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• 35188

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  P21 - Locoregional and Oligometastatic Disease - Treatment of Locally Advanced NSCLC (ID 131)

  • Event: WCLC 2020
  • Type: Posters
  • Track: Locoregional and Oligometastatic Disease
  • Presentations: 1
  • Moderators:
  • Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall

  • 35208

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    P21.14 - The Promising role of Chemo-Immunotherapy in Non-Small Cell Lung Cancer Neoadjuvant Setting (ID 3551)

    00:00 - 00:00  |  Presenting Author(s): Helena Bote
    • Abstract
    • Slides

    Introduction
    

    Stage III non-small cell lung cancer (NSCLC) is a heterogeneous disease which includes patients with different prognosis depending on resectable, potentially resectable or unresectable tumours. Chemo-immunotherapy in neoadjuvant setting is currently under evaluation in clinical trials. We present two case reports of patients who received this therapeutic approach due to tumour unresectability at diagnosis.

    Methods
    

    Data were collected from electronic history and clinical records. All procedures performed were in accordance with ethical standards of the institutional research Committee and the treatment strategy was approved as compassionate use in both cases.

    Results
    

    A 56-year old male and a 48-year old female (37 and 45 pack-year history, respectively) presented with two-month history of productive cough and moderate progressive dyspnoea. In Case 1, the ¹⁸F-FDG PET/CT showed a 12 cm (diameter greater) necrotic mass (SUVmax 18.43) and non-metabolic ipsilateral pleural effusion (Figure 1A), staging cT4N0M0 (IIIA). On the other hand, a 5.8 cm (diameter greater) right hilar mass (SUVmax 20.25), ipsilateral pleural effusion (SUVmax 6.45) and a right subcarinal suspicious adenopathy were shown in Case 2 (Figure 1C). Bronchoscopic biopsy revealed a primary pulmonary squamous cell carcinoma with PD-L1 expression 90% (22C3) in both cases and they were presented in Multidisciplinary Tumour Board. In Case 1, the mass was considered unresectable and the patient was not eligible for radical chemo-radiotherapy, so systemic therapy was finally decided. Otherwise, pleural effusion cytological assessment was performed several times without showing malignant cells in Case 2 (staging cT3N2Mx) and systemic treatment was started too due to the tumour unresectability. Chemo-immunotherapy combination with carboplatin AUC 5mg/ml/min, paclitaxel 175mg/m² and pembrolizumab 200mg every three weeks according to the results of KEYNOTE-407 was given in both cases. Favourable response was achieved after four cycles (Case 1, Figure 1B; Case 2, Figure 1D), therefore both cases were discussed again in Multidisciplinary Session in order to reevaluate surgical indication. After mediastinoscopy, Case 1 underwent right pneumonectomy in December 2019 (postoperative staging ypT1cN0M0) and Case 2 underwent middle and lower bilobectomy in June 2019, with major pathological response (MPR). At present, both patients are asymptomatic, with no evidence disease and no antineoplastic treatment.

    

    Conclusion
    

    Radiological response achieved with chemo-immunotherapy allowed a surgical approach in patients with non-resectable tumours at diagnosis. MPR is a surrogate of overall survival in resectable NSCLC, so results of ongoing clinical trials exploring this combination strategy are expected with much interest because they could change the therapeutic paradigm of these patients.

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