Surgical Outcomes After Chemotherapy Plus Nivolumab and Chemotherapy Plus Nivolumab and Ipilimumab in Patients With Non-Small Cell Lung Cancer

Authors

Hope Feldman
Boris Sepesi
Cheuk H Leung
Heather Lin
Annikka Weissferdt
Apar Pataer
William N William
Garrett L Walsh
David C Rice
Jack A Roth
Reza J Mehran
Wayne L Hofstetter
Mara B Antonoff
Ravi Rajaram
Don L Gibbons
J Jack Lee
John V Heymach
Ara A Vaporciyan
Stephen G Swisher
Tina Cascone

Publication Date

4-1-2024

Journal

The Journal of Thoracic and Cardiovascular Surgery

DOI

10.1016/j.jtcvs.2023.09.073

PMID

37816395

Abstract

Objective: Chemotherapy plus nivolumab is the standard of care neoadjuvant treatment for patients with resectable stage IB to IIIA non-small cell lung cancer. The influence of dual checkpoint blockade with chemotherapy on surgical outcomes remains unknown. We aimed to determine operative complexity and perioperative outcomes associated with neoadjuvant chemotherapy and nivolumab with or without ipilimumab.

Methods: A total of 44 patients with stage IB (≥4 cm) to IIIA non-small cell lung cancer were treated on sequential platform arms of the NEOSTAR trial. A total of 22 patients were treated with nivolumab + chemotherapy, and 22 patients were treated with ipilimumab + nivolumab + chemotherapy. The safety of surgical resection after neoadjuvant therapy was estimated using 30-day complication rates. Operative reports and surgeons' narratives were evaluated to determine procedural complexity and operative conduct.

Results: All 22 of 22 patients (100%) treated with nivolumab + chemotherapy underwent surgical resection: 20 R0 (90.9%), 17 (77.3%) lobectomies, 1 wedge resection, 2 segmentectomies, and 2 pneumonectomies. The majority, 21 of 22 (95%), were performed by thoracotomy. A total of 13 of 22 (59.1%) were rated as challenging resections. A total of 4 of 22 patients (18.2%) experienced grade 3 or greater Clavien-Dindo complication. A total of 20 of 22 patients (90.9%) treated with ipilimumab + nivolumab + chemotherapy underwent surgical resection: 19 R0 (95%), 18 (90%) lobectomies, 1 pneumonectomy, and 1 segmentectomy. A total of 16 of 20 (80%) resections were performed via thoracotomy, 3 of 20 (15%) via robotics, and 1 of 20 (5%) via thoracoscopy. A total of 9 of 20 (45%) resections were considered challenging. A total of 4 of 20 patients (20%) experienced grade 3 or greater Clavien-Dindo complication.

Conclusions: Surgical resections are feasible and safe, with high rates of R0 after neoadjuvant chemotherapy and nivolumab with or without ipilimumab. Overall, approximately half of cases (22/42, 52.3%) were considered to be more challenging than a standard lobectomy.

Keywords

Humans, Antineoplastic Combined Chemotherapy Protocols, Carcinoma, Non-Small-Cell Lung, Ipilimumab, Lung Neoplasms, Neoadjuvant Therapy, Neoplasm Staging, Nivolumab, Treatment Outcome, Randomized Controlled Trials as Topic, NSCLC, clinical trial, immunotherapy

Published Open-Access

yes

Recommended Citation

Feldman, Hope; Sepesi, Boris; Leung, Cheuk H; et al., "Surgical Outcomes After Chemotherapy Plus Nivolumab and Chemotherapy Plus Nivolumab and Ipilimumab in Patients With Non-Small Cell Lung Cancer" (2024). Faculty, Staff and Student Publications. 4435.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/4435