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S. Watanabe
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P3.03 - Poster Session/ Treatment of Locoregional Disease – NSCLC (ID 214)
- Event: WCLC 2015
- Type: Poster
- Track: Treatment of Locoregional Disease – NSCLC
- Presentations: 1
- Moderators:
- Coordinates: 9/09/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P3.03-021 - Neoadjuvant Chemotherapy for Locally Advanced Non-Small Cell Lung Cancer (NSCLC) Patients (ID 1372)
09:30 - 09:30 | Author(s): S. Watanabe
- Abstract
Background:
Neoadjuvant chemotherapy (NAC) has gained popularity in recent years, becoming a standard treatment for locally advanced non-small cell lung cancer (NSCLC) to improve resectability and downstage nodal disease, which have clear impacts on prognosis. Potential disadvantages are increased morbidity and/or mortality after surgery and risk of progression of disease that could have been initially resected. The purpose of this study was to evaluate outcomes in a series of patients with locally advanced NSCLC receiving NAC followed by surgery.
Methods:
A total of 12 patients (66.7% males; median age, 71 years) affected by NSCLC in clinical stage IIA-IIIB underwent platinum-based NAC followed by surgery between 2008 and 2014. The clinical stage was IIA in 3 patients, IIIA in 8 (4 of which were IIIAN2), and IIIB in 1. Histology was adenocarcinoma in 8, squamous cell carcinoma in 3, and adenosquamous carcinoma in 1.
Results:
All patients received platinum-based chemotherapy (median, 4 cycles). The NAC regimen was weekly paclitaxel-carboplatin in 6 patients, pemetrexed-carboplatin in 3, paclitaxel-carboplatin-bevacizumab in 2, and gemcitabine-cisplatin in 1. Radiologic response to NAC was complete in 1 patient (8.3%), partial in 8 (66.7%) and stable disease in 3 (25.0%). Overall response rate was 75.0% (95% confidence interval, 51-100%). Grade 3 or 4 hematological toxicities were common, including neutropenia (50%) and anemia (8.3%), but were transient and manageable. Non-hematological toxicities were moderate and no treatment-related deaths were encountered. Eleven patients (91.7%) underwent complete surgical resection after induction. Surgical procedures comprised lobectomy in 10 patients, bilobectomy in 1 and pneumonectomy in 1. No severe intraoperative complications or 30-/90-day mortality were seen. At pathological evaluation, 8 patients (66.7%) showed downstaging of disease, with complete in 1 (8.3%), major in 3 (25.0%) and minor in 7 (58.3%). With a median follow-up of 12.7 months (range, 5.2-50.8 months), the 1-year relapse-free survival rate was 56.6%. Four of the 12 patients developed metastasis (at 4.7, 6.0, 8.4, and 9.2 months), and 2 patients died at 14.7 and 23.9 months.
Conclusion:
NAC using platinum-based chemotherapy with new-generation cytotoxic agents for locally advanced NSCLC seems justified by low morbidity and mortality, good response rates, and high resectability. Although the evidence level for induction chemotherapy is low, incorporation of chemotherapy and surgery will greatly impact strategies for future lung cancer treatment.
