Neoadjuvant therapy in non-small cell lung cancer: basis, promise, and challenges

被引:2
|
作者
Kalvapudi, Sukumar [1 ]
Vedire, Yeshwanth [1 ]
Yendamuri, Sai [1 ,2 ]
Barbi, Joseph [1 ,3 ]
机构
[1] Roswell Pk Comprehens Canc Ctr, Dept Thorac Surg, Buffalo, NY 14203 USA
[2] SUNY Buffalo, Jacobs Sch Med & Biomed Sci, Buffalo, NY 14222 USA
[3] Roswell Pk Comprehens Canc Ctr, Dept Immunol, Buffalo, NY 14203 USA
来源
FRONTIERS IN ONCOLOGY | 2023年 / 13卷
基金
美国国家卫生研究院;
关键词
neoadjuvant; preoperative; NSCLC; systemic therapy; immunotherapy; chemoimmunotherapy; targeted therapy; IMMUNE CHECKPOINT INHIBITORS; COMPARING PERIOPERATIVE CHEMOTHERAPY; VINORELBINE PLUS CISPLATIN; RANDOMIZED PHASE-III; RESECTED STAGE-I; PREOPERATIVE CHEMOTHERAPY; OPEN-LABEL; ADJUVANT CHEMOTHERAPY; 1ST-LINE TREATMENT; AMERICAN SOCIETY;
D O I
10.3389/fonc.2023.1286104
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
IntroductionSurvival rates for early-stage non-small cell lung cancer (NSCLC) remain poor despite the decade-long established standard of surgical resection and systemic adjuvant therapy. Realizing this, researchers are exploring novel therapeutic targets and deploying neoadjuvant therapies to predict and improve clinical and pathological outcomes in lung cancer patients. Neoadjuvant therapy is also increasingly being used to downstage disease to allow for resection with a curative intent. In this review, we aim to summarize the current and developing landscape of using neoadjuvant therapy in the management of NSCLC.MethodsThe PubMed.gov and the ClinicalTrials.gov databases were searched on 15 January 2023, to identify published research studies and trials relevant to this review. One hundred and seven published articles and seventeen ongoing clinical trials were selected, and relevant findings and information was reviewed.Results & DiscussionNeoadjuvant therapy, proven through clinical trials and meta-analyses, exhibits safety and efficacy comparable to or sometimes surpassing adjuvant therapy. By attacking micro-metastases early and reducing tumor burden, it allows for effective downstaging of disease, allowing for curative surgical resection attempts. Research into neoadjuvant therapy has necessitated the development of surrogate endpoints such as major pathologic response (MPR) and pathologic complete response (pCR) allowing for shorter duration clinical trials. Novel chemotherapy, immunotherapy, and targeted therapy agents are being tested at a furious rate, paving the way for a future of personalized systemic therapy in NSCLC. However, challenges remain that prevent further mainstream adoption of preoperative (Neoadjuvant) therapy. These include the risk of delaying curative surgical resection in scenarios of adverse events or treatment resistance. Also, the predictive value of surrogate markers of disease cure still needs robust verification. Finally, the body of published data is still limited compared to adjuvant therapy. Addressing these concerns with more large scale randomized controlled trials is needed.
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页数:16
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