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Immunochemotherapy as induction treatment in Stage III (N2, N3) Non-small cell lung cancer

By Hongsheng Deng, Hengrui Liang, Wei Wang, Jianfu Li, Shan Xiong, Bo Cheng, Caichen Li, Qing Ai, Zhuxing Chen, Haixuan Wang, Wenhua Liang, Jianxing He

Posted 05 Jun 2021
medRxiv DOI: 10.1101/2021.06.03.21257757

Background: To increase locoregional and systemic tumor control, a portion of patients with stage III (N2, N3) non-small cell lung cancer (NSCLC) received pulmonary resection after immunochemotherapy in our center. Herein, we assessed the real-world downstage (T, N stage) effectiveness of induction immunochemotherapy and explored the proper cycle number for stage III (N2, N3) NSCLC. Methods: Biopsy confirmed stage III (N2, N3) NSCLC patients underwent induction immunochemotherapy between January 1st, 2018, to August 30th, 2019, were retrospectively identified. Tumor radiologic regression, lymph node down-staging, and pathological response information were collected. Results: In total, 16 patients with stage IIIA NSCLC, 30 with stage IIIB NSCLC, 9 with stage IIIC NSCLC (N2, N3 metastasis) were included. After immunochemotherapy, 25/55 (45.5%) patients achieved an objective response. Ultimately, 33/55 (60.0%) patients received lobectomy plus systemic lymphadenectomy, of whom 18/33 (54.5%) obtained major pathological response (MPR) of the primary lesion, and 24 (72.7%) had pathological-confirmed lymph node downstage (N2-3 to N0-1). Notably, four patients had MPR of the primary lesion but without lymph node downstage. At the data cutoff time (December 30th, 2020), the median follow-up duration was 9.2 months (IQR 8.0-11.7), 24/33 (72.7%) of patients that had surgery were progression-free, with 30 of them alive. Binary logistics analysis showed that 3-4 induction cycles were favorably associated with MPR than 1-2 cycles (p = 0.017). Conclusions: Induction immunochemotherapy showed encouraging MPR and nodal down-staging rates in stage III (N2, N3) NSCLC in this study. Prolonged (3-4) cycles of immunochemotherapy were recommended for better pathological response.

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