Experience with perioperative drug therapy in patients with stage III non-small cell lung cancer (results of the observational study CARL-001)

Introduction. The article considers approaches to the treatment of patients with stage III non-small-cell lung cancer (NSCLC). Particular attention is paid to neoadjuvant and adjuvant drug therapy. Aim. To evaluate the efficacy of neoadjuvant treatments, such as neoadjuvant chemotherapy and immunochemotherapy, and adjuvant approaches to the stage III NSCLC treatment. Materials and methods . The results were obtained during the study: Clinical Testing of Lung Cancer (“CARL-001”). A total of 186 untreated patients with stage IIIA-IIIC NSCLC (160 patients with stage IIIA, 25 patients with IIIB and 1 with IIIC) were enrolled in the study. The study included 108 patients with adenocarcinoma and 78 with squamous cell carcinoma. 118 patients underwent surgery with adjuvant polychemotherapy (aPCT), 49 patients underwent neoadjuvant polychemotherapy (neoPCT) followed by surgery, and 19 patients had neoadjuvant immunotherapy combined with chemotherapy (neoICT). The median follow-up was 40 months. Results. Both adjuvant and neoadjuvant chemotherapy shared equivalent efficacy. The median relapse-free survival (RFS) in the aPCT and neoPCT groups was 30.4 and 32.6 months, respectively (differences between groups were not statistically significant). There was no significant difference in overall survival (OS) either. The use of neoICT showed better results as compared to neoPCT. The median RFS was not reached in the neoICT group, the median RFS in the neoPCT group was 32.6 months. OS was numerically higher in the neoICT group as compared to the neoPCT group, and accounted for 78.9% and 59.18% over a 36-month follow-up period, respectively. Conclusions. Preoperative chemotherapy is proven to be equal to the postoperative chemotherapy in the treatment of patients with stage III NSCLC. The use of neoICT demonstrated better results as compared to neoPCT. Further study of these treatments will allow a more personalized approach to the treatment of patients with stage III NSCLC.