2023 World Conference on Lung Cancer (Posters)-P2.07. Development of Postoperative Bronchopleural Fistula after Neoadjuvant Immunochemotherapy in Non-small Cell Lung Cancer: Case Reports

P2.07. Development of Postoperative Bronchopleural Fistula after Neoadjuvant Immunochemotherapy in Non-small Cell Lung Cancer: Case Reports - PDF(Slides)

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The use of immune checkpoint inhibitors (ICIs) has revolutionized the treatment of advanced non-small cell lung cancer (NSCLC). However, the occurrence of immune-related adverse events (irAEs) has limited the application of ICIs. One serious and rarely reported complication after pneumonectomy is bronchopleural fistula (BPF), especially in patients who receive neoadjuvant immunotherapy or chemoimmunotherapy. <br /><br />In this study, the authors reported on four patients who developed postoperative BPF after receiving a neoadjuvant regimen of sintilimab plus chemotherapy. They also reviewed the literature on eight other patients who developed BPF after receiving immuno-neoadjuvant therapy. The patients in the study were predominantly male, smokers, and had stage III central type lung cancer. <br /><br />The authors summarized the pathological changes observed after surgery, with some patients showing major pathologic responses and reparative changes in the tumor bed, accompanied by fibrous tissue proliferation and chronic inflammatory cell or lymphocyte infiltration. Other patients had immune infiltrative changes and necrosis in the tumor bed, with a large quantity of lymphocytes infiltrating around the tumor nest. <br /><br />Most surgeries were performed within 30 days after the last cycle of neoadjuvant therapy, and the overall mortality rate in these patients was 37.5 percent. The authors concluded that although BPF is rare in patients receiving neoadjuvant immunochemotherapy, it should be given more attention due to its life-threatening nature. They suggested that reinforcement of the bronchial stump should be considered in cases of neoadjuvant immunochemotherapy for lung cancer patients, especially those at higher risk of developing BPF.<br /><br />Overall, this study highlights the need for increased awareness of the potential risk of BPF in patients receiving neoadjuvant immunochemotherapy for NSCLC and suggests strategies for preventing and managing this complication.

Asset Subtitle

Kewei Ma

Meta Tag

Speaker Kewei Ma

Topic Metastatic NSCLC: Immunotherapy - Retrospective

Keywords

immune checkpoint inhibitors

non-small cell lung cancer

immune-related adverse events

bronchopleural fistula

neoadjuvant immunotherapy

chemoimmunotherapy

pathological changes

tumor bed

fibrous tissue proliferation

lymphocyte infiltration