Department of Medical Oncology, Christian Medical College, Vellore, India.
Division of Medical Oncology, Department of Medicine, University of Michigan, Ann Arbor, MI, USA.
Oncologist. 2023 Sep 7;28(9):752-764. doi: 10.1093/oncolo/oyad125.
Non-small cell lung cancer (NSCLC) remains a major cause of morbidity and mortality worldwide. One-third of NSCLC patients present with surgically resectable, non-metastatic disease; however, many of these patients will recur despite curative surgery and adjuvant therapy. The recent publication of randomized trials incorporating immune check-point inhibitors (ICI) to the standard neo-adjuvant and adjuvant treatment regimens has reported improved survival with manageable toxicity profiles. The IMpower 010 studied the use of adjuvant atezolizumab after standard surgery and adjuvant chemotherapy. They demonstrated an improvement in 3-year disease-free survival (DFS) prompting a change in treatment guidelines. The Checkmate 816 and NADIM II studies evaluated the addition of pembrolizumab and nivolumab, respectively, to standard neo-adjuvant chemotherapy. The results from both trials showed an improvement in 2-year event-free survival (EFS) and 2-year PFS (PFS), respectively. In this review, we summarize the prior data regarding adjuvant and neo-adjuvant chemotherapy in NSCLC and elaborate on results from the newer trials incorporating ICIs. We briefly discuss the pros and cons of each treatment approach along with areas that need further clarity to inform clinical practice and future directions for research in this disease.
非小细胞肺癌(NSCLC)仍然是全球发病率和死亡率的主要原因。三分之一的 NSCLC 患者表现为可手术切除的非转移性疾病;然而,尽管进行了根治性手术和辅助治疗,许多患者仍会复发。最近发表的纳入免疫检查点抑制剂(ICI)的随机试验,将其纳入标准新辅助和辅助治疗方案,报告了具有可管理毒性特征的生存改善。IMpower 010 研究了在标准手术和辅助化疗后使用辅助阿替利珠单抗。他们证明了 3 年无病生存率(DFS)的改善,促使治疗指南发生了变化。Checkmate 816 和 NADIM II 研究分别评估了在标准新辅助化疗中加入 pembrolizumab 和 nivolumab。这两项试验的结果均显示 2 年无事件生存率(EFS)和 2 年无进展生存率(PFS)分别有所改善。在这篇综述中,我们总结了 NSCLC 辅助和新辅助化疗的先前数据,并详细阐述了纳入 ICI 的最新试验结果。我们简要讨论了每种治疗方法的优缺点,以及需要进一步澄清的领域,以告知临床实践和该疾病的未来研究方向。
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