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Evolution of systemic therapy for stages I–III non-metastatic non-small-cell lung cancer

Authors :
Jamie E. Chaft
Mark G. Kris
Andreas Rimner
Tina Cascone
Christopher G. Azzoli
Walter Weder
Source :
Nat Rev Clin Oncol
Publication Year :
2021
Publisher :
Springer Science and Business Media LLC, 2021.

Abstract

The treatment goal for patients with early-stage lung cancer is cure. Multidisciplinary discussions of surgical resectability and medical operability determine the modality of definitive local treatment (surgery or radiotherapy) and the associated systemic therapies to further improve the likelihood of cure. Trial evidence supports cisplatin-based adjuvant therapy either after surgical resection or concurrently with radiotherapy. Consensus guidelines support neoadjuvant chemotherapy in lieu of adjuvant chemotherapy and carboplatin-based regimens for patients who are ineligible for cisplatin. The incorporation of newer agents, now standard for patients with stage IV lung cancer, into the curative therapy paradigm has lagged owing to inefficient trial designs, the lengthy follow-up needed to assess survival end points and a developmental focus on the advanced-stage disease setting. Surrogate end points, such as pathological response, are being studied and might shorten trial durations. In 2018, the anti-PD-L1 antibody durvalumab was approved for patients with stage III lung cancer after concurrent chemoradiotherapy. Since then, the study of targeted therapies and immunotherapies in patients with early-stage lung cancer has rapidly expanded. In this Review, we present the current considerations in the treatment of patients with early-stage lung cancer and explore the current and future state of clinical research to develop systemic therapies for non-metastatic lung cancer. The authors of this Review present the current considerations in the treatment of patients with early-stage lung cancer, discussing the critical determination of resectability by thoracic surgical oncologists and the management of both resectable and unresectable disease with a focus on systemic therapy selection. They also address innovations in drug development, trial design and efforts to identify early-stage cancers.

Details

ISSN :
17594782 and 17594774
Volume :
18
Database :
OpenAIRE
Journal :
Nature Reviews Clinical Oncology
Accession number :
edsair.doi.dedup.....9fb6e7949d663c6f5dc6efd659c1aee3
Full Text :
https://doi.org/10.1038/s41571-021-00501-4