Abstract
Targeted therapy improves outcomes in patients with advanced-stage non-small cell lung cancer (NSCLC) and in the adjuvant setting, but data on its use before surgery are limited. We sought to investigate the safety and feasibility of preoperative targeted therapy in patients with operable NSCLC. We retrospectively reviewed 51 patients with clinical stage I to III NSCLC who received targeted therapy, alone or in combination with chemotherapy, before surgical resection with curative intent, treated from 2004 to 2021. The primary outcome was the safety and feasibility of preoperative targeted therapy; secondary outcomes included objective response rate, major pathologic response (defined as ≤10% viable tumor) rate, recurrence-free survival (RFS), and overall survival. Of the 51 patients included, 46 had an activating epidermal growth factor receptor gene alteration and 5 had an anaplastic lymphoma kinase fusion. Overall, 37 of 46 evaluable patients experienced at least 1 adverse event before surgery; however, only 3 patients experienced a grade 3 or 4 event. The objective response rate was 38% (17/45) for all evaluable patients and 44% (14/32) for patients with clinical stage II or III disease. The major pathologic response rate was 20% (9/44); 2 patients had a complete pathologic response. Median RFS was 3.8 years (95% CI, 2.8 to not reached). Targeted therapy alone was associated with better RFS than combination therapy (P = .009) in patients with clinical stage II or III disease. Preoperative targeted therapy was well tolerated and associated with good outcomes, with or without induction chemotherapy. In addition, radiographic response and pathologic response were strongly correlated.
Overview
- The study investigates the safety and feasibility of preoperative targeted therapy in patients with operable non-small cell lung cancer (NSCLC).
- The study retrospectively reviewed 51 patients who received targeted therapy before surgical resection with curative intent, treated from 2004 to 2021. The primary outcome was the safety and feasibility of preoperative targeted therapy; secondary outcomes included objective response rate, major pathologic response rate, recurrence-free survival (RFS), and overall survival. Of the 51 patients included, 46 had an activating epidermal growth factor receptor gene alteration and 5 had an anaplastic lymphoma kinase fusion. Overall, 37 of 46 evaluable patients experienced at least 1 adverse event before surgery; however, only 3 patients experienced a grade 3 or 4 event. The objective response rate was 38% (17/45) for all evaluable patients and 44% (14/32) for patients with clinical stage II or III disease. The major pathologic response rate was 20% (9/44); 2 patients had a complete pathologic response. Median RFS was 3.8 years (95% CI, 2.8 to not reached). Targeted therapy alone was associated with better RFS than combination therapy in patients with clinical stage II or III disease. Preoperative targeted therapy was well tolerated and associated with good outcomes, with or without induction chemotherapy. In addition, radiographic response and pathologic response were strongly correlated.
Comparative Analysis & Findings
- The study compared the outcomes observed under different experimental conditions or interventions, specifically the safety and feasibility of preoperative targeted therapy in patients with operable NSCLC. The study found that preoperative targeted therapy was well tolerated and associated with good outcomes, with or without induction chemotherapy. The study also found that radiographic response and pathologic response were strongly correlated. The study identified that targeted therapy alone was associated with better recurrence-free survival (RFS) than combination therapy in patients with clinical stage II or III disease. The study also found that the objective response rate was 38% (17/45) for all evaluable patients and 44% (14/32) for patients with clinical stage II or III disease. The major pathologic response rate was 20% (9/44); 2 patients had a complete pathologic response.
Implications and Future Directions
- The study's findings suggest that preoperative targeted therapy is safe and feasible in patients with operable NSCLC. The study also found that preoperative targeted therapy was associated with good outcomes, with or without induction chemotherapy. The study identified that targeted therapy alone was associated with better RFS than combination therapy in patients with clinical stage II or III disease. The study also found that the objective response rate was 38% (17/45) for all evaluable patients and 44% (14/32) for patients with clinical stage II or III disease. The major pathologic response rate was 20% (9/44); 2 patients had a complete pathologic response. The study suggests that preoperative targeted therapy should be considered as a treatment option for patients with operable NSCLC. Future research should focus on larger studies to confirm the safety and efficacy of preoperative targeted therapy in patients with operable NSCLC. Future research should also focus on identifying the optimal combination of targeted therapy and chemotherapy for patients with operable NSCLC. The study also suggests that radiographic response and pathologic response are strongly correlated, future research should focus on developing a predictive model to identify patients who are likely to respond to preoperative targeted therapy.