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Anatomic lung resection after immune checkpoint inhibitors for initially unresectable advanced-staged non-small cell lung cancer: a retrospective cohort analysis

BACKGROUND: Patients with initially unresectable advanced non-small cell lung cancer (NSCLC) might experience prolonged responses under immune checkpoint inhibitors (ICIs). In this setting, Multidisciplinary Tumor Board (MTB) seldomly suggest surgical resection of the primary tumor with the ultimate...

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Autores principales: Etienne, Harry, Fournel, Ludovic, Mordant, Pierre, Delatour, Bertrand Richard, Pfeuty, Karel, Frey, Gil, Seguin-Givelet, Agathe, Fourdrain, Alex, Lancelin, Christophe, Berna, Pascal, Legras, Antoine, Alifano, Marco, Bagan, Patrick, Assouad, Jalal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9992580/
https://www.ncbi.nlm.nih.gov/pubmed/36910122
http://dx.doi.org/10.21037/jtd-22-704
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author Etienne, Harry
Fournel, Ludovic
Mordant, Pierre
Delatour, Bertrand Richard
Pfeuty, Karel
Frey, Gil
Seguin-Givelet, Agathe
Fourdrain, Alex
Lancelin, Christophe
Berna, Pascal
Legras, Antoine
Alifano, Marco
Bagan, Patrick
Assouad, Jalal
author_facet Etienne, Harry
Fournel, Ludovic
Mordant, Pierre
Delatour, Bertrand Richard
Pfeuty, Karel
Frey, Gil
Seguin-Givelet, Agathe
Fourdrain, Alex
Lancelin, Christophe
Berna, Pascal
Legras, Antoine
Alifano, Marco
Bagan, Patrick
Assouad, Jalal
author_sort Etienne, Harry
collection PubMed
description BACKGROUND: Patients with initially unresectable advanced non-small cell lung cancer (NSCLC) might experience prolonged responses under immune checkpoint inhibitors (ICIs). In this setting, Multidisciplinary Tumor Board (MTB) seldomly suggest surgical resection of the primary tumor with the ultimate goal to eradicate macroscopic residual disease. Our objective was to report the perioperative outcomes of patients who underwent anatomic lung resection in these infrequent circumstances. METHODS: We set a retrospective multicentric single arm study, including all patients with advanced-staged initially unresectable NSCLC (stage IIIB to IVB) who received systemic therapy including ICIs and eventually anatomical resection of the primary tumor in 10 French thoracic surgery units from January 2016 to December 2020. Coprimary endpoints were in-hospital mortality and morbidity. Secondary endpoints were the rate of complete resection of the pulmonary disease, major pathologic response, risk factors associated with post-operative complications, and overall survival. RESULTS: Twenty-one patients (median age 64, female 62%) were included. Eighteen patients (86%) progressed after first line chemotherapy and received second line ICI. The median time between diagnosis and surgery was 22 months [interquartile range (IQR) 18–35 months]. Minimally-invasive approach was used in 10 cases (48%), with half of these requiring conversion to open thoracotomy. Nine patients (43%) presented early post-operative complications, and one patient died from broncho-pleural fistula one month after surgery. Rates of complete resection of the pulmonary disease and major pathologic response were 100% and 43%, respectively. In univariable analysis, diffusing capacity for carbon monoxide (DLCO) was the only factor associated with the occurrence of postoperative complications (P=0.027). After a median follow-up of 16.0 months after surgery (IQR, 12.0–30.0 months), 19 patients (90%) were still alive. CONCLUSIONS: Anatomic lung resections appear to be a reasonable option for initially unresectable advanced NSCLC experiencing prolonged response under ICIs. Nonetheless, minimally invasive techniques have a low applicability and post-operative complications remains higher in patients who had lower DLCO values. The late timing of surgery may also contribute to complications.
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spelling pubmed-99925802023-03-09 Anatomic lung resection after immune checkpoint inhibitors for initially unresectable advanced-staged non-small cell lung cancer: a retrospective cohort analysis Etienne, Harry Fournel, Ludovic Mordant, Pierre Delatour, Bertrand Richard Pfeuty, Karel Frey, Gil Seguin-Givelet, Agathe Fourdrain, Alex Lancelin, Christophe Berna, Pascal Legras, Antoine Alifano, Marco Bagan, Patrick Assouad, Jalal J Thorac Dis Original Article BACKGROUND: Patients with initially unresectable advanced non-small cell lung cancer (NSCLC) might experience prolonged responses under immune checkpoint inhibitors (ICIs). In this setting, Multidisciplinary Tumor Board (MTB) seldomly suggest surgical resection of the primary tumor with the ultimate goal to eradicate macroscopic residual disease. Our objective was to report the perioperative outcomes of patients who underwent anatomic lung resection in these infrequent circumstances. METHODS: We set a retrospective multicentric single arm study, including all patients with advanced-staged initially unresectable NSCLC (stage IIIB to IVB) who received systemic therapy including ICIs and eventually anatomical resection of the primary tumor in 10 French thoracic surgery units from January 2016 to December 2020. Coprimary endpoints were in-hospital mortality and morbidity. Secondary endpoints were the rate of complete resection of the pulmonary disease, major pathologic response, risk factors associated with post-operative complications, and overall survival. RESULTS: Twenty-one patients (median age 64, female 62%) were included. Eighteen patients (86%) progressed after first line chemotherapy and received second line ICI. The median time between diagnosis and surgery was 22 months [interquartile range (IQR) 18–35 months]. Minimally-invasive approach was used in 10 cases (48%), with half of these requiring conversion to open thoracotomy. Nine patients (43%) presented early post-operative complications, and one patient died from broncho-pleural fistula one month after surgery. Rates of complete resection of the pulmonary disease and major pathologic response were 100% and 43%, respectively. In univariable analysis, diffusing capacity for carbon monoxide (DLCO) was the only factor associated with the occurrence of postoperative complications (P=0.027). After a median follow-up of 16.0 months after surgery (IQR, 12.0–30.0 months), 19 patients (90%) were still alive. CONCLUSIONS: Anatomic lung resections appear to be a reasonable option for initially unresectable advanced NSCLC experiencing prolonged response under ICIs. Nonetheless, minimally invasive techniques have a low applicability and post-operative complications remains higher in patients who had lower DLCO values. The late timing of surgery may also contribute to complications. AME Publishing Company 2023-01-05 2023-02-28 /pmc/articles/PMC9992580/ /pubmed/36910122 http://dx.doi.org/10.21037/jtd-22-704 Text en 2023 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Original Article
Etienne, Harry
Fournel, Ludovic
Mordant, Pierre
Delatour, Bertrand Richard
Pfeuty, Karel
Frey, Gil
Seguin-Givelet, Agathe
Fourdrain, Alex
Lancelin, Christophe
Berna, Pascal
Legras, Antoine
Alifano, Marco
Bagan, Patrick
Assouad, Jalal
Anatomic lung resection after immune checkpoint inhibitors for initially unresectable advanced-staged non-small cell lung cancer: a retrospective cohort analysis
title Anatomic lung resection after immune checkpoint inhibitors for initially unresectable advanced-staged non-small cell lung cancer: a retrospective cohort analysis
title_full Anatomic lung resection after immune checkpoint inhibitors for initially unresectable advanced-staged non-small cell lung cancer: a retrospective cohort analysis
title_fullStr Anatomic lung resection after immune checkpoint inhibitors for initially unresectable advanced-staged non-small cell lung cancer: a retrospective cohort analysis
title_full_unstemmed Anatomic lung resection after immune checkpoint inhibitors for initially unresectable advanced-staged non-small cell lung cancer: a retrospective cohort analysis
title_short Anatomic lung resection after immune checkpoint inhibitors for initially unresectable advanced-staged non-small cell lung cancer: a retrospective cohort analysis
title_sort anatomic lung resection after immune checkpoint inhibitors for initially unresectable advanced-staged non-small cell lung cancer: a retrospective cohort analysis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9992580/
https://www.ncbi.nlm.nih.gov/pubmed/36910122
http://dx.doi.org/10.21037/jtd-22-704
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