Kemper Marcel, Elges Sandra, Kies Peter, Wiebe Karsten, Lenz Georg, Bleckmann Annalen, Evers Georg
Department of Medicine A, Hematology, Oncology, Hemostaseology and Pulmonology, University Hospital Muenster, Muenster, Germany.
West German Cancer Center, University Hospital Muenster, Muenster, Germany.
Transl Lung Cancer Res. 2024 Oct 31;13(10):2813-2827. doi: 10.21037/tlcr-24-359. Epub 2024 Oct 28.
The standard first-line treatment for patients with advanced non-small cell lung cancer (NSCLC) harbouring epidermal growth factor receptor () mutations or anaplastic lymphoma kinase () fusions is targeted therapy using tyrosine kinase inhibitors (TKIs). However, data are still lacking on the use of TKIs as a neoadjuvant or induction approach. Therefore, this narrative review aims to summarize the current knowledge on resectable -mutant and -fused NSCLC regarding available perioperative treatment regimens and off-label neoadjuvant use of targeted therapy.
The relevant literature was identified by using PubMed and ClinicalTrials.gov (last search phase June 2024) and was restricted to English language. Peer-reviewed manuscripts but also conference abstracts that did not undergo peer-review were included.
Patients with -mutations and -fusions have typically been excluded from available phase III perioperative immunotherapy trials due to lower efficacy and higher toxicity of immunotherapy in those patients. In the adjuvant setting, recent evidence from the phase III ALINA and ADAURA trials demonstrated efficacy and safety of targeted therapy in resected -fused and -mutant NSCLC. However, to date there is no approval for the use of TKIs as neoadjuvant or induction therapy in those patients. We have therefore identified a number of case series and phase II trials using targeted therapy in resectable -mutant and -fused NSCLC.
Current evidence suggests that targeted therapies might be effective in patients with resectable -mutant and -positive NSCLC, but ongoing trials will need to provide further evidence on the safety and efficacy of perioperative TKI therapy.
对于携带表皮生长因子受体（EGFR）突变或间变性淋巴瘤激酶（ALK）融合的晚期非小细胞肺癌（NSCLC）患者，标准的一线治疗是使用酪氨酸激酶抑制剂（TKI）进行靶向治疗。然而，关于TKI作为新辅助或诱导治疗方法的数据仍然缺乏。因此，本叙述性综述旨在总结关于可切除的EGFR突变和ALK融合NSCLC在可用围手术期治疗方案以及靶向治疗的非标签新辅助使用方面的现有知识。
通过使用PubMed和ClinicalTrials.gov（最后检索阶段为2024年6月）确定相关文献，并仅限于英文文献。纳入经过同行评审的手稿以及未经过同行评审的会议摘要。
由于免疫疗法在携带EGFR突变和ALK融合的患者中疗效较低且毒性较高，这些患者通常被排除在可用的III期围手术期免疫治疗试验之外。在辅助治疗方面，III期ALINA和ADAURA试验的最新证据证明了靶向治疗在可切除的ALK融合和EGFR突变NSCLC中的疗效和安全性。然而，迄今为止，尚无批准将TKI用于这些患者的新辅助或诱导治疗。因此，我们确定了一些在可切除的EGFR突变和ALK融合NSCLC中使用靶向治疗的病例系列和II期试验。
目前的证据表明，靶向治疗可能对可切除的EGFR突变和ALK阳性NSCLC患者有效，但正在进行的试验需要提供关于围手术期TKI治疗安全性和疗效的进一步证据。
