Prognosis of Patients With Locally Advanced, Metastatic NSCLC Who Have Undergone Prior TKI Treatment and Later Lung Surgery

Salvage surgery can be considered in patients who show downstaging of lung cancer after targeted therapy, and resection of regrowing pulmonary masses can also be performed to acquire a tumor specimen. The results of a study that aimed to evaluate the prognosis of patients with locally advanced and metastatic NSCLC who underwent prior tyrosine kinase inhibitor (TKI) treatment and later lung surgery were presented at the ESMO Congress 2023.

The study consisted of 40 patients who had prior targeted treatment and later received surgical resection. The primary end point was OS, defined as the time between surgical resection and death or censoring. The secondary end point was postoperative PFS.

The study found that among the 40 patients, 36 (87.8%) received prior epidermal growth factor receptor (EGFR) TKI treatment and four (9.8%) received anaplastic lymphoma kinase TKI treatment. At the time of TKI initiation, 31 patients (77.5%) were stage IV and nine (22.5%) were stage III. Salvage surgery was performed in 18 patients (45%) and 22 (55%) underwent resection for biopsy purposes. At the time of resection, tumor burden was unchanged in seven patients (17.5%), significantly regressing in 12 patients (30.0%), and increasing in 21 patients (52.5%). Among the 28 patients with EGFR mutations from resected tumor specimens, nine (32.1%) exhibited the T790M mutation. Next-generation sequencing of the resected samples identified mutations such as MET amplification and TP53. The researchers observed only one postoperative complication (atrial fibrillation). Results showed that patients with poor ECOG scores had significantly worse 1-year and 2-year survival rates (P=.014 and P=.011, respectively). There was a significant difference in 6-month PFS rates between groups stratified by pleural invasion levels (PLO-3; P=.029). Further, patients with T790M mutation showed a trend toward improved PFS (P=.052).

The researchers concluded that “lung surgery following targeted therapies is safe and can be used to predict the prognosis of patients with initially unresectable NSCLC.”

Source: Lim JU. Importance of the resected lung tumor specimen in patients with locally advanced and metastatic non-small cell lung cancer undergoing prior targeted therapy. Abstract of a poster presented at the ESMO Congress 2023; October 20-24, 2023; Madrid, Spain.