Perioperative Therapy for Resectable Non-Small-Cell Lung Cancer: Weighing Options for the Present and Future.
Dipesh UpretyHoward Jack WestPublished in: JCO oncology practice (2023)
Anatomic surgical resection followed by cisplatin-based platinum-doublet adjuvant chemotherapy has been a long-standing standard of care for patients with early-stage, resectable non-small-cell lung cancer (NSCLC). More recently, incorporating of immunotherapy and targeted therapy in the perioperative setting has demonstrated improved disease-free or event-free survival in biomarker-defined subsets of patients. This article summarizes the results of major trials that led to approvals beyond chemotherapy in the perioperative setting. Alongside adjuvant osimertinib as a favored strategy for patients with EGFR mutation-positive NSCLC, there are competing potential standards of care for integrating immunotherapy in the neoadjuvant versus adjuvant setting, with advantages and disadvantages for each strategy. Emerging data in the coming years will provide further insight that may potentially lead to a combination of neoadjuvant and adjuvant treatment for many patients. Future trials should focus on clarifying the benefit of each component of treatment, defining an optimal treatment duration, and incorporating minimal residual disease to optimize treatment decisions.
Keyphrases
- early stage
- small cell lung cancer
- locally advanced
- end stage renal disease
- healthcare
- patients undergoing
- cardiac surgery
- chronic kidney disease
- newly diagnosed
- advanced non small cell lung cancer
- lymph node
- ejection fraction
- squamous cell carcinoma
- climate change
- deep learning
- quality improvement
- combination therapy
- acute kidney injury
- machine learning
- patient reported outcomes
- epidermal growth factor receptor
- sentinel lymph node