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. 2024 Apr;167(4):1444-1453.e4.
doi: 10.1016/j.jtcvs.2023.09.073. Epub 2023 Oct 8.

Surgical outcomes after chemotherapy plus nivolumab and chemotherapy plus nivolumab and ipilimumab in patients with non-small cell lung cancer

Hope Feldman  1 , Boris Sepesi  1 , Cheuk H Leung  2 , Heather Lin  2 , Annikka Weissferdt  3 , Apar Pataer  3 , William N William Jr  4 , Garrett L Walsh  1 , David C Rice  1 , Jack A Roth  1 , Reza J Mehran  5 , Wayne L Hofstetter  1 , Mara B Antonoff  1 , Ravi Rajaram  1 , Don L Gibbons  6 , J Jack Lee  2 , John V Heymach  6 , Ara A Vaporciyan  1 , Stephen G Swisher  1 , Tina Cascone  6
Affiliations

Surgical outcomes after chemotherapy plus nivolumab and chemotherapy plus nivolumab and ipilimumab in patients with non-small cell lung cancer

Hope Feldman et al. J Thorac Cardiovasc Surg. 2024 Apr.

Abstract

Objective: Chemotherapy plus nivolumab is the standard of care neoadjuvant treatment for patients with resectable stage IB to IIIA non-small cell lung cancer. The influence of dual checkpoint blockade with chemotherapy on surgical outcomes remains unknown. We aimed to determine operative complexity and perioperative outcomes associated with neoadjuvant chemotherapy and nivolumab with or without ipilimumab.

Methods: A total of 44 patients with stage IB (≥4 cm) to IIIA non-small cell lung cancer were treated on sequential platform arms of the NEOSTAR trial. A total of 22 patients were treated with nivolumab + chemotherapy, and 22 patients were treated with ipilimumab + nivolumab + chemotherapy. The safety of surgical resection after neoadjuvant therapy was estimated using 30-day complication rates. Operative reports and surgeons' narratives were evaluated to determine procedural complexity and operative conduct.

Results: All 22 of 22 patients (100%) treated with nivolumab + chemotherapy underwent surgical resection: 20 R0 (90.9%), 17 (77.3%) lobectomies, 1 wedge resection, 2 segmentectomies, and 2 pneumonectomies. The majority, 21 of 22 (95%), were performed by thoracotomy. A total of 13 of 22 (59.1%) were rated as challenging resections. A total of 4 of 22 patients (18.2%) experienced grade 3 or greater Clavien-Dindo complication. A total of 20 of 22 patients (90.9%) treated with ipilimumab + nivolumab + chemotherapy underwent surgical resection: 19 R0 (95%), 18 (90%) lobectomies, 1 pneumonectomy, and 1 segmentectomy. A total of 16 of 20 (80%) resections were performed via thoracotomy, 3 of 20 (15%) via robotics, and 1 of 20 (5%) via thoracoscopy. A total of 9 of 20 (45%) resections were considered challenging. A total of 4 of 20 patients (20%) experienced grade 3 or greater Clavien-Dindo complication.

Conclusions: Surgical resections are feasible and safe, with high rates of R0 after neoadjuvant chemotherapy and nivolumab with or without ipilimumab. Overall, approximately half of cases (22/42, 52.3%) were considered to be more challenging than a standard lobectomy.

Keywords: NSCLC; clinical trial; immunotherapy.

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Conflict of interest statement

Conflict of Interest Statement T.C. reports (over the past 36 months) speaker fees/honoraria from the Society for Immunotherapy of Cancer, Mark Foundation for Cancer Research, Bristol Myers Squibb, Roche, Medscape, IDEOlogy Health, Physicians' Education Resource LLC, OncLive, PeerView, and Clinical Care Options; advisory role/consulting fees from MedImmune/AstraZeneca, Bristol Myers Squibb, Merck & Co, Genentech, Ar Pharmaceuticals, Pfizer Inc, and Regeneron; institutional research funding from MedImmune/AstraZeneca and Bristol Myers Squibb; and travel, food, or beverage expenses from Physicians' Education Resource LLC, Dava Oncology, Society for Immunotherapy of Cancer, International Association for the Study of Lung Cancer, Parker Institute for Cancer Immunotherapy, IDEOlogy Health, OncLive, AstraZeneca, and Bristol Myers Squibb. W.N.W. reports consulting or advisory role fees from Clovis Oncology and AstraZeneca; speaker’s fees from Boehringer Ingelheim; honoraria from Roche/Genentech, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Merck, Bayer, Pfizer, and Eli Lilly; and research funding from OSI Pharmaceuticals, Boehringer Ingelheim, Bristol Myers Squibb, Eli Lilly, and Merck. J.V.H. reports Advisory Committees – Genentech, Mirati Therapeutics, Eli Lilly & Co, Janssen Pharmaceuticals, Boehringer-Ingelheim Pharmaceuticals, Regeneron, Takeda Pharmaceuticals, BerGenBio, Jazz Pharmaceuticals, Curio Science, Novartis, AstraZeneca Pharmaceuticals, BioAlta, Sanofi, Spectrum Pharmaceuticals, GlaxoSmithKline, EMD Serono, BluePrint Medicine, and Chugai Pharmaceutical. Research Support—AstraZeneca, Boehringer-Ingelheim, Spectrum, Mirati, Bristol-Myer Squibb, and Takeda. Licensing/Royalties—Spectrum. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

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