Retrospective study of conversion surgery after EGFR-TKI induction for initially unresectable EGFR-mutant stage III NSCLC

Patients with stage III EGFR-mutant non-small cell lung cancer (NSCLC) may be considered unresectable because of mediastinal nodal disease or invasion of adjacent structures. A retrospective study at the First Affiliated Hospital of Guangzhou Medical University (Guangzhou, China) evaluated whether EGFR-TKI-based induction therapy could enable conversion surgery in selected patients with initially unresectable disease. The study enrolled 162 consecutive patients with initially unresectable stage IIIA-N2b to IIIC EGFR-mutant NSCLC who received EGFR-TKI-based induction therapy. After induction, 70 patients were considered technically resectable by multidisciplinary reassessment. Of these, 42 chose conversion surgery and 28 decined surgery and continued non-surgical treatment. All 42 surgical patients unerwent video-assisted thoracoscopic surgery without conversion to thoracotomy. R0 resection was achieved in 41 patients (97.6%). Major pathologic response was observed in 13 patients (31.0%), including one patient (2.4%) with pathologic complete response. Lymph node downstaging occurred in 25 patients (59.5%). After IPTW, conversion surgery was associated with longer event-free survival and overall survival than non-surgical treatment. The authors conclude that in this selected retrospective cohort, conversion surgery after EGFR-TKI-based induction therapy was feasible and was associated with longer EFS and OS than continued non-surgical treatment. Prospective validation is warranted (graphical abstract).