Aguado Carlos, Chara Luis, Antoñanzas Mónica, Matilla Gonzalez Jose Maria, Jiménez Unai, Hernanz Raul, Mielgo-Rubio Xabier, Trujillo-Reyes Juan Carlos, Couñago Felipe
Department of Medical Oncology, Hospital Clínico Universitario San Carlos, Madrid 28040, Spain.
Department of Medical Oncology, Hospital Universitario de Guadalajara, Guadalajara 19002, Spain.
World J Clin Oncol. 2022 May 24;13(5):314-322. doi: 10.5306/wjco.v13.i5.314.
The aim of neoadjuvant treatment in non-small cell lung cancer (NSCLC) is to eliminate micrometastatic disease to facilitate surgical resection. Neoadjuvant chemotherapy (ChT) in localised NSCLC has numerous advantages over other therapeutic modalities and is considered standard treatment in resectable disease. Treatment with immune checkpoint inhibitors (ICI) improves long-term survival in advanced disease and has a better toxicity profile than conventional therapies. These immunotherapy agents (anti-PD1/PD-L1), administered with or without ChT, are currently being evaluated in the preoperative setting, with initial results showing better pathological response rates and more long-term benefits. Importantly, these drugs do not appear to increase the rate of severe adverse effects and/or postoperative complications. However, several questions still need to be resolved, including the identification of predictive biomarkers; comparative studies of immunotherapy alone combined treatment with ChT and/or radiotherapy; the optimal duration of treatment; the timing of surgery; the need for adjuvant treatment; appropriate radiologic evaluation and mediastinal staging; and the correlation between pathological response and survival outcomes. Here we review the current evidence for immunotherapy from a multidisciplinary perspective and discuss current and future controversies.
非小细胞肺癌（NSCLC）新辅助治疗的目的是消除微转移病灶，以利于手术切除。局部NSCLC的新辅助化疗（ChT）相较于其他治疗方式具有诸多优势，被视为可切除疾病的标准治疗方法。免疫检查点抑制剂（ICI）治疗可提高晚期疾病的长期生存率，且毒性比传统疗法更小。这些免疫治疗药物（抗PD1/PD-L1），无论是否联合ChT给药，目前正在术前环境中进行评估，初步结果显示病理反应率更高且长期获益更多。重要的是，这些药物似乎并未增加严重不良反应和/或术后并发症的发生率。然而，仍有几个问题需要解决，包括预测性生物标志物的鉴定；免疫治疗单独使用、与ChT和/或放疗联合治疗的比较研究；最佳治疗持续时间；手术时机；辅助治疗的必要性；适当的放射学评估和纵隔分期；以及病理反应与生存结果之间的相关性。在此，我们从多学科角度综述免疫治疗的当前证据，并讨论当前和未来的争议。
