removed, remaining statistical may have due bias related conduct. Future work utilize larger samples additional methods clarify relative designs.

Language: Английский

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Precision Immuno-Oncology in NSCLC through Gender Equity Lenses

Cancers, Journal Year: 2024, Volume and Issue: 16(7), P. 1413 - 1413

Published: April 4, 2024

Precision immuno-oncology involves the development of personalized cancer treatments that are influenced by unique nature an individual’s DNA, immune cells, and their tumor’s molecular characterization. Biological sex influences immunity; females typically mount stronger innate adaptive responses than males. Though more research is warranted, we continue to observe enhanced benefit for with lung when treated combination chemoimmunotherapy in contrast preferred approach utilizing immunotherapy alone men. Despite observed differences response treatments, women remain underrepresented oncology clinical trials, largely as a result gender-biased misconceptions. Such exclusion has resulted less efficacious treatment guidelines recommendations created knowledge gap regard immunotherapy-related survivorship issues such fertility. To develop precise care overcome from flexible trial schedules, multilingual communication strategies, financial, transportation assistance participants should be adopted. The impact intersectionality other determinants health affect diagnosis, treatment, outcomes must also considered order comprehensive understanding all cancer.

Language: Английский

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A stage IIIA lung adenocarcinoma case achieving pathological response with only one cycle of preoperative nivolumab combination chemotherapy

General Thoracic and Cardiovascular Surgery Cases, Journal Year: 2025, Volume and Issue: 4(1)

Published: Feb. 3, 2025

Abstract Background Preoperative nivolumab combination chemotherapy has shown its efficacy in resectable stage II–III non-small cell lung cancer and become one of the standard treatments. While preoperative is generally a regimen three cycles, when treatment prematurely discontinued remains unclear. Case presentation An 81-year-old man was diagnosed as adenocarcinoma (cT3N1M0, cStage IIIA). A computed tomography (CT) showed 58 mm mass left upper lobe with an intrapulmonary metastasis, positron-emission tomography/CT suggested metastatic lymph nodes at pulmonary hilum. + carboplatin paclitaxel were administered; however, after first cycle, due to grade 3 anorexia, 1 body weight loss, 4 neutropenia. It affair that continuation therapy made him unsuitable for surgery, CT scan reduction tumor size 20 mm. Then, we decided discontinue perform surgery. Video-assisted thoracoscopic lobectomy node dissection performed, postoperative course uneventful. The pathological examination revealed 15% residual primary lesion no diagnosed. patient did not undergo adjuvant chemotherapy, recurrence observed 1.5 years surgery Conclusions In this case, combined only cycle adverse events; significant effect achieved. Therefore, even it unable continue therapy, important miss chance good may have been

Language: Английский

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Upfront surgery for stage IIIA/B non-small cell lung cancer: retrospective cohort study

BJS Open, Journal Year: 2024, Volume and Issue: 8(2)

Published: Jan. 15, 2024

Abstract Background Stage III non-small cell lung cancer is a heterogeneous disease. Several international guidelines recommend neoadjuvant treatment before surgery; however, upfront surgery the preferred approach for technically resectable in East Asia. The aim of this retrospective study was to evaluate long-term outcomes curative-intent stage IIIA/B cancer. Methods Patients who underwent with cIIIA/B were identified. clinical and pathological variables survival evaluated. Results Overall, 664 patients identified, whom 320 (48.8%) had N2 disease, 66.7% males, 49.4% smoking history, 61.2% adenocarcinoma. Lobectomy most performed surgical procedure (84.9%). A total 40 (6.02%) positive margins (R1/R2). grade adverse event rate 2.0% (13 664). median follow-up 30.6 (range 1.9–97.7) months. At follow-up, mortality 13.3% (88 664) 37.2% (247 recurrence. Lung (101 247 (40.9%)) brain (53 (21.5%)) common sites overall 60.0 (95% c.i. 51.5 67.6) months, probability at 1, 2, 3, 5 years being 89.6%, 77.8%, 67.2%, 49.0% respectively. R0 cohort showed an improved compared R1/R2 (67.4 versus 26.5 months respectively; P = greater than 0.001). multivariable analysis revealed that age or equal 65 (HR 1.51, 95% 1.08 2.12; reference less years), tumour size (greater cm 2.13, 1.41 3.21) 3 but 1.15, 0.78 1.71); cm), adjuvant (chemotherapy 0.69, 0.49 0.96) targeted therapy 0.30, 0.12 0.76); none) significantly predicted survival. Conclusion Upfront option management

Language: Английский

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Potential predictors of the pathologic response after neoadjuvant chemoimmunotherapy in resectable non-small cell lung cancer: a narrative review

Translational Lung Cancer Research, Journal Year: 2024, Volume and Issue: 13(5), P. 1137 - 1149

Published: May 1, 2024

Background and Objective: Neoadjuvant chemoimmunotherapy (NACI) is the standard of care for patients with resectable non-small cell lung cancer (NSCLC). Although pathological complete response (pCR) after NACI reportedly exceeds 20%, an optimal predictor pCR yet to be established. This review aims examine possible predictors NACI. Methods: We identified research article published between 2018 2022 in English by PubMed database. Fifty studies were considered as relevant article, examined edit information this narrative review. Key Content Findings: Recently, several have explored potential biomarkers For example, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) imaging, tumor microenvironment (TME), genetic alternation such circulating DNA (ctDNA), clinical markers neutrophil-to-lymphocyte ratio (NLR) smoking signature assessed NSCLC predict Based on PET criteria, metabolic (CMR) achieved a positive predictive value (PPV) 71.4% predicting pCR, decreasing rate post-therapy maximum standardized uptake (SUVmax) substantially correlated major (MPR). TME, significant marker MPR specimens, was increase CD8+ T cells decrease CD3+ or Foxp3 cells. Considering blood samples, TME comprised CD4+PD-1+ natural killer CD3+CD56+CTLA4+ cells, total Th myeloid-derived suppressor (MDSCs), regulatory low pretreatment levels ctDNA undetectable markedly associated survival, relationship remains elusive. Moreover, high baseline NLR had incidence pCR. Heavy (>40 pack-years) favorable response. Conclusions: A reduced 18F-FDG post-NACI TME-related surface lymphocytes could However, role these poorly validated, warranting further investigations. focuses NSCLC.

Language: Английский

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