In the MDT-BRIDGE trial, 92% of patients with stage II-III lung cancer reached surgery or chemoradiation after a midtreatment tumor board review.
On top of being a difficult disease to treat, lung cancer is costly for patients and payers. Total monthly treatment costs can range from about $10,000 to $15,000 or more, according to
In the phase 2 MDT-BRIDGE trial, published in Nature Medicine, bringing a patient’s full care team back together after two cycles of preoperative chemoimmunotherapy helped route 92.3% of patients to curative-intent surgery or chemoradiation (CRT).
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“To help inform clinical practice in these patient populations, the MDT-BRIDGE study (NCT05925530) is investigating the safety and efficacy of perioperative durvalumab plus neoadjuvant chemotherapy in patients with resectable or borderline resectable NSCLC and evaluating the efficacy and safety of CRT followed by consolidation durvalumab in patients with disease that becomes unresectable during neoadjuvant chemoimmunotherapy,” the authors wrote.
About 65% of patients were judged operable at the start, and about 35% were “borderline,” meaning it wasn’t clear surgery was possible. After two cycles, a multidisciplinary team reassessed each patient. At minimum, that team was a medical or pulmonary oncologist, thoracic surgeon, radiation oncologist and pathologist. Patients judged resectable received one to two more cycles and went to surgery. Those judged unresectable switched to about six weeks of chemoradiation.
Turning “maybe operable” patients into surgical candidates may alter downstream costs and outcomes. Both pathways end with up to one year of durvalumab, which is a real cost line.
The overall resection rate was 74.6%: 81.5% among patients resectable at baseline and 62% among those deemed borderline. Among patients who had surgery, 96.2% had R0 resections, with no tumor left at the margins. Of the 50 borderline patients, 43 (86%) received either surgery or chemoradiation.
Among the 121 patients deemed resectable after reassessment, 27.3% had a pathological complete response. Twelve-month event-free survival was 88.5% overall. The authors called that consistent with AEGEAN but cautioned that AEGEAN enrolled a more surgically selected population.
All 25 patients who switched to chemoradiation completed it, and 23 went on to consolidation durvalumab. Grade 3/4 side effects during the durvalumab phase occurred in 7.4% of resected patients and 17.4% of chemoradiation patients. Three patients (2.1%) had adverse events that led to death.
A consensus from the European Organisation for Research and Treatment of Cancer (EORTC) recognizes that resectability exists along a spectrum rather than as a single category, and that treatment decisions in stage III NSCLC require multidisciplinary team evaluation, the authors noted.
The trial had no randomized comparator. Borderline status was assessed by local teams without predefined criteria or central review, and median follow-up for event-free survival was 10.9 months, so survival data remain immature. An ongoing randomized phase 2 trial, InDuRanS, is comparing surgery with chemoradiation after induction chemoimmunotherapy in borderline resectable stage III NSCLC.
“By incorporating local MDT reassessment based on what is achievable within a given institutional system, the MDT-BRIDGE strategy appeared to preserve rather than compromise patients’ opportunity to receive local therapy,” the authors wrote.
