Emerging precision neoadjuvant systemic therapy for patients with resectable non-small cell lung cancer: current status and perspectives.

Emerging precision neoadjuvant systemic therapy for patients with resectable non-small cell lung cancer: current status and perspectives.
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DOI:
10.1186/s40364-022-00444-7
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发表时间:
2023-01-18
期刊:
影响因子:
11.1
通讯作者:
--
中科院分区:
医学2区
文献类型:
--
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在过去的十年中,针对癌基因驱动的非小细胞肺癌的靶向治疗和针对非癌基因驱动的非小细胞肺癌的免疫检查点抑制剂分别极大地提高了不可切除的非小细胞肺癌患者的生存率和生活质量。越来越多的早期NSCLC患者在手术前或手术后给予这些生物标志物引导的全身治疗。2022年3月,美国FDA批准新辅助纳武单抗和化疗用于IB-IIIA期NSCLC患者。一些II/III期试验正在分别评估各种新辅助免疫检查点抑制剂联合治疗非癌基因驱动型NSCLC和新辅助分子靶向治疗非癌基因驱动型NSCLC的临床疗效。然而,精准新辅助治疗的临床应用需要早期NSCLC诊断中生物标志物检测和多学科合作的范式转变。在这篇全面的综述中,我们总结了当前的诊断和治疗前景,最近的进展,生物标志物检测和终点选择的新挑战,及时多学科合作诊断的实际考虑,以及可切除的早期非小细胞肺癌患者新辅助精确全身治疗的前景。这些生物标志物引导的新辅助治疗有望改善手术和病理结果,减少全身复发,指导术后治疗,并提高可切除NSCLC患者的治愈率。
Over the past decade, targeted therapy for oncogene-driven NSCLC and immune checkpoint inhibitors for non-oncogene-driven NSCLC, respectively, have greatly improved the survival and quality of life for patients with unresectable NSCLC. Increasingly, these biomarker-guided systemic therapies given before or after surgery have been used in patients with early-stage NSCLC. In March 2022, the US FDA granted the approval of neoadjuvant nivolumab and chemotherapy for patients with stage IB-IIIA NSCLC. Several phase II/III trials are evaluating the clinical efficacy of various neoadjuvant immune checkpoint inhibitor combinations for non-oncogene-driven NSCLC and neoadjuvant molecular targeted therapies for oncogene-driven NSCLC, respectively. However, clinical application of precision neoadjuvant treatment requires a paradigm shift in the biomarker testing and multidisciplinary collaboration at the diagnosis of early-stage NSCLC. In this comprehensive review, we summarize the current diagnosis and treatment landscape, recent advances, new challenges in biomarker testing and endpoint selections, practical considerations for a timely multidisciplinary collaboration at diagnosis, and perspectives in emerging neoadjuvant precision systemic therapy for patients with resectable, early-stage NSCLC. These biomarker-guided neoadjuvant therapies hold the promise to improve surgical and pathological outcomes, reduce systemic recurrences, guide postoperative therapy, and improve cure rates in patients with resectable NSCLC.
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