Safety of Surgery after Neoadjuvant Targeted Therapies in Non-Small Cell Lung Cancer: A Narrative Review
Abstract
:1. Introduction
2. Typical Complications of EGFR-TKIs
2.1. Skin Toxicity
2.2. Gastrointestinal Toxicity
2.3. Pulmonary Toxicity
2.4. Cardiac Complications
2.5. Treatment-Related Mortality
3. Neoadjuvant EGFR-TKIs in Early NSCLC
4. Typical Complications in ALK Inhibitors
4.1. Gastrointestinal and Hepatic Complications
4.2. Pulmonary Complications
4.3. Cardiac Complications
4.4. Treatment-Related Mortality
5. Neoadjuvant Treatment with ALK Inhibitors in Early NSCLC
6. Final Remarks
Author Contributions
Funding
Conflicts of Interest
Abbreviations
ALK | anaplastic lymphoma kinase |
ALT | Alanine aminotransferase |
AST | Aspartate aminotransferase |
CTCAE | Common Toxicity Criteria for Adverse Events |
DFS | disease-free survival |
EGFR | epidermal growth factor receptor |
HR | hazard ratio |
GI | gastrointestinal |
ILD | interstitial lung disease |
MPR | major pathological response |
NR | not reported |
NSCLC | non-smallcell lung cancer |
OS | overall survival |
PAL | persistent air leak |
pCR | pathological complete response |
PD-L1 | programmed cell death ligand-1 |
SAE | serious adverse event |
TKI | tyrosine kinase inhibitors |
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Study | EGFR-TKI in Study Group | Number of Patients in Study Group | Delay of Surgery | EGFR-TKI Complications | Intraoperative Complications in EGFR-TKI Group | R0 Resection Rate in EGFR-TKI Group | Postoperative Complications in EGFR-TKI Group |
---|---|---|---|---|---|---|---|
Schaake et al., 2012 [44] | Erlotinib | 60 | 24 days | Rash 61% Diarrhea 35% Pneumonitis 5% | 0% | 7% of patients found out to be unresectable | Pneumonia 2% PAL 2% Blood transfusion 3% |
Han et al., 2012 [75] | Erlotinib | 7 | 56 days | NR | 0% | 20% of resected patients | NR |
Zhong et al., 2015 [40] | Erlotinib | 24 | 6 weeks of treatment | Rash 100% Diarrhea 42% | 0% | 50% | 0% |
Tan et al., 2019 [43] | Gefitinib | 14 | At least 4 weeks of treatment | AST/ALT elevation 8% | NR | NR | NR |
W.Z. Zhong et al., 2019 [39] | Erlotinib | 37 | 6 weeks of treatment | Rash 76% Diarrhea 68% Deterioration of pulmonary function precluding surgery 3% | 0% | 73% | Arrhytmia 6% Lung infection 6% Poor wound healing 6% PAL 3% Pneumothorax 3% |
Xiong et al., 2019 [37] | Erlotinib | 19 | 56 days | Rash 26% 13% were not operated due to SAE | NR | 68% of resected patients | NR |
Lv et al., 2020 [42] | Different agents | 43 | 8 weeks of treatment | NR | 0% | 95% | Chylothorax 7% Atelectasis 5% Arrhytmia 2% |
Y. Zhang et al., 2021 [38] | Gefitinib | 35 | 61 days | Skin toxicity 69% GI symptoms 49% | 0% | 12% of patients found out to be stage IV at surgery | Chylothorax 12% |
Bao et al., 2021 [41] | Different agents | 42 | NR | NR | NR | NR | NR |
Study | ALK Inhibitor in Study Group | Number of Patients | Delay of Surgery | ALK Inhibitor Complications | Intraoperative Complications | Postoperative Complications |
---|---|---|---|---|---|---|
Tian et al., 2020 [89] | Crizotinib | 1 | 12 weeks | Grade 1 hepatic damageMild edema | None | None |
Kilickap et al., 2019 [90] | Crizotinib | 1 | 6 weeks | NR | NR | NR |
Xie et al., 2021 [91] | Gemcitabine, cisplatine, crizotinib | 1 | 2 months | None | NR | NR |
C. Zhang et al., 2019 [92] | Crizotinib | 11 | Median 41 days | Grade 4 hepatitis 9% | None | Pneumonia 9% Dyspnoe 9% |
Imanishi et al., 2018 [93] | Alectinib | 1 | 3 months | None | None | None |
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Marjanski, T.; Dziedzic, R.; Kowalczyk, A.; Rzyman, W. Safety of Surgery after Neoadjuvant Targeted Therapies in Non-Small Cell Lung Cancer: A Narrative Review. Int. J. Mol. Sci. 2021, 22, 12244. https://doi.org/10.3390/ijms222212244
Marjanski T, Dziedzic R, Kowalczyk A, Rzyman W. Safety of Surgery after Neoadjuvant Targeted Therapies in Non-Small Cell Lung Cancer: A Narrative Review. International Journal of Molecular Sciences. 2021; 22(22):12244. https://doi.org/10.3390/ijms222212244
Chicago/Turabian StyleMarjanski, Tomasz, Robert Dziedzic, Anna Kowalczyk, and Witold Rzyman. 2021. "Safety of Surgery after Neoadjuvant Targeted Therapies in Non-Small Cell Lung Cancer: A Narrative Review" International Journal of Molecular Sciences 22, no. 22: 12244. https://doi.org/10.3390/ijms222212244