Transitioning to Neoadjuvant Therapy for Resectable Non-Small Cell Lung Cancer: Trends and Surgical Outcomes in a Regionalized Pulmonary Oncology Network

Yohann Pilon; Merav Rokah; Joseph Seitlinger; Boris Sepesi; Roni F Rayes; Jonathan Cools-Lartigue; Sara Najmeh; Christian Sirois; David Mulder; Lorenzo Ferri; Bassam Abdulkarim; Nicole Ezer; Richard Fraser; Sophie Camilleri-Broët; Pierre-Olivier Fiset; Annick Wong; Shelly Sud; Adrian Langleben; Jason Agulnik; Carmela Pepe; Benjamin Shieh; Vera Hirsh; Linda Ofiara; Scott Owen; Jonathan D Spicer

doi:10.1016/j.cllc.2023.12.005

Transitioning to Neoadjuvant Therapy for Resectable Non-Small Cell Lung Cancer: Trends and Surgical Outcomes in a Regionalized Pulmonary Oncology Network

Clin Lung Cancer. 2023 Dec 19:S1525-7304(23)00264-4. doi: 10.1016/j.cllc.2023.12.005. Online ahead of print.

Authors

Yohann Pilon¹, Merav Rokah¹, Joseph Seitlinger¹, Boris Sepesi², Roni F Rayes³, Jonathan Cools-Lartigue¹, Sara Najmeh¹, Christian Sirois¹, David Mulder¹, Lorenzo Ferri¹, Bassam Abdulkarim⁴, Nicole Ezer⁵, Richard Fraser⁶, Sophie Camilleri-Broët⁶, Pierre-Olivier Fiset⁶, Annick Wong⁷, Shelly Sud⁸, Adrian Langleben⁴, Jason Agulnik⁹, Carmela Pepe⁹, Benjamin Shieh⁴, Vera Hirsh⁴, Linda Ofiara⁴, Scott Owen⁴, Jonathan D Spicer¹⁰

Affiliations

¹ Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada.
² No current official affiliation.
³ Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Goodman Cancer Institute, McGill University, Montreal, QC, Canada.
⁴ Department of Oncology, McGill University, Montreal, QC, Canada.
⁵ Department of Epidemiology, Biostatistics and Occupational Health, McGill University, QC, Canada.
⁶ Department of Pathology, McGill University, Montreal, QC, Canada.
⁷ Department of Oncology, McGill University, Montreal, QC, Canada; Hôpital du Suroît, Salaberry-de-Valleyfield, QC, Canada.
⁸ Department of Oncology, Gatineau Hospital, Gatineau, QC, Canada.
⁹ Department of Oncology, McGill University, Montreal, QC, Canada; Division of Pulmonary Diseases, Jewish General Hospital, Montreal, Canada.
¹⁰ Division of Thoracic Surgery, Department of Surgery, McGill University Health Centre, Montreal, QC, Canada; Goodman Cancer Institute, McGill University, Montreal, QC, Canada. Electronic address: jonathan.spicer@mcgill.ca.

PMID: 38378398
DOI: 10.1016/j.cllc.2023.12.005

Abstract

Background: Several regulatory agencies have approved the use of the neoadjuvant chemo-immunotherapy for resectable stage II and III of non-small cell lung cancer (NSCLC) and numerous trials investigating novel agents are underway. However, significant concerns exist around the feasibility and safety of offering curative surgery to patients treated within such pathways. The goal in this study was to evaluate the impact of a transition towards a large-scale neoadjuvant therapy program for NSCLC.

Methods: Medical charts of patients with clinical stage II and III NSCLC who underwent resection from January 2015 to December 2020 were reviewed. The primary outcome was perioperative complication rate between neoadjuvant-treated versus upfront surgery patients. Multivariable logistic regression estimated occurrence of postoperative complications and overall survival was assessed as an exploratory secondary outcome by Kaplan-Meier and Cox-regression analyses.

Results: Of the 428 patients included, 106 (24.8%) received neoadjuvant therapy and 322 (75.2%) upfront surgery. Frequency of minor and major postoperative complications was similar between groups (P = .22). Occurrence in postoperative complication was similar in both cohort (aOR = 1.31, 95% CI 0.73-2.34). Neoadjuvant therapy administration increased from 10% to 45% with a rise in targeted and immuno-therapies over time, accompanied by a reduced rate of preoperative radiation therapy use. 1-, 2-, and 5-year overall survival was higher in neoadjuvant therapy compared to upfront surgery patients (Log-Rank P = .017).

Conclusions: No significant differences in perioperative outcomes and survival were observed in resectable NSCLC patients treated by neoadjuvant therapy versus upfront surgery. Transition to neoadjuvant therapy among resectable NSCLC patients is safe and feasible from a surgical perspective.

Keywords: Locally advanced non-small cell lung cancer; Perioperative outcomes; Personalized medicine; Preoperative therapies; Thoracic oncology.