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Can Chemoimmunotherapy Achieve Pathologic Downstaging in Resectable Lung Cancer?

By: Vanessa A. Carter, BS
Posted: Thursday, January 7, 2021

In resectable non–small cell lung cancer (NSCLC), nodal and tumor downstaging after neoadjuvant therapy appears achievable with a combined platinum doublet plus nivolumab. However, whether the effect of such downstaging improves survival will require longer follow-up. At the 2020 Society for Immunotherapy of Cancer (SITC) Annual Meeting (Abstract 277), Boris Sepesi, MD, of The University of Texas MD Anderson Cancer Center, Houston, and colleagues studied the effects of four systemic adjuvant therapies on nodal, tumor, and overall pathologic downstaging in surgically resectable stage I to IIIA NSCLC. Their findings were also published in the Journal for ImmunoTherapy of Cancer.

“The combination of neoadjuvant platinum doublet chemotherapy with nivolumab achieves the most robust tumor and overall pathological downstaging and decreases the probability of upstaging at surgery,” concluded the study authors. “These results suggest superior downstaging effect and clinically meaningful lower upstaging probability of combined platinum doublet chemotherapy plus nivolumab as compared to other neoadjuvant regimens.”

Of the 361 enrolled patients, 84% were treated with three cycles of a neoadjuvant platinum doublet. The remaining participants were from the NEOSTAR study (ClinicalTrials.gov identifier NCT03158129); 6% received neoadjuvant nivolumab, 6% received a platinum doublet plus nivolumab, and 4% received nivolumab plus ipilimumab.

The rates of clinical-to-pathologic tumor downstaging were 59%, 38%, 29%, and 26% with the platinum doublet plus nivolumab, nivolumab plus ipilimumab, nivolumab alone, and neoadjuvant platinum doublet, respectively. For nodal downstaging in patients with N1 or N2 disease, the rates were 42%, 50%, 50%, and 55%, respectively. The overall clinical downstaging rates with the platinum doublet plus nivolumab, nivolumab plus ipilimumab, nivolumab alone, and neoadjuvant platinum doublet were 68%, 38%, 38%, and 38%, respectively. For patients being overall upstaged after each therapy, the rates were 14%, 38%, 38%, and 28%, respectively.

Disclosure: For full disclosures of the study authors, visit jitc.bmj.com.



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