Division of Medical Oncology, Duke Cancer Institute, Duke University Medical Center, DUMC 3841, Durham, NC, 27710, USA.
Drugs. 2022 Jun;82(8):855-863. doi: 10.1007/s40265-022-01721-3. Epub 2022 May 21.
Approximately a third of patients with non-small-cell lung cancer (NSCLC) present with surgically resectable disease. Patients who undergo surgical resection are at a high risk of relapse, and neoadjuvant and adjuvant chemotherapy improves disease-free survival (DFS) and overall survival (OS). The outcomes with neoadjuvant and adjuvant chemotherapy are similar, and both are used in clinical practice. Recent trials investigated the role of immunotherapy and targeted therapy in patients with early-stage disease. A phase III trial of adjuvant atezolizumab compared with standard of care (SOC) in patients with resected stage II or III disease and PD-L1 expression of 1% or greater, and a second trial of adjuvant pembrolizumab compared with placebo in patients with stage IB-III (regardless of tumor proportion score PD-L1 expression), both demonstrated an improvement in DFS. In the neoadjuvant setting, results of a phase III trial of chemotherapy and nivolumab compared with chemotherapy alone revealed an improvement in pathological complete response rate and event-free survival in patients with stage IB-IIIA disease. Finally, for epidermal growth factor receptor (EGFR) mutant NSCLC, a phase III trial of osimertinib compared with SOC revealed an improvement in DFS. The results of these and ongoing trials illustrate the integration of immunotherapy and targeted therapies into the treatment paradigm of patients with surgically resected NSCLC and have led to FDA and EMA approvals in selected populations. Neoadjuvant trials have investigated novel endpoints such as major and complete pathological response, which have the potential to serve as surrogate endpoints for future trials.
大约三分之一的非小细胞肺癌 (NSCLC) 患者表现为可手术切除的疾病。接受手术切除的患者复发风险较高,新辅助和辅助化疗可改善无病生存期 (DFS) 和总生存期 (OS)。新辅助和辅助化疗的结果相似,在临床实践中均被使用。最近的试验研究了免疫治疗和靶向治疗在早期疾病患者中的作用。一项辅助阿特珠单抗与标准治疗 (SOC) 比较的 III 期试验,纳入了 PD-L1 表达为 1%或更高的 II 期或 III 期疾病患者,第二项辅助派姆单抗与安慰剂比较的 IIB-III 期患者(无论肿瘤比例评分 PD-L1 表达)的试验,均显示 DFS 改善。在新辅助治疗中,化疗联合纳武利尤单抗与单纯化疗比较的 III 期试验结果显示,IB-III 期疾病患者的病理完全缓解率和无事件生存期有所改善。最后,对于表皮生长因子受体 (EGFR) 突变 NSCLC,奥希替尼与 SOC 比较的 III 期试验显示 DFS 改善。这些和正在进行的试验结果说明了免疫治疗和靶向治疗已被纳入手术切除的 NSCLC 患者的治疗模式,并且已经在选定人群中获得了 FDA 和 EMA 的批准。新辅助试验研究了主要和完全病理缓解等新的终点,这些终点有可能成为未来试验的替代终点。
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