Salvage surgery for non-small cell lung cancer after tyrosine kinase inhibitor treatment. (March 2021)

• Record Type: Journal Article
• Authors: Ohtaki, Yoichi; Shimizu, Kimihiro; Suzuki, Hiroyuki; Suzuki, Kenji; Tsuboi, Masahiro; Mitsudomi, Tetsuya; Takao, Motoshi; Murakawa, Tomohiro; Ito, Hiroyuki; Yoshimura, Kenichi; Okada, Morihito; Chida, Masayuki
• Is Part Of: Lung cancer. Volume 153(2021)
• Page Start: 108
• Page End: 116
• Publication Date: 2021-03
• Subjects: Salvage surgery -- Conversion therapy -- Non-small cell lung cancer -- Epidermal growth factor receptor -- Anaplastic lymphoma kinase -- Tyrosine kinase inhibitor; Lungs -- Cancer -- Periodicals; Lung Neoplasms -- Abstracts; Lung Neoplasms -- Periodicals; Poumons -- Cancer -- Périodiques; Lungs -- Cancer; Periodicals; Electronic journals; Electronic journals; 616.99424
• DOI: 10.1016/j.lungcan.2020.12.037
• Languages: English
• ISSNs: 0169-5002

Abstract

Graphical abstract: Highlights: Salvage surgery after TKI treatment may be beneficial in NSCLC. 3-year recurrence-free and overall survival rates are 22 % and 75 %, respectively. Treatment response and carcinoembryonic antigen levels can predict overall survival. Age and pT stage are independent prognostic factors of recurrence-free survival. Salvage surgery could contribute to prolong OS through local disease control. Abstract: Objectives: The prognostic impact of surgical intervention for recurrent or residual non-small cell lung cancer (NSCLC) harboring epidermal growth factor receptor ( EGFR ) mutation or anaplastic lymphoma kinase ( ALK ) rearrangement after tyrosine-kinase inhibitor (TKI) treatment remains unclear. We aimed to describe the characteristics and outcomes of patients undergoing salvage surgery in this setting. Methods: We retrospectively collected and analyzed nationwide Japanese data on perioperative and postoperative outcomes of patients who underwent salvage surgery after EGFR or ALK-TKI during 2010−2015. The primary endpoint was a 3-year overall survival (OS) rate and secondary endpoints were the rate of adverse events, perioperative mortality rate, 3-year recurrence-free survival (RFS) rate, and median survival time after salvage lung resection. Univariate and multivariate analyses were performed to identify independent prognostic factors of OS and RFS. Results: Thirty-six patients were included (EGFR-TKI: 33, ALK-TKI: 3). The 3-year OS and RFS after the surgery were 75.1 % (95 % confidence interval [CI] 55.9–86.9 %) and 22.2 % (95 % CI 8.6–39.7 %), respectively. Of clinicopathological factors, the progression of disease while on TKI and preoperative carcinoembryonic antigen (CEA) levels (≥5 ng/mL) were shown to be worse independent prognosticators of OS (hazard ratio [HR] 9.38, 95 % CI 1.57–55.88, P = .014; HR 4.84, 95 % CI 1.62–14.46, P = .005, respectively). Older age at initial treatment (≥70 years) and advanced pathological T stage (T2-T4) were the worse prognosticators for RFS (HR 12.58, 95 % CI 2.51–62.97, P = .002; HR 3.06, 95 % CI 1.04–9.03, P = .043, respectively). Grade 3 adverse events occurred in 5.6 % (2/36) patients, but no deaths were reported within 90 days after surgery. Conclusion: Our study showed that salvage surgery after TKI treatment was safe and feasible and may contribute to prolonged OS time by reducing the local tumor burden.