Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China; School of Medicine, South China University of Technology, Guangzhou, Guangdong, China.
Lung Cancer. 2022 Oct;172:160-169. doi: 10.1016/j.lungcan.2022.05.007. Epub 2022 May 21.
Targeted therapy has stepped into the perioperative treatment arena and launched a radical revolution in the treatment of early-stage oncogene-driven non-small-cell lung cancer (NSCLC). A series of practice-changing clinical trials has enriched the therapeutic perspectives of potentially curable NSCLC. While the CTONG1104 trial took the first step in investigating the adjuvant gefitinib - a first-generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI), for the treatment of resected EGFR-mutated NSCLC - the subsequent ADAURA study marked adjuvant osimertinib as the standard of care for resected EGFR-mutant NSCLC. Other targeted agents matched for ALK, ROS1, NTRK, BRAF V600, and RET molecular alterations are also currently being evaluated in the adjuvant and neoadjuvant settings, and there is an urgent need to study biomarker selection, optimal duration, and paradigm making. All these efforts are intended to hit the same target, which is to treat patients on a more personalized level. We review herein the recent major breakthroughs in perioperative targeted therapy for oncogene-driven NSCLC, focusing especially on data from published clinical trials. We discuss challenges from surgical, pathological, and oncological perspectives, and provide recommended strategies for the clinical management of early-stage NSCLC patients.
靶向治疗已经进入围手术期治疗领域，在驱动基因阳性的早期非小细胞肺癌（NSCLC）的治疗中掀起了一场彻底的革命。一系列改变实践的临床试验丰富了潜在可治愈 NSCLC 的治疗视角。虽然 CTONG1104 试验率先研究了辅助吉非替尼（第一代表皮生长因子受体酪氨酸激酶抑制剂[EGFR-TKI]）治疗可切除 EGFR 突变 NSCLC，但随后的 ADAURA 研究将辅助奥希替尼作为可切除 EGFR 突变 NSCLC 的标准治疗方法。其他针对 ALK、ROS1、NTRK、BRAF V600 和 RET 分子改变的靶向药物也正在辅助和新辅助治疗中进行评估，迫切需要研究生物标志物选择、最佳持续时间和治疗模式。所有这些努力都是为了实现一个共同的目标，即为患者提供更具个性化的治疗。我们在此回顾了驱动基因阳性 NSCLC 的围手术期靶向治疗的最新重大突破，重点关注已发表的临床试验数据。我们从手术、病理和肿瘤学角度讨论了挑战，并为早期 NSCLC 患者的临床管理提供了推荐策略。
