Surgical removal of residual tumor masses in patients undergoing targeted therapy for EGFR-mutated advanced NSCLC

Non-small cell lung cancer (NSCLC) patients with EGFR mutations usually receive continuous treatment with TKIs until disease progression. A multicenter retrospective study in Russia evaluated whether surgical excision of residual tumor masses offers a survival advantage when performed before progression on TKI therapy. The study included 230 patients with locally advanced or metastatic EGFR-mutated NSCLC who received first-line EGFR TKI. Among these patients, surgical intervention appeared technically feasible in 57 patients, 41 of whom underwent cytoreductive surgery while 16 were not operated for various reasons. Both surgically treated and nonsurgically treated patients received TKI until disease progression. The median duration of TKI treatment before surgery was 7.3 months. There was no perioperative mortality, while 8/41 (19.5%) patients experienced surgery-related complications. The mediane progression-free survival and overall survival in the surgically treated group were 28.4 months and 46.9 months, respectively, which was significantly better than in patients with potentially resectable disease who did not undergo surgery (PFS: 15.4 months, p=0.010; OS 26.5 months, p=0.015) and patients not amenable to cytoreduction (PFS: 19.4 monhts, p=0.006; OS 31.7 months; p=0.001). At the time of data cutoff, 12/41 (29%) surgically treated patients remained disease-free. The authors conclude that surgical removal of residual tumor masses in EGFR-mutated NSCLC during response to TKI may confer survival advantage (graphical abstract).