Neoadjuvant chemotherapy and Avelumab in early stage resectable nonsmall cell lung cancer

Cancer Medicine

Kamal Al Rabi¹  Hady Ghanem²  Fadi El Karak³  Fouad Boulos⁴  Ibrahim Khalifeh⁴  Ramy Mahfouz⁴  Youssef Zeidan⁵  Bassem Youssef⁵  Mohamad Haidar⁶  Alain Abi Ghanem⁶  Pierre Sfeir⁷  Ziad Mansour⁸  Pierre Youssef⁹  Hazem Assi^1,10  Hanine Atwi^1,10  Majd Al Assaad^1,10  Reem Akel^1,10  Fadlo Khuri^1,10  Arafat Tfayli^1,10  Rachelle Bejjany^1,10  Ghina Fakhri^1,10  Fadi Farhat^1,11 

[1] Department of Internal Medicine King Hussien Cancer Center Amman Jordan;Department of Internal Medicine Lebanese American University Medical Center‐Rizk Hospital Beirut Lebanon;Department of Internal Medicine Saint Joseph University Beirut Lebanon;Department of Pathology American University of Beirut Medical Center Beirut Lebanon;Department of Radiation Oncology American University of Beirut Medical Center Beirut Lebanon;Department of Radiology American University of Beirut Medical Center Beirut Lebanon;Division of Cardiothoracic Surgery American University of Beirut Medical Center Beirut Lebanon;Division of Cardiothoracic Surgery Geitaoui Medical Center Beirut Lebanon;Division of Cardiothoracic Surgery Hammoud Hospital University Medical Center Saida Lebanon;Division of Hematology‐Oncology American University of Beirut Medical Center Beirut Lebanon;Division of Hematology‐Oncology Hammoud Hospital University Medical Center Saida Lebanon;

关键词: immune checkpoint inhibitors;    neoadjuvant therapy;    nonsmall cell lung cancer;    oncogenic drivers;   

DOI  :  10.1002/cam4.3456

来源: DOAJ

【 摘 要 】

Abstract Multiple randomized studies have shown that combination of chemotherapy and immune checkpoint inhibitors (ICIs) leads to better response rates and survival as compared to chemotherapy alone in the advanced stage of NSCLC. Data suggesting a benefit to using ICIs in the neoadjuvant therapy of patients with early stage NSCLC are emerging. Eligible subjects were treatment naïve patients with stage IB, II, and resectable IIIA NSCLC. Patients received three cycles of neoadjuvant chemotherapy with four doses of avelumab every 2 weeks. Patients with squamous cell cancer received cisplatin or carboplatin on day 1 and gemcitabine on days 1 and 8 of each cycle of chemotherapy. Patients with nonsquamous histology received cisplatin or carboplatin with pemetrexed on day 1 of each cycle. Patients then proceeded to their planned surgery. Out of 15 patients accrued as part of stage 1 of the study, four had a radiologic response (1 complete response), lower than the minimum of six responses needed to continue to phase 2 of the study. The study was therefore terminated. Majority had adenocarcinoma histology and stage IIIA disease. The treatment was well tolerated with no unexpected side effects. Four patients (26.7%) had grade III/IV CTCAE toxicity. This study confirms that the preoperative administration of chemotherapy and avelumab is safe. There was no indication of increased surgical complications. The benefit of adding immunotherapy to chemotherapy did not appear to enhance the overall response rate of patients in the neoadjuvant setting in patients with resectable NSCLC because this study failed to meet its primary endpoint.

【 授权许可】

Unknown