Molecular targeted therapies such as epidermal growth factor receptor (EGFR)-TKI or anaplastic lymphoma kinase (ALK)-TKI have dramatically changed clinical outcomes in such patients with driver-gene alterations, Dr Kimihiro Shimizu of Shinshu University School of Medicine, in Matsumoto, and colleagues note in Lung Cancer.
However, they add, "TKI treatments rarely lead to tumor remission; even if tumors undergo complete response, they virtually always acquire resistance to TKI after a while and become a systemic disease." But if tumor spread is limited to the thorax, salvage surgery might present a therapeutic option, the team says.
To investigate, the researchers examined data covering 2010 to 2015 on perioperative and postoperative outcomes of 27 women and nine men who underwent salvage surgery after EGFR-TKI or ALK-TKI therapy. All were never-smokers and none had interstitial lung disease.
Driver-gene alterations were confirmed in all patients and the median time between the start of TKI and salvage surgery was 14 months.
Complete resection was achieved in 29 patients. Perioperatively there were grade-3 adverse events in two patients, one of whom experienced postoperative hemorrhage and the other who had wound infection and empyema.
The median length of hospital stay was 8.5 days and there were no deaths in hospital or within 90 days. Patients were followed for a median of 43 months.
Overall survival was 75% at three years and 44% at five years. Recurrence-free survival was 22% at both three and five years.
Six patients survived for more than 5 years.
The progression of disease while on TKI was an independent prognosticator of worse survival (hazard ratio, 9.38) as were preoperative carcinoembryonic antigen levels at or beyond 5 ng/mL (HR, 4.8). This was also the case for being 70 years of age or more and also for advanced pathological T stage at initial treatment.
The researchers concede that they did not collect data on patients who had similar cancer conditions and did not undergo surgical intervention. Nevertheless, they say that the results "suggest that the salvage surgery might be insufficient to obtain systemic disease-free condition, yet it could contribute to prolonged (overall survival) time through local disease control."
Dr. Shimizu did not respond to requests for comments.
SOURCE: https://bit.ly/39OFXyE Lung Cancer, online January 10, 2021.
By Reuters Staff
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