Lampridis Savvas, Scarci Marco
Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Front Surg. 2023 Jan 20;9:1126486. doi: 10.3389/fsurg.2022.1126486. eCollection 2022.
The mainstay of treatment for early-stage non-small-cell lung cancer (NSCLC) is surgical resection. Traditionally, chemotherapy has been used perioperatively in locally extensive disease to improve the oncologic outcomes of surgery, with a 5-year absolute survival benefit of approximately 5%. In recent years, immunotherapy and molecular targeted therapy have shown excellent results in the treatment of locoregionally advanced and metastatic NSCLC, replacing chemotherapy as first-line treatment in certain cases. Consequently, researchers have been increasingly investigating the use of immunotherapy or targeted therapy in combination with surgery for the treatment of early-stage disease. This growing research interest has resulted in several published and ongoing studies of various size and design. In this mini review, we provide a succinct and up-to-date overview of recently published, phase 3 randomized clinical trials on adjuvant and neoadjuvant immunotherapy or targeted therapy for NSCLC. We subsequently discuss some important unresolved clinical issues, including the optimal duration of treatment, scheduling with respect to surgery, and potential combinations of different systemic therapies. Finally, we reference large, randomized, phase 3 studies that are currently in progress and may give answers to those and other clinical questions.
早期非小细胞肺癌（NSCLC）的主要治疗方法是手术切除。传统上，化疗一直用于局部广泛病变的围手术期，以改善手术的肿瘤学预后，5年绝对生存获益约为5%。近年来，免疫疗法和分子靶向疗法在局部晚期和转移性NSCLC的治疗中显示出优异的效果，在某些情况下取代化疗成为一线治疗方法。因此，研究人员越来越多地研究免疫疗法或靶向疗法联合手术治疗早期疾病。这种日益增长的研究兴趣导致了多项不同规模和设计的已发表及正在进行的研究。在本综述中，我们简要且最新地概述了最近发表的关于NSCLC辅助和新辅助免疫疗法或靶向疗法的3期随机临床试验。随后，我们讨论了一些重要的未解决的临床问题，包括最佳治疗持续时间、与手术相关的时间安排以及不同全身疗法的潜在联合。最后，我们引用了目前正在进行的大型、随机、3期研究，这些研究可能会回答这些及其他临床问题。
