Integration of New Systemic Adjuvant Therapies for Non-small Cell Lung Cancer: Role of the Surgeon.
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
06 2023
06 2023
Historique:
received:
29
06
2022
revised:
24
08
2022
accepted:
12
09
2022
medline:
26
5
2023
pubmed:
30
9
2022
entrez:
29
9
2022
Statut:
ppublish
Résumé
This review describes a new therapeutic landscape in the adjuvant treatment of resectable non-small cell lung cancer (NSCLC) and discusses the role of the surgeon in ensuring the best outcomes within this treatment paradigm. We conducted a narrative literature review using the search terms "non-small cell lung cancer" and "adjuvant" to identify randomized Phase III trials of systemic adjuvant therapy for NSCLC through March 17, 2022. We also searched ClinicalTrials.gov to identify ongoing trials of adjuvant immunotherapies and targeted therapies for NSCLC. Three recent randomized Phase III trials reported significant improvements in disease-free survival with adjuvant immune checkpoint inhibitors or targeted therapy in patients with resectable NSCLC: IMpower010 (atezolizumab vs best supportive care; NCT02486718), KEYNOTE-091 (PEARLS) (pembrolizumab vs placebo; NCT02504372), and ADAURA (osimertinib vs placebo; NCT02511106). Numerous other Phase III trials evaluating adjuvant immune checkpoint inhibitors and targeted therapies are currently underway, many of which demonstrate an evolution of trial design and end points for adjuvant therapy trials. This rapidly changing treatment landscape requires a shift in the role of the surgeon to facilitate appropriate biomarker screening for planning of the perioperative period and molecular testing of the surgical specimen to guide adjuvant therapy. After decades of stagnation in the management of NSCLC, recent results with immune checkpoint inhibitors and targeted therapies are ushering in a new era of precision medicine in the adjuvant treatment of early-stage NSCLC. Surgeons have an important role in facilitating multidisciplinary care in this rapidly evolving landscape.
Sections du résumé
BACKGROUND
This review describes a new therapeutic landscape in the adjuvant treatment of resectable non-small cell lung cancer (NSCLC) and discusses the role of the surgeon in ensuring the best outcomes within this treatment paradigm.
METHODS
We conducted a narrative literature review using the search terms "non-small cell lung cancer" and "adjuvant" to identify randomized Phase III trials of systemic adjuvant therapy for NSCLC through March 17, 2022. We also searched ClinicalTrials.gov to identify ongoing trials of adjuvant immunotherapies and targeted therapies for NSCLC.
RESULTS
Three recent randomized Phase III trials reported significant improvements in disease-free survival with adjuvant immune checkpoint inhibitors or targeted therapy in patients with resectable NSCLC: IMpower010 (atezolizumab vs best supportive care; NCT02486718), KEYNOTE-091 (PEARLS) (pembrolizumab vs placebo; NCT02504372), and ADAURA (osimertinib vs placebo; NCT02511106). Numerous other Phase III trials evaluating adjuvant immune checkpoint inhibitors and targeted therapies are currently underway, many of which demonstrate an evolution of trial design and end points for adjuvant therapy trials. This rapidly changing treatment landscape requires a shift in the role of the surgeon to facilitate appropriate biomarker screening for planning of the perioperative period and molecular testing of the surgical specimen to guide adjuvant therapy.
CONCLUSIONS
After decades of stagnation in the management of NSCLC, recent results with immune checkpoint inhibitors and targeted therapies are ushering in a new era of precision medicine in the adjuvant treatment of early-stage NSCLC. Surgeons have an important role in facilitating multidisciplinary care in this rapidly evolving landscape.
Identifiants
pubmed: 36174774
pii: S0003-4975(22)01240-1
doi: 10.1016/j.athoracsur.2022.09.029
pii:
doi:
Substances chimiques
Immune Checkpoint Inhibitors
0
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1544-1555Informations de copyright
Copyright © 2023 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.