Short-term efficacy and safety of pembrolizumab combined with neoadjuvant chemotherapy for the treatment of non-small cell lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Yixing ¹ , ZHAO Heng ¹ , LIU Bohao ¹ , WANG Jizhao ¹ , ZHANG Yanpeng ¹ , GUO Chendong ² , ZHAO Chuchen ² , FAN Kun ¹ , WANG Hongyi ¹ , TAO Runyi ¹ , WANG Zhiyu ¹ , ZHANG Jia ¹ , FU Junke ¹ ,  ZHANG Guangjian ¹

1. Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P. R. China;
2. Xi'an Jiaotong University Medical Department, Xi'an, 710061, P. R. China;

Corresponding author：

ZHANG Guangjian, Email: michael8039@163.com

Keywords：

Immune checkpoint inhibitors; programmed cell death-1; pembrolizumab; neoadjuvant immunotherapy; non-small cell lung cancer

DOI：

10.7507/1007-4848.202107018

Video：

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Objective To explore the short-term efficacy and safety of pembrolizumab combined with chemotherapy in the neoadjuvant treatment of non-small cell lung cancer. Methods The clinical data of 11 male patients with non-small cell lung cancer who underwent pembrolizumab combined with neoadjuvant chemotherapy in the Department of Thoracic Surgery, the First Affiliated Hospital of Xi'an Jiaotong University from December 2019 to June 2021 were retrospectively analyzed. The average age of the patients was 52.0-79.0 (62.0±6.9) years. The imaging data and pathological changes before and after neoadjuvant treatment were compared, and adverse reactions during neoadjuvant treatment were recorded. Objective remission rate (ORR) and main pathological remission rate (MPR) and pathological complete remission rate (pCR) were the main observation endpoints. Results After preoperative neoadjuvant therapy with pembrolizumab combined with platinum or paclitaxel, all patients successfully underwent thoracoscopic radical resection of lung cancer. The ORR was 72.7%, and the MPR was 81.8%. Among them, 45.5% of patients achieved pCR. The main adverse reactions were hypoalbuminemia, decreased appetite and nausea. The mortality rate within 30 days after surgery was 0, and no tumor metastasis was observed. Conclusion Pembrolizumab combined with neoadjuvant chemotherapy is safe and feasible to treat non-small cell lung cancer, and the short-term efficacy is beneficial.

Citation： LI Yixing, ZHAO Heng, LIU Bohao, WANG Jizhao, ZHANG Yanpeng, GUO Chendong, ZHAO Chuchen, FAN Kun, WANG Hongyi, TAO Runyi, WANG Zhiyu, ZHANG Jia, FU Junke, ZHANG Guangjian. Short-term efficacy and safety of pembrolizumab combined with neoadjuvant chemotherapy for the treatment of non-small cell lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(3): 369-374. doi: 10.7507/1007-4848.202107018 Copy

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1. Rosell R, Karachaliou N. Large-scale screening for somatic mutations in lung cancer. Lancet, 2016, 387(10026): 1354-1356.
2. Ettinger DS, Wood DE, Aisner DL, et al. NCCN guidelines insights: Non-small cell lung cancer, version 2. 2021. J Natl Compr Canc Netw, 2021, 19(3): 254-266.
3. Provencio M, Nadal E, Insa A, et al. Neoadjuvant chemotherapy and nivolumab in resectable non-small-cell lung cancer (NADIM): An open-label, multicentre, single-arm, phase 2 trial. Lancet Oncol, 2020, 21(11): 1413-1422.
4. Cascone T, William WN, Weissferdt A, et al. Neoadjuvant nivolumab or nivolumab plus ipilimumab in operable non-small cell lung cancer: The phase 2 randomized NEOSTAR trial. Nat Med, 2021, 27(3): 504-514.
5. 刘雨桃, 高禹舜, 毛友生, 等. 程序性细胞死亡蛋白1单抗联合化疗在Ⅱ期和Ⅲ期非小细胞肺癌术前新辅助治疗中的疗效和安全性. 中华肿瘤杂志, 2020, 42(6): 480-485.
6. 白悦, 孙大强, 张逊, 等. PD-1抑制剂联合化疗在Ⅲ期非小细胞肺癌术前新辅助治疗中的随机对照研究. 中国胸心血管外科临床杂志, 2021, 28(8): 963-971.
7. Herbst RS, Baas P, Kim DW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): A randomised controlled trial. Lancet, 2016, 387(10027): 1540-1550.
8. Reck M, Rodríguez-Abreu D, Robinson AG, et al. Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med, 2016, 375(19): 1823-1833.
9. Mok TSK, Wu YL, Kudaba I, et al. Pembrolizumab versus chemotherapy for previously untreated, PD-L1-expressing, locally advanced or metastatic non-small-cell lung cancer (KEYNOTE-042): A randomised, open-label, controlled, phase 3 trial. Lancet, 2019, 393(10183): 1819-1830.
10. Gadgeel SM, Stevenson JP, Langer CJ, et al. Pembrolizumab and platinum-based chemotherapy as first-line therapy for advanced non-small-cell lung cancer: Phase 1 cohorts from the KEYNOTE-021 study. Lung Cancer, 2018, 125: 273-281.
11. Garassino MC, Gadgeel S, Esteban E, et al. Patient-reported outcomes following pembrolizumab or placebo plus pemetrexed and platinum in patients with previously untreated, metastatic, non-squamous non-small-cell lung cancer (KEYNOTE-189): A multicentre, double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Oncol, 2020, 21(3): 387-397.
12. Paz-Ares L, Luft A, Vicente D, et al. Pembrolizumab plus chemotherapy for squamous non-small-cell lung cancer. N Engl J Med, 2018, 379(21): 2040-2051.
13. Zhao Z, Gao Y, Xue Q, et al. Safety and efficacy of neoadjuvant immune checkpoint inhibitor therapy in patients with resectable non-small-cell lung cancer: A systematic review. Target Oncol, 2021, 16(4): 425-434.
14. Tong BC, Gu L, Wang X, et al. Perioperative outcomes of pulmonary resection after neoadjuvant pembrolizumab in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg, 2021, S0022-5223(21): 00583-3.
15. Chen Y, Zhang L, Yan B, et al. Feasibility of sleeve lobectomy after neo-adjuvant chemo-immunotherapy in non-small cell lung cancer. Transl Lung Cancer Res, 2020, 9(3): 761-767.
16. Shen D, Wang J, Wu J, et al. Neoadjuvant pembrolizumab with chemotherapy for the treatment of stage ⅡB-ⅢB resectable lung squamous cell carcinoma. J Thorac Dis, 2021, 13(3): 1760-1768.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term efficacy and safety of pembrolizumab combined with neoadjuvant chemotherapy for the treatment of non-small cell lung cancer

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