Surgical Outcomes After Neoadjuvant Nivolumab or Nivolumab With Ipilimumab in Patients With Non-Small Cell Lung Cancer

Authors

Boris Sepesi
Nicolas Zhou
William N William
Heather Y Lin
Cheuk H Leung
Annikka Weissferdt
Kyle G Mitchell
Apar Pataer
Garrett L Walsh
David C Rice
Jack A Roth
Reza J Mehran
Wayne L Hofstetter
Mara B Antonoff
Ravi Rajaram
Marcelo V Negrao
Anne S Tsao
Don L Gibbons
J Jack Lee
John V Heymach
Ara A Vaporciyan
Stephen G Swisher
Tina Cascone

Publication Date

11-1-2022

Journal

The Journal of Thoracic and Cardiovascular Surgery

Abstract

BACKGROUND: Surgical outcomes for non-small cell lung cancer after neoadjuvant immune checkpoint inhibitors continue to be debated. We assessed perioperative outcomes of patients treated with Nivolumab or Nivolumab plus Ipilimumab (NEOSTAR) and compared them with patients treated with chemotherapy or previously untreated patients with stage I-IIIA non-small cell lung cancer.

METHODS: Forty-four patients with stage I to IIIA non-small cell lung cancer (American Joint Committee on Cancer Staging Manual, seventh edition) were randomized to nivolumab (N; 3 mg/kg intravenously on days 1, 15, and 29; n = 23) or nivolumab with ipilimumab (NI; I, 1 mg/kg intravenously on day 1; n = 21). Curative-intent operations were planned between 3 and 6 weeks after the last dose of neoadjuvant N. Patients who completed resection upfront or after chemotherapy from the same time period were used as comparison.

RESULTS: In the N arm, 21 (91%) were resected on-trial, 1 underwent surgery off-trial, and one was not resected (toxicity-related). In the NI arm, 16 (76%) resections were performed on-trial, one off-trial, and 4 were not resected (none toxicity-related). Median time to operation was 31 days, and consisted of 2 (5%) pneumonectomies, 33 (89%) lobectomies, and 1 (3%) each of segmentectomy and wedge resection. The approach was 27 (73%) thoracotomy, 7 (19%) thoracoscopy, and 3 (8%) robotic-assisted. Conversion occurred in 17% (n = 2/12) of minimally invasive cases. All 37 achieved R0 resection. Pulmonary, cardiac, enteric, neurologic, and wound complications occurred in 9 (24%), 4 (11%), 2 (5%), 1 (3%), and 1 (3%) patient, respectively. The 30- and 90-day mortality rate was 0% and 2.7% (n = 1), respectively. Postoperative complication rates were comparable with lung resection upfront or after chemotherapy.

CONCLUSIONS: Operating after neoadjuvant N or NI is overall safe and effective and yields perioperative outcomes similar to those achieved after chemotherapy or upfront resection.

Keywords

neoadjuvant, immunotherapy, nivolumab, ipilimumab, lung surgery, lung resection, lobectomy

Comments

PMID: 35190177