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WCLC 2022 | Adjuvant chemotherapy in NSCLC patients treated with preoperative chemotherapy

Lei Deng, MD, Roswell Park Comprehensive Cancer Center, Buffalo, NY, discusses an investigation utilizing the National Cancer Database into the impact on survival of adjuvant chemotherapy after neoadjuvant treatment following curative surgery in patients with non-small cell lung cancer (NSCLC). Although patients without clear response to neoadjuvant treatment are more likely to receive adjuvant chemotherapy, it did not appear to improve outcomes of NSCLC. These findings highlight the need for more novel agents within this field. This interview took place at the IASLC 2022 World Conference on Lung Cancer congress in Vienna, Austria.

Transcript (edited for clarity)

So, although it’s not standard of care, perioperative chemotherapy has been utilized in a lot of patients in the United States. And so some of them only got neoadjuvant chemotherapy, but some of them also get additional adjuvant chemotherapy. So our study wanted to look at further to this adjuvant chemotherapy in a setting of neoadjuvant chemotherapy can improve the outcome, particularly in the era that neoadjuvant chemo IO is a line of standard of care...

So, although it’s not standard of care, perioperative chemotherapy has been utilized in a lot of patients in the United States. And so some of them only got neoadjuvant chemotherapy, but some of them also get additional adjuvant chemotherapy. So our study wanted to look at further to this adjuvant chemotherapy in a setting of neoadjuvant chemotherapy can improve the outcome, particularly in the era that neoadjuvant chemo IO is a line of standard of care. So we look at a National Cancer Database, which is a U.S. National Cancer Registry, covers about 70% of non-small cell lung cancer diagnosed. We included patients who have diagnosed with the clinical stage II to III, who have received a neoadjuvant chemotherapy. And we were able to adjust for a lot of demographic factors. More importantly, we wanted to take a look at what’s the contribution of neoadjuvant and chemo sensitivity. The definition is very simple, just based on the stage changed between and after chemotherapy, including complete pathologic response.

And those who have downstage, meaning their pathologic response stage is less than the clinical stage and others, people are not down-staged. So we identify about 2100 patients, and about 16% of patients have received adjuvant chemotherapy among those who have already received neoadjuvant chemotherapy. Very interesting, we show that those who have no downstage were much more likely to have received adjuvant chemotherapy. The proportion is about 20% in those who have not down-staged, about 16% in those who have down-staged and then 9% in those who have not pathologic complete response. However, when we look at survival, we could and couldn’t identify that even receiving more Adjuvant chemotherapy, there’s an improved postoperative outcome. Even in those who have not achieved down staging, meaning that in our cohort more treatment after surgery doesn’t necessarily mean improved outcome. So in conclusion, in the era of neoadjuvant chemo IO, that’s becoming one of standard care in non-small cell small Lung Cancer. I think our study is relevant to give some guidance in the choice of adjuvant systemic treatment in those patients.

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