Can FDG-PET after neoadjuvant chemotherapy plus nivolumab predict residual disease in non-small cell lung cancer?

Neoadjuvant therapy with nivolumab improves event-free survival (EFS) in patients with resectable non-small cell lung cancer, and a pathological complete response is a predictor of longer EFS. We assessed metabolic responses using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) before and after neoadjuvant treatment to explore its surrogacy for pathological complete response (pCR). We describe three patients with squamous cell lung carcinoma who underwent neoadjuvant therapy with nivolumab plus chemotherapy, followed by surgery. In Cases 1 and 2, preoperative tumour response were PR per RECIST and demonstrated marked metabolic response on FDG-PET after neoadjuvant therapy, with both resected tumours showing a pCR. On the other hand, Case 3 showed a tumour response before surgery (PR per RECIST), however, the tumour, maintained FDG uptake (19.5 → 15.1), and the resected tumour remained residual cells (RVT, 15%). Thus, reduction of FDG uptake on FDG-PET can predict the pathological response to neoadjuvant therapy with nivolumab.

Neoadjuvant nivolumab plus chemotherapy followed by resection for superior sulcus tumour with high PD-L1 expression: A case report.

The standard treatment for resectable non-small cell lung cancer (NSCLC) located in the superior sulcus is neoadjuvant chemoradiotherapy followed by highly invasive resection. Based on the results of the CheckMate 816 trial, which showed a marked improvement in the efficacy of neoadjuvant chemo-immunotherapy, we report a case of minimally invasive resection after neoadjuvant nivolumab plus chemotherapy for superior sulcus NSCLC, resulting in a pathologic complete response. The patient was a 76-year-old man with a 65-mm right superior sulcus tumour diagnosed as squamous cell carcinoma with 95% PD-L1. After two courses of neoadjuvant nivolumab plus chemotherapy, the tumour was completely resected through an 11-cm right lateral thoracotomy with second rib resection and first rib preservation. No residual tumour cells were observed in the specimen, and the patient had a pathologic complete response. This report represents a new treatment option for superior sulcus tumours.