2023 World Conference on Lung Cancer (Posters)-EP07.05. Minimal Residual Lesion Might Predict Adequate Cycles for Neoadjuvant Immunotherapy in Non-small Cell Lung Cancer

EP07.05. Minimal Residual Lesion Might Predict Adequate Cycles for Neoadjuvant Immunotherapy in Non-small Cell Lung Cancer - PDF(Slides)

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A recent investigator-initiated trial aimed to assess the cycles of neoadjuvant immunotherapy targeting the PD-1/PD-L1 pathway in non-small cell lung cancer (NSCLC) patients. The study enrolled patients with stage IIIA NSCLC who were EGFR- and ALK- negative. After two courses of Sintilimab and platinum-based chemotherapy, the patients were randomly assigned to either a control group or an experimental group. The control group underwent surgical resection and received two courses of postoperative treatment, while the experimental group underwent additional two courses of preoperative treatment before surgical resection.<br /><br />The primary endpoint of the study was the pathological complete response (pCR) rate. Minimal residual lesion was assessed through dynamic monitoring of ctDNA (circulating tumor DNA) using ultradeep targeted next-generation sequencing. A total of 12 patients were enrolled, with 6 patients in each group. Out of the three cases that underwent dynamic monitoring of minimal residual lesion, patient A showed complete ctDNA clearance after 4 cycles, patient B showed a steep decline but not complete clearance, and patient C showed a decrease in ctDNA max AF (allele frequency) after 2 cycles.<br /><br />Radiological evaluation showed partial regression in all three patients, while pathologically, patients A and B were evaluated as pCR while patient C was not. Additionally, the study found that ctDNA clearance happened after 2 plus 2 cycles, but it could still exist at the two-cycle time point.<br /><br />The study concluded that 4 cycles of preoperative immunotherapy may have advantages over 2 cycles. It also highlighted the potential value of minimal residual lesion in determining the optimal cycles of preoperative immunotherapy. This study provides important insights into the use of neoadjuvant immunotherapy in NSCLC patients and the potential role of ctDNA monitoring in assessing treatment response.

Asset Subtitle

Dong Lin

Meta Tag

Speaker Dong Lin

Topic Early-Stage NSCLC: Pushing the Boundaries

Keywords

neoadjuvant immunotherapy

PD-1/PD-L1 pathway

non-small cell lung cancer

NSCLC

surgical resection

pathological complete response

minimal residual lesion

ctDNA

circulating tumor DNA

preoperative immunotherapy