Is Radical Local Therapy Effective in Postoperative Recurrent EGFR-mutated Non-small Cell Lung Cancer?

Overview

Journal Thorac Cancer

Specialties Oncology
Pulmonary Medicine

Date 2023 May 5

PMID 37143400

Authors

Tomoyoshi Takenaka

Tokujiro Yano

Koji Yamazaki

Tatsuro Okamoto

Motoharu Hamatake

Shinkichi Takamori

Mikihiro Kohno

Naoko Miura

Mototsugu Shimokawa

Tomoharu Yoshizumi

Affiliations

Soon will be listed here.

Abstract

Background: Long-term survival can be achieved with radical local therapy in some cases of postoperative recurrence of non-small cell lung cancer (NSCLC). Here, we evaluated post-recurrence survival (PRS) after treatment of postoperative recurrent epidermal growth factor receptor (EGFR) mutated NSCLC and examined the effectiveness of radical local therapy.

Methods: This multicenter prospective cohort study was conducted in 14 hospitals. The inclusion criteria for this study were patients with recurrence after radical resection for NSCLC. Information about the patient characteristics at recurrence, tumor-related variables, primary surgery, and treatment for recurrence was collected. After registration, follow-up data (e.g., treatment and survival outcomes) were obtained and analyzed.

Results: From 2010 to 2015, 505 patients with recurrent NSCLC were enrolled into the study, and 154 EGFR mutation-positive cases were included. As the initial treatment for recurrence, 111 patients (72%) received chemotherapy, 14 (9%) received chemoradiotherapy, 14 (9%) received definitive radiotherapy, and seven (5%) received surgical resection. The remaining eight patients (5%) received supportive care. The median PRS and 5-year survival rates for all cases were 64 months and 53.2%, respectively. The 5-year survival rate according to the initial treatment was as follows: supportive care, 0%; chemotherapy, 53.3% and radical local therapy, 60.1%. The six patients who received radical local treatment remained recurrence-free for more than 3 years after recurrence with only initial treatment.

Conclusions: Although radical local therapy may be curative in some patients, chemotherapy including EGFR-TKI treatment is expected to provide long-term survival comparable to that of radical local therapy.

Citing Articles

Is radical local therapy effective in postoperative recurrent EGFR-mutated non-small cell lung cancer?.

Takenaka T, Yano T, Yamazaki K, Okamoto T, Hamatake M, Takamori S Thorac Cancer. 2023; 14(18):1660-1667.

PMID: 37143400 PMC: 10290912. DOI: 10.1111/1759-7714.14911.

References

Kenmotsu H, Yamamoto N, Yamanaka T, Yoshiya K, Takahashi T, Ueno T . Randomized Phase III Study of Pemetrexed Plus Cisplatin Versus Vinorelbine Plus Cisplatin for Completely Resected Stage II to IIIA Nonsquamous Non-Small-Cell Lung Cancer. J Clin Oncol. 2020; 38(19):2187-2196. DOI: 10.1200/JCO.19.02674. View

Sonoda D, Matsuura Y, Kondo Y, Ichinose J, Nakao M, Ninomiya H . Characteristics of surgically resected non-small cell lung cancer patients with post-recurrence cure. Thorac Cancer. 2020; 11(11):3280-3288. PMC: 7605994. DOI: 10.1111/1759-7714.13669. View

Fitzmaurice C, Akinyemiju T, Al Lami F, Alam T, Alizadeh-Navaei R, Allen C . Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study. JAMA Oncol. 2018; 4(11):1553-1568. PMC: 6248091. DOI: 10.1001/jamaoncol.2018.2706. View

Hishida T, Yoshida J, Aokage K, Nagai K, Tsuboi M . Postoperative oligo-recurrence of non-small-cell lung cancer: clinical features and survival†. Eur J Cardiothorac Surg. 2015; 49(3):847-53. DOI: 10.1093/ejcts/ezv249. View

Ramalingam S, Vansteenkiste J, Planchard D, Cho B, Gray J, Ohe Y . Overall Survival with Osimertinib in Untreated, -Mutated Advanced NSCLC. N Engl J Med. 2019; 382(1):41-50. DOI: 10.1056/NEJMoa1913662. View

Matsuguma H, Nakahara R, Wakamatsu I, Kishikawa T, Sugiyama T, Nakamura Y . Definitive Local Therapy for Oligo-recurrence in Patients With Completely Resected Non-small Cell Lung Cancer. Am J Clin Oncol. 2019; 43(3):210-217. DOI: 10.1097/COC.0000000000000656. View

Sharma S, Bell D, Settleman J, Haber D . Epidermal growth factor receptor mutations in lung cancer. Nat Rev Cancer. 2007; 7(3):169-81. DOI: 10.1038/nrc2088. View

Seol K, Lee J, Cho J, Lee D, Seok Y, Kang M . Salvage radiotherapy for regional lymph node oligo-recurrence after radical surgery of non-small cell lung cancer. Thorac Cancer. 2017; 8(6):620-629. PMC: 5668518. DOI: 10.1111/1759-7714.12497. View

Aoki S, Yamashita H, Takahashi W, Nawa K, Ota T, Imae T . Salvage stereotactic body radiotherapy for post-operative oligo-recurrence of non-small cell lung cancer: A single-institution analysis of 59 patients. Oncol Lett. 2020; 19(4):2695-2704. PMC: 7068670. DOI: 10.3892/ol.2020.11407. View

10.

Takenaka T, Takenoyama M, Toyozawa R, Inamasu E, Yoshida T, Toyokawa G . Concurrent chemoradiotherapy for patients with postoperative recurrence of surgically resected non-small-cell lung cancer. Clin Lung Cancer. 2014; 16(1):51-6. DOI: 10.1016/j.cllc.2014.06.001. View

11.

Takenaka T, Takenoyama M, Yamaguchi M, Toyozawa R, Inamasu E, Kojo M . Impact of the epidermal growth factor receptor mutation status on the post-recurrence survival of patients with surgically resected non-small-cell lung cancer. Eur J Cardiothorac Surg. 2014; 47(3):550-5. DOI: 10.1093/ejcts/ezu227. View

12.

Travis W, Brambilla E, Nicholson A, Yatabe Y, Austin J, Beasley M . The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic, Clinical and Radiologic Advances Since the 2004 Classification. J Thorac Oncol. 2015; 10(9):1243-1260. DOI: 10.1097/JTO.0000000000000630. View

13.

Shimada Y, Saji H, Yoshida K, Kakihana M, Honda H, Nomura M . Prognostic factors and the significance of treatment after recurrence in completely resected stage I non-small cell lung cancer. Chest. 2013; 143(6):1626-1634. DOI: 10.1378/chest.12-1717. View

14.

Sholl L, Aisner D, Varella-Garcia M, Berry L, Dias-Santagata D, Wistuba I . Multi-institutional Oncogenic Driver Mutation Analysis in Lung Adenocarcinoma: The Lung Cancer Mutation Consortium Experience. J Thorac Oncol. 2015; 10(5):768-777. PMC: 4410843. DOI: 10.1097/JTO.0000000000000516. View

15.

Takenaka T, Yano T, Yamazaki K, Okamoto T, Hamatake M, Takamori S . Is radical local therapy effective in postoperative recurrent EGFR-mutated non-small cell lung cancer?. Thorac Cancer. 2023; 14(18):1660-1667. PMC: 10290912. DOI: 10.1111/1759-7714.14911. View

16.

Yano T, Okamoto T, Haro A, Fukuyama S, Yoshida T, Kohno M . Local treatment of oligometastatic recurrence in patients with resected non-small cell lung cancer. Lung Cancer. 2013; 82(3):431-5. DOI: 10.1016/j.lungcan.2013.08.006. View

17.

Niibe Y, Nishimura T, Inoue T, Karasawa K, Shioyama Y, Jingu K . Oligo-recurrence predicts favorable prognosis of brain-only oligometastases in patients with non-small cell lung cancer treated with stereotactic radiosurgery or stereotactic radiotherapy: a multi-institutional study of 61 subjects. BMC Cancer. 2016; 16(1):659. PMC: 4992231. DOI: 10.1186/s12885-016-2680-8. View

18.

Saisho S, Yasuda K, Maeda A, Yukawa T, Okita R, Hirami Y . Post-recurrence survival of patients with non-small-cell lung cancer after curative resection with or without induction/adjuvant chemotherapy. Interact Cardiovasc Thorac Surg. 2012; 16(2):166-72. PMC: 3548532. DOI: 10.1093/icvts/ivs450. View

19.

Tan A, Tan D . Targeted Therapies for Lung Cancer Patients With Oncogenic Driver Molecular Alterations. J Clin Oncol. 2022; 40(6):611-625. DOI: 10.1200/JCO.21.01626. View

20.

Martini N, Melamed M . Multiple primary lung cancers. J Thorac Cardiovasc Surg. 1975; 70(4):606-12. View