Search

Background: Chemoradiotherapy with durvalumab consolidation has yielded excellent results in stage III non-small-cell lung cancer (NSCLC). Therefore, it is essential to identify patients who might benefit from a surgical approach., Material and Methods: Data from 437 patients with operable stage III NSCLC enrolled in four consecutive Swiss Group for Clinical Cancer Research (SAKK) trials (16/96, 16/00, 16/01, 16/08) were pooled and outcomes were analyzed in 431 eligible patients. All patients were treated with three cycles of induction chemotherapy (cisplatin/docetaxel), followed in some patients by neoadjuvant radiotherapy (44 Gy, 22 fractions) (16/00, 16/01, 16/08) and cetuximab (16/08)., Results: With a median follow-up time of 9.3 years (range 8.5-10.3 years), 5- and 10-year overall survival (OS) rates were 37% and 25%, respectively. Overall, 342 patients (79%) underwent tumor resection, with a complete resection (R0) rate of 80%. Patients (n = 272, 63%) with R0 had significantly longer OS compared to patients who had surgery but incomplete resection (64.8 versus 19.2 months, P < 0.001). OS for patients who achieved pathological complete remission (pCR) (n = 66, 15%) was significantly better compared to resected patients without pCR (86.5 versus 37.0 months, P = 0.003). For patients with pCR, the 5- and 10-year event-free survival and OS rates were 45.7% [95% confidence interval (CI) 32.8% to 57.7%] and 28.1% (95% CI 15.2% to 42.6%), and 58.2% (95% CI 45.2% to 69.2%) and 45.0% (95% CI 31.5% to 57.6%), respectively., Conclusion: We report favorable long-term outcomes in patients with operable stage III NSCLC treated with neoadjuvant chemotherapy with cisplatin and docetaxel ± neoadjuvant sequential radiotherapy from four prospective SAKK trials. Almost two-third of the patients underwent complete resection after neoadjuvant therapy. We confirm R0 resection and pCR as important predictors of outcome., Competing Interests: Disclosure DK: consulting or advisory role: AstraZeneca (AZ) (fee to institution). IO: grants (all fees to institution): Roche, Medtronic; honoraria (all fees to speakers bureau): AZ, Roche; advisory role: AZ, Merck, Sharp, and Dohme (MSD). WW: honoraria, consulting or advisory role, travel/accommodations: AZ, Medtronic. SIR: honoraria, consulting or advisory role (all fees to institution): AbbVie, Amgen, AZ, Boehringer Ingelheim, Bristol-Myers Squibb (BMS), Eli Lilly, Eisai, Janssen, MSD, Merck Serono, Novartis, PharmaMar, Pfizer, Roche, Takeda; travel/accommodations: Boehringer Ingelheim, BMS, Roche; Research support: AZ, Roche. AA: consulting or advisory role: AZ, Astella, BMS, MSD, Novartis, Roche; honoraria: AZ, Eli Lilly, Novartis. MM: consulting or advisory role: AZ (institution), BMS, Janssen, MSD, Roche. SP (all fees to institution): consulting or advisory role: AbbVie, Amgen, AZ, Bayer, Beigene, Biocartis, Boehringer Ingelheim, BMS, Clovis, Daiichi Sankyo, Debiopharm, ecancer, Eli Lilly, Elsevier, Fishawack, Foundation Medicine, Illumina, Imedex, IQVIA, Incyte, Janssen, Medscape, MSD, Merck Serono, Merrimack, Novartis, OncologyEducation, PharmaMar, Phosplatin Therapeutics, PER, Pfizer, PRIME, Regeneron, RMEI, Roche/Genentech, RTP, Sanofi, Seattle Genetics, Takeda, Talk: AZ, Boehringer Ingelheim, BMS, ecancer, Eli Lilly, Illumina, Imedex, Medscape, MSD, Novartis, PER, Pfizer, Prime, Roche/Genentech, RTP, Sanofi, Takeda; Grants/research support: Amgen, AZ, Biodesix, Boehringer Ingelheim, BMS, Clovis, GSK, Illumina, Lilly, MSD, Merck Serono, Mirati, Novartis, and Pfizer, Phosplatin Therapeutics, Roche/Genentech. MP: honoraria: Bayer, Janssen, Nestle; consulting or advisory role: AbbVie, Amgen, AZ, Bayer, Boehringer Ingelheim, BMS, Eisei, Janssen, MSD, Merck Serono, Nestle, Novartis, Pfizer, Roche, Sanofi, Takeda; travel/accommodations: AZ, Boehringer Ingelheim, BMS, Roche, Takeda, Vifor. MF: grants (all to institution): AZ, BMS; consulting or advisory role: AZ, Boehringer Ingelheim, BMS, MSD, Pfizer, Roche, Takeda; travel/accommodations: Merck Serono. All other authors have declared no conflicts of interest., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The coronavirus pandemic has provoked discussions among healthcare providers how to manage cancer patients when faced with the threat of severe acute respiratory syndrome related coronavirus 2 (SARS-CoV-2) infection. Immune checkpoint inhibitor (ICI) containing regimens are standard of care in the majority of metastatic clear cell renal cell carcinoma (mccRCC) patients. It remains unclear whether therapies should be modified in response to the COVID-19 pandemic., Methods: We performed an online survey among physicians involved in the treatment of mccRCC, and 41 experts responded. Questions focused on criteria relevant for treatment decision outside the pandemic and the modifications of systemic therapy during COVID-19., Findings: For the majority of experts (73%), the combination of International metastatic renal cell carcinoma Database Consortium (IMDC) risk category and patient fitness are two important factors for decision-making. The main treatment choice in fit, favourable risk patients outside the pandemic is pembrolizumab/axitinib for 53%, avelumab/axitinib, sunitinib or pazopanib for 13% of experts each. During the pandemic, ICI-containing regimens are chosen less often in favour of a tyrosine kinase inhibitors (TKI) monotherapy, mainly sunitinib or pazopanib (35%).In fit, intermediate/poor-risk patients outside the pandemic, over 80% of experts choose ipilimumab/nivolumab, in contrast to only 41% of physicians during COVID-19, instead more TKI monotherapies are given. In patients responding to established therapies with ICI/ICI or ICI/TKI combinations, most participants modify treatment regimen by extending cycle length, holding one ICI or even both., Conclusion: mccRCC treatment modifications in light of the coronavirus pandemic are variable, with a shift from ICI/ICI to ICI/TKI or TKI monotherapy., Competing Interests: Competing interests: SA: MSD (C/A), Sanofi-Genzyme (C/A) recipient: my institution. TE: Personal: AstraZeneca (RF, E, OI), Bayer (RF), Pfizer (RF), Roche (E, OI); Institution: AstraZeneca (RF), Roche (RF). BE: Pfizer (C/A), BMS (C/A), Ipsen (C/A), Roche (C/A), Oncorena (C/A), Aveo (C/A). SF: Bayer (TS), Astellas (RF, TS). VG: Astra Zeneca (C/A, H, OI, RF), Bristol-Myers Squibb (C/A, H, OI, RF), Roche Pharma AG (C/A, H), MSD Oncology (C/A, H, OI, RF), Ipsen (C/A, H, RF), Bayer (H, RF), Merck Serono (C/A, H), Janssen Cliag (C/A, H), Pfizer (C/A, H), Lilly (C/A, H), PharmaMar (H), EUSAPharm (C/A, H), Novartis (C/A, H, RF), EISAI (H), Onkowissen (C/A). JML: Achilles Therapeutics (C/A, grant support), Bristol-Myers Squibb (C/A, grant support), Merck Sharp & Dohme (C/A, grant support), Nektar (C/A, grant support), Novartis (C/A, grant support), Pfizer (C/A, grant support), Roche–Genentech (C/A, grant support), Immunocore (C/A, grant support), AstraZeneca (C/A), Boston Biomedical (C/A), Eisai (C/A), EUSA Pharma (C/A), GlaxoSmithKline (C/A), Ipsen (C/A), Imugen (C/A), Incyte (C/A), iOnctura (C/A), Kymab (C/A), Merck Serono (C/A), Pierre Fabre (C/A), Secama (C/A), Vitaccess (C/A), Covance (C/A), Aveo (C/A), Pharmacyclics (C/A). DM: BMS (H, C/A), Pfizer (H, C/A), Merck (H, C/A), Alkermes, Inc. (H, C/A). AO: Personal: Astellas (TS), Bayer (TS), Sanofi (TS), Janssen (TS). Instituional: Astellas (C/A, SB), Bayer (C/A, SB), Sanofi (C/A), Roche (C/A), Janssen (C/A, RF, SB), MSD (C/A), Molecular Partners (C/A), Teva (RF). CP: Bristol-Myers Squibb (personal fees), Merck Sharpe & Dohme (personal fees), Novartis (personal fees), Ipsen (personal fees), EUSA (personal fees), Eisai (personal fees), Janssen (personal fees), AstraZeneca (personal fees), General Electric (personal fees), Pfizer (grants and personal fees). BR: Merck (C/A), BMS (C/A), AVEO (C/A), Pfizer (C/A), Roche(C/A), Pfizer (RF), Merck (RF), BMS (RF), AVEO (RF), Astra-Zeneca (RF), Roche (RF). MS: Pfizer, BMS, Ipsen, MSD, Merck, Exelixis, EISAI, EUSA, Roche, Novartis, Alkermes. CS: Pfizer (C/A), MSD (C/A), Merck (C/A), AstraZeneca (C/A), Astellas (C/A), Sanofi-Genzyme (C/A), Roche-Genentech (C/A), Incyte (C/A). CR: Pfizer (C/A), Bristol-Myers Squibb (C/A), Roche Pharma AG (C/A), MSD Oncology (C/A), Merck (Schweiz) AG (C/A) recipient for all: my institution. Astellas Pharma (RF) recipient: my institution. Legend: (C/A) Consulting/advisory relationship; (RF) Research funding; (E) Employment; (ET) Expert testimony; (H) Honoraria received; (TS) Travel Support; (OI) Ownership interests; (IP) Intellectual property rights/inventor/patent holder; (SAB) Scientific advisory board, Speaker Bureau (SB)., (© Author (s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. Published by BMJ on behalf of the European Society for Medical Oncology.)