Induction Immunotherapy plus Chemotherapy for Pancoast Lung Cancer Tumors - Are We Ready to Shift Our Standards?

Q: Why are Pancoast tumors considered challenging to treat?

They are rare and anatomically complex, invade the apical chest wall and thoracic inlet structures, and are closely related to vital neurovascular structures, which complicates local control and surgical management.

Q: What is the current standard trimodality treatment for Pancoast tumors?

Neoadjuvant chemoradiotherapy followed by surgical resection has been the standard trimodality approach, based on landmark trial outcomes over the past two decades.

Q: What does this communication evaluate regarding induction chemoimmunotherapy?

It reports surgical and pathological findings after induction chemoimmunotherapy in resectable Pancoast tumors and discusses potential advantages, limitations, and future challenges for integrating this approach into standard care.

Sep 23, 2026

Uploaded by Jasmine

Pancoast tumors represent a rare, anatomically complex subset of non-small-cell lung cancer that often requires specialized centers and intensive trimodality management. Traditional care uses induction chemoradiotherapy followed by surgery, yet only a minority of routine patients can receive it. Emerging data in resectable NSCLC indicate induction chemoimmunotherapy as a new standard. This short communication reports surgical and pathological findings after induction chemoimmunotherapy in resectable Pancoast tumors and evaluates potential advantages, limitations, and future integration challenges.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages5

Reading Time13 min

AccessFree to download

Introduction

Rationale for induction therapy in Pancoast tumors

Background: evolving standards in resectable NSCLC

Current focus of the communication

Surgical and pathological findings

Future considerations

SHORT COMMUNICATION Induction immunotherapy plus chemotherapy for Pancoast lung cancer tumors: are we ready to shift our standards? J. Remon1 ∗, F. Porez2, H. Clermidy2, O. Mercier2, D. Mitilian2, N. Guezour3, C. Caramella4, P. Pradère5, S. Saing5, V. T. de Montpreville6, A. Botticella7 & E. Fadel2 1Department of Cancer Medicine, Gustave Roussy, Villejuif; 2Department of Thoracic Surgery, Hôpital Marie Lannelongue, Le Plessis-Robinson; 3Department of Pneumology, Hôpital Saint Joseph, Paris; Departments of 4Radiology; 5Pneumology, Hôpital Marie Lannelongue, Le Plessis-Robinson; 6Department of Radiation Oncology, Gustave Roussy, Villejuif, 7Department of Pathology, Hôpital Marie Lannelongue, Le Plessis-Robinson, France Available online xxx Pancoast tumors are a distinct and rare subset of non-small-cell lung cancers (NSCLCs) . Although a trimodality approach combining induction chemoradiotherapy followed by surgery has been the standard of care over the past two decades, only a limited number of patients are eligible for this intensive treatment in routine clinical practice. Moreover, surgical procedures for Pancoast tumors often require highly specialized thoracic surgery centers. Recent studies evaluating induction chemoimmunotherapy in resectable NSCLC have demonstrated clinically meaningful outcomes, establishing this strategy as a new standard of care. Given these promising results, the application of this approach in patients with resectable Pancoast tumors warrants further investigation. In this communication, we report surgical and pathological findings following induction chemoimmunotherapy in this specific setting. Additionally, we discuss the potential advantages, limitations, and future challenges of integrating this approach into the standard clinical management of Pancoast tumors. Key words: Pancoast, superior sulcus, non-small-cell lung cancer, induction chemoimmunotherapy INTRODUCTION Pancoast tumors are a distinct and rare subset of non-small-cell lung cancers (NSCLCs) located at the apex of the lung. These tumors invade the apical chest wall and structures of the thoracic inlet through contiguous tissue spread. Involved structures may include the parietal pleura, the first and second ribs or their periosteum, adjacent vertebral bodies (T1 and T2), the lower nerve roots of the brachial plexus, the upper sympathetic chain and stellate ganglion, as well as the subclavian vein and artery.1 Pancoast tumors account for <3%-5% of all lung cancers. They are considered complex due to the anatomical intricacies of the thoracic inlet, and because their radiological classification can sometimes be subjective in clinical practice. Surgical management is particularly challenging given their proximity to vital neurovascular structures, which complicates local control of the disease.2 These tumors also carry a substantial risk of distant metastases, *Correspondence to: Dr Jordi Remon, Department of Cancer Medicine Gustave Roussy, Paris-Saclay University, 114, rue Edouard Vaillant, 94805 Villejuif, France. Tel: +33(0)1-42-11-42-11 E-mail: [JORDI.REMON-MASIP@gustaveroussy.fr](JORDI.REMON-MASIP@gustaveroussy.fr) (J. Remon). 2059-7029/© 2025 The Author(s). Published by Elsevier Ltd on behalf of European Society for Medical Oncology. This is an open access article under the CC BY-NC-ND license ([http://creativecommons.org/licenses/by-nc-nd/4.0/](http://creativecommons.org/licenses/by-nc-nd/4.0/)). predominantly to the brain, and consequently, the prognosis remains poor.2 Since the publication of the landmark nonrandomized Intergroup 0160 trial, neoadjuvant chemoradiotherapy followed by surgical resection has become the standard trimodality therapy for mediastinoscopy-negative T3 or T4 N0/1 Pancoast tumors over the past two decades.3,4 This approach has demonstrated a median overall survival (OS) of 33 months, with no difference observed between T3 and T4 tumors; and a 5-year OS rate of 44% .4 A phase II

FAQs

Why are Pancoast tumors considered challenging to treat?

They are rare and anatomically complex, invade the apical chest wall and thoracic inlet structures, and are closely related to vital neurovascular structures, which complicates local control and surgical management.

What is the current standard trimodality treatment for Pancoast tumors?

Neoadjuvant chemoradiotherapy followed by surgical resection has been the standard trimodality approach, based on landmark trial outcomes over the past two decades.

What does this communication evaluate regarding induction chemoimmunotherapy?

It reports surgical and pathological findings after induction chemoimmunotherapy in resectable Pancoast tumors and discusses potential advantages, limitations, and future challenges for integrating this approach into standard care.

Sep 23, 2026

Uploaded by Jasmine