TOPLINE:

Surgical removal of residual tumour masses during TKI therapy was associated with improved survival in patients with epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC).

METHODOLOGY:

• Researchers conducted a retrospective study of 230 patients with locally advanced or metastatic EGFR-mutated NSCLC treated with first-line TKI therapy between 2015 and 2022 at cancer centres in Russia.
• A total of 41 patients underwent cytoreductive surgery during TKI therapy, whereas 16 patients were potentially amenable to surgery but did not undergo the procedure, and 173 patients had inoperable disease.
• The median time from the start of TKI therapy to surgery was 7.3 months, and patients restarted TKI therapy within 5-7 days after surgery and continued until disease progression.
• Outcomes included progression-free survival (PFS) and overall survival evaluated from the first day of TKI therapy, with surgical complications graded according to the Clavien-Dindo classification.

TAKEAWAY:

• The median PFS was 28.4 months for surgically treated patients vs 15.4 months for potentially operable but non-operated patients (P = .010) and 19.0 months for those with inoperable disease (P = .006).
• The median overall survival was 46.9 months for surgically treated patients vs 26.5 months for potentially operable but non-operated patients (P = .015) and 31.7 months for those with inoperable disease (P = .001).
• Complete tumour resection was achieved in 21 of 41 (51.2%) patients who were operated, with no difference in survival outcomes observed between those with complete and near-complete resection.
• Surgical complications were observed in 8 out of 41 patients (19.5%), with grade 3 complications such as pneumonia, chylothorax, atrial fibrillation, pulmonary embolism, and local pleural empyema reported in six patients. A grade 4 complication of cardiac arrest was observed in only one patient.

IN PRACTICE:

The findings suggest that "some patients receiving EGFR TKIs may benefit from cytoreductive surgery"; however, future research needs to "utilize rigorous criteria for patient selection, ensure proper size of the control group, and avoid diversity of EGFR inhibitors by using osimertinib or similar third-generation drugs," the authors concluded.

SOURCE:

The study was led by Fedor Moiseenko, N.P. Napalkov Cancer Center, St Petersburg, Russia. It was published online on June 11, 2026, in the International Journal of Cancer.

LIMITATIONS:

The retrospective design of the study and the consideration of factors such as the probability of complete or near-complete cytoreduction, associated risks, and patient preferences may have led to selection bias for cytoreductive surgery. Most patients received first- or second-generation inhibitors rather than currently preferred third-generation osimertinib, which limited the generalisability of the findings to current treatment standards. The study included patients from multiple centres in Russia, which may have affected the applicability of the results to other healthcare settings and populations.

DISCLOSURES:

This study was funded by the Russian Science Foundation. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.