Surgical outcomes and patient-reported outcomes of unresectable stage III non-small cell lung cancer patients who underwent PD-1 inhibitor plus chemo as induction therapy.

person Xin Wang Sichuan Cancer Hospital, Chengdu, Sichuan, China info_outline Xin Wang, Guixian Liu, Jintao He, Xiang Zhuang

Authors person Xin Wang Sichuan Cancer Hospital, Chengdu, Sichuan, China info_outline Xin Wang, Guixian Liu, Jintao He, Xiang Zhuang Organizations Sichuan Cancer Hospital, Chengdu, Sichuan, China, Southwest Medical University, Luzhou, Sichuan, China, Sichuan cancer hospital, Chengdu, Sichuan, China, Thocacic Surgery Department, Sichuan Cancer hospital institute/Sichuan Cancer Center/University of Electronic Science and Technology of China, Chengdu, Sichuan, China Abstract Disclosures Research Funding Institutional Funding Sichuan Cancer Hospital & Institute Sichuan Cancer Center, University of Electronic Science and Technology of China Background: For locally advanced unresectable NSCLC, studies of PD-1 inhibitor plus chemo as induction therapy and its roles on subsequent surgical resection are still limited. In this study, a consecutive series of unresectable stage III NSCLC patients were collected to investigate the surgical outcome and postoperative symptom changes in locally advanced patients who received adjuvant chemotherapy combined with immunotherapy. Methods: 92 locally advanced NSCLC patients received 2-4 cycles of chemotherapy combined with immunotherapy. Surgical rates, major pathologic remissions(MPR), pathologic complete remissions(PCR), postoperative complications, and immune-related adverse reactions(irAEs) were assesd. The follow-up of symptoms was performed during treatment and within 3 months postoperatively, and symptom changes were described based on patient-reported outcomes. Results: 26.09% of patients developed irAEs, the most common was skin toxicity, followed by thyroid dysfunction. 71.74% of patients underwent surgical resection. 63.64% (42/66) achieved MPR and PCR, of which 37.87% (25/66) were PCR. Most of these patients have clinical symptoms at the time of presentation, mainly cough (90%), and after treatment, cough is significantly reduced compared with before treatment. After treatment, the cough was significantly reduced compared with before treatment , nausea and vomiting , loss of appetite , dry mouth , and diarrhea were increased or aggravated. The most common symptoms on the first day after operation included pain (90%), shortness of breath (62.5%), fatigue (45%), cough (42.5%), and dry mouth (37.5%). On the third day after surgery, the incidence and severity of each symptom changed significantly, pain and dry mouth decreased significantly compared with before, cough, shortness of breath, and fatigue worsened and the incidence increased. Pain remains the most severe symptom in the early postoperative period, with the most severe on the first day after operation and then reduced, returning to preoperative levels 1.5 months after surgery. Cough was the main symptom at the time of presentation, which was significantly reduced after preoperative treatment, and the incidence and severity of postoperative cough increased significantly compared with preoperative treatment and returned to the preoperative level within 1 week after surgery. Dyspnea lasts long after surgery. Two weeks after surgery, shortness of breath (dyspnea) becomes the most obvious symptom. Conclusions: Preoperative chemotherapy combined with immunotherapy provides more opportunities for radical resection in locally advanced NSCLC patients. The most common postoperative symptoms are pain, dyspnea, cough, and fatigue; dyspnea is the symptom that affects patients the most and lasts the longest after surgery.