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Outcomes and pathologic response of primary lung cancer treated with tyrosine kinase inhibitor/immune checkpoint inhibitor before salvage surgery

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Abstract

Purpose

Advances in primary lung cancer drug therapy have extended patients’ survival, including patients with stage IV disease. This study assessed the safety and effectiveness of salvage surgery following tyrosine kinase inhibitor (TKI) or immune checkpoint inhibitor (ICI) therapy in primary lung cancer.

Methods

A retrospective chart review was conducted of 2050 primary lung cancer surgeries performed at our institution between 2012 and 2022. The study included patients who underwent salvage surgery for unresectable lesions that became resectable or localized residual lesions after treatment. We investigated patients’ clinicopathological characteristics, therapeutic responses, and survival outcomes.

Results

We identified eight cases of salvage surgery after TKI treatment and eight cases after ICI treatment. Five patients experienced early recurrence after surgery; however, the long-term outcome in the post-TKI group was favorable, with a median overall survival (OS) of 66 (range: 28–80) months. Postoperative recurrence was confined to local lymph node recurrence in one patient in the post-ICI group. Despite the relatively short observation period, the long-term prognosis remained promising, with a median OS of 18.7 (range: 9.7–55.8) months.

Conclusions

Salvage surgery after TKI or ICI treatment can be safely performed, and the OS may be favorable.

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Abbreviations

OS:

Overall survival

RFS:

Recurrence-free survival

TKI:

Tyrosine kinase inhibitor

ICI:

Immune checkpoint inhibitor

RECIST:

Response evaluation criteria in solid tumors

EGFR-TKIs:

Epidermal growth factor receptor tyrosine kinase inhibitors

ALK:

Anaplastic lymphoma kinase

PR:

Partial response

SD:

Stable disease

CR:

Complete response

pCR:

Pathological complete response

MPR:

Major pathological response

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Acknowledgements

The authors wish to thank all of their colleagues in the Second Department of Surgery (Chest Surgery), Hospital of the University of Occupational and Environmental Health, Japan, for their helpful contributions to perioperative care. We would also like to thank Editage (www.editage.com) for the English language editing.

Funding

This work was not supported by any funding agency in the public, commercial, or not-for-profit sector.

Author information

Authors and Affiliations

  1. Second Department of Surgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan

    Masaru Takenaka, Fumihiro Tanaka, Kenta Kajiyama, Takehiko Manabe, Katsuma Yoshimatsu, Masataka Mori, Masatoshi Kanayama, Akihiro Taira, Taiji Kuwata & Koji Kuroda

  2. Department of Pathology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan

    Aya Nawata

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  1. Masaru Takenaka
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Contributions

MT: Investigation, Methodology, Writing—original draft. FT: Conceptualization, Investigation, Supervision, Writing, review, and editing. KK: Investigation, Methodology, Data curation. TM: Investigation, Methodology, Data curation. KY: Investigation, Methodology, Data curation. MM: Investigation, Methodology, Data curation. MK: Investigation, Methodology, Data curation. AT: Supervision, Writing—review. TK: Supervision, Writing—review. AN: Investigation, Data curation. KK: Investigation, Supervision, Writing—review and editing.

Corresponding author

Correspondence to Masaru Takenaka.

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Conflict of interest

FT received research grants from Boehringer Ingelheim Japan, Ono Pharmaceutical, Taiho Pharmaceutical, Eli Lilly Japan, and Chugai Pharmaceutical. FT also reports receiving consulting fees from AstraZeneca, Chugai Pharmaceutical, and Ono Pharmaceutical, as well as payment for lectures from MSD, Bristol-Myers Squibb, Boehringer Ingelheim Japan, Ono Pharmaceutical, Taiho Pharmaceutical, Eli Lilly Japan, AstraZeneca, Chugai Pharmaceutical, Kyowa-Kirin, Takeda Pharmaceutical, and Pfizer. The authors declare that they have no conflicts of interest.

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Meeting presentation: This manuscript was presented at the 31st Annual Meeting of the Asian Society for Cardiovascular and Thoracic Surgery held at BEXCO in Busan, Korea on June 1, 2023.

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Takenaka, M., Tanaka, F., Kajiyama, K. et al. Outcomes and pathologic response of primary lung cancer treated with tyrosine kinase inhibitor/immune checkpoint inhibitor before salvage surgery. Surg Today (2024). https://doi.org/10.1007/s00595-024-02811-3

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