P2.08-004 Pathologic Complete Response as an Independed Prognostic Factor in Patients with Locally Advanced Non-Small Cell Lung Cancer

In 2017 the first published PFS results of PACIFIC study demonstrated new opportunities of immunotherapy in locally-advanced unresectable non-small-cell lung cancer (NSCLC) after chemoradiation (CRT). The positive overall survival results in this trial were received next year. This trial has become the first positive study in the more then 10 years after failure of all trials which investigated different approaches for improvement efficacy of standard CRT (induction therapy, consolidation therapy, target therapy, increased RT dose). The PACIFIC trial has opened new opportunities to improve outcomes in this patient’s population. Durvalumab was registered in Russia in July 2019, however clinical experience of durvalumab administration is still limited and we need to build expertise in this field. In this article we present the first example of durvalumab therapy in post CRT period in Bashkortostan real clinical practices. Patient with IIIB st NSCLC started durvalumab therapy after standard CRT. The complete response was registered after 4 months of therapy and currently after 9 months of therapy it is still remain.

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Preoperative chemotherapy followed by concurrent chemoradiation therapy based on hyperfractionated accelerated radiotherapy and definitive surgery in locally advanced non-small-cell lung cancer: mature results of a phase II trial.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.2.622 ◽

1998 ◽

Vol 16 (2) ◽

pp. 622-634 ◽

Cited By ~ 247

Author(s):

W Eberhardt ◽

H Wilke ◽

G Stamatis ◽

M Stuschke ◽

A Harstrick ◽

...

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Locally Advanced ◽

Pathologic Complete Response ◽

Small Cell ◽

Small Cell Lung ◽

Term Survival ◽

Accelerated Radiotherapy ◽

Definitive Surgery

PURPOSE To evaluate the feasibility and efficacy of an intensive multimodality approach with combination chemotherapy, hyperfractionated accelerated chemoradiotherapy, and definitive surgery in prognostically unfavorable subgroups of locally advanced non-small-cell lung cancer stages IIIA and IIIB (LAD-NSCLC). PATIENTS AND METHODS Following staging, including mediastinoscopy, 94 patients with inoperable LAD-NSCLC were treated preoperatively with chemotherapy (three courses of split-dose cisplatin and etoposide [PE]) followed by concurrent chemoradiotherapy (one course of PE combined with 45 Gy hyperfractionated accelerated radiotherapy). After repeat mediastinoscopy, patients underwent surgery 4 weeks postradiation. RESULTS Of 94 consecutive patients (52 stage IIIA [> or = two lymph node levels involved] and 42 stage IIIB [no pleural effusion, no supraclavicular nodes]), 62 (66%) completed induction and underwent surgery. Complete resection (R0) was achieved in 50 (53% of all patients) and pathologic complete response (PCR) in 24 (26%). After a median follow-up of 43 months, the median survival time was 20 months for IIIA, 18 months for IIIB, and 42 months for R0 patients. Calculated survival rates at 4 years were 31%, 26%, and 46%. Two patients died of sepsis preoperatively and four died postoperatively of pleural empyema (n = 1), stump insufficiency (n = 2), and cardiac failure (n = 1). Other toxicities were acceptable-mainly hematologic during chemotherapy or chemoradiotherapy and esophagitis during chemoradiotherapy. CONCLUSION This intensive multimodality treatment is feasible and demonstrates high efficacy in prognostically unfavorable LAD-NSCLC subgroups with high R0 rates and improved long-term survival compared with historical controls

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Is tumor location an independent prognostic factor in locally advanced non-small cell lung cancer treated with trimodality therapy?

Journal of Thoracic Disease ◽

10.21037/jtd.2017.03.183 ◽

2017 ◽

Vol 9 (5) ◽

pp. E489-E491 ◽

Cited By ~ 1

Author(s):

Kazuhiko Shien ◽

Shinichi Toyooka ◽

Junichi Soh ◽

Hiromasa Yamamoto ◽

Shinichiro Miyoshi

Keyword(s):

Lung Cancer ◽

Prognostic Factor ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Locally Advanced ◽

Tumor Location ◽

Small Cell ◽

Independent Prognostic Factor ◽

Small Cell Lung ◽

Trimodality Therapy

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Surgically Proven Complete Response of Stage III Non-Small Cell Lung Cancer after Cisplatin-Enhanced Radiotherapy. Clinical Implications and Long-Term Results

Tumori Journal ◽

10.1177/030089160308900104 ◽

2003 ◽

Vol 89 (1) ◽

pp. 16-19

Author(s):

Amedeo Vittorio Bedini ◽

Luca Tavecchio ◽

Vincenzo Delledonne ◽

Stefano Michele Andreani

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Pathologic Complete Response ◽

Complete Response ◽

Small Cell ◽

Stage Iii ◽

Clinical Implications ◽

Small Cell Lung

Aims and Background Pathologic complete response in locally advanced non-small cell lung cancer is the main end point of combined therapies (chemotherapy and/or radiotherapy). Surgery after an induction treatment can improve local control, allowing the histologic assessment of treatment activity by means of resection or extensive biopsies. Methods Thirty patients surgically assessed without viable tumor after concurrent radiotherapy and continuous infusion of low-dose cisplatin, owing to an initially unresectable stage III non-small-cell lung cancer, were the object of evaluation to assess clinical implications, short- and long-term surgical results. Results The specificity rate of the preoperative restaging was 36.6%. The surgical procedures consisted of 22 resections and of extensive biopsies in 8 cases. The operative mortality was 4% (1/25) for procedures other than right pneumonectomy (3/5). No patient received postoperative chemotherapy. Eleven distant progressions, 4 local recurrences, and 4 new primary tumors were assessed as initial failures. The 8-year overall survival was 36%. Conclusions Pathologic complete response after cisplatin-enhanced radiotherapy cannot be satisfactorily assessed by clinical means. Surgery is required to obtain a reliable evaluation; however, right pneumonectomy should be contraindicated because of prohibitive risk. Although an effective local treatment can cure patients with advanced stage III disease, the addition of chemotherapy seems advisable to improve tumor relapse control.

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