Interpretation of neoadjuvant and adjuvant therapies for early stage resectable non-small cell lung cancer: Consensus recommendations form the International Association for the Study of Lung Cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Zhuokun ,  LI Ning ,  GENG Qing

Department of Thoracic Surgery Ⅰ, Renmin Hospital of Wuhan University, Wuhan, 430000, P. R. China;

Corresponding author：

LI Ning, Email: md.lining@whu.edu.cn; GENG Qing, Email: gengqingwhu@whu.edu.cn

Keywords：

Non-small cell lung cancer; neoadjuvant therapy; adjuvant therapy; immunotherapy; targeted therapy; chemotherapy; radiation therapy; interpretation

DOI：

10.7507/1007-4848.202412017

Video：

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With the release of outcomes from multiple phase 2 and phase 3 clinical trials, the multidisciplinary management protocols for early-stage resectable non-small cell lung cancer (rNSCLC) are experiencing expedited evolution. These studies have elucidated the pronounced efficacy of neoadjuvant and adjuvant therapies in enhancing the prognosis of rNSCLC patients, concurrently highlighting the imperative need for the revision and enhancement of congruent therapeutic regimens and clinical pathways. In light of this, the International Association for the Study of Lung Cancer (IASLC) has constituted a heterogeneous, multidisciplinary international consortium of experts to appraise ongoing clinical trials pertinent to rNSCLC, offering diagnostic, staging, and therapeutic recommendations for patients with stage Ⅱ and Ⅲ rNSCLC in accordance with the American Joint Committee on Cancer-Union for International Cancer Control, 8th Edition (AJCC-UICC 8th Edition). The document "Neoadjuvant and adjuvant therapy for early-stage resectable non-small cell lung cancer: Consensus recommendations from the International Association for the Study of Lung Cancer" enumerates a total of 20 recommendations, with 19 garnering consensus approval from over 85% of the experts. It is stipulated that patients with early-stage rNSCLC should undergo multidisciplinary team evaluations and complete requisite radiological assessments prior to definitive diagnosis. For patients with stage ⅢA or ⅢB, neoadjuvant chemotherapy and immunotherapy are advocated, whereas such therapies are not recommended for patients harboring epidermal growth factor receptor (EGFR) or anaplasticlymphoma kinase (ALK) mutations sensitive to tyrosine kinase inhibitors (TKIs). Postoperatively, adjuvant immunotherapy is considered contingent upon programmed cell death ligand 1 (PD-L1) expression levels, and additional oncogenic driver genes are scrutinized. For patients with specific genetic mutations, adjuvant therapy with osimertinib or alectinib is endorsed. These recommendations are designed to afford individualized, precision therapeutic strategies for patients with early-stage rNSCLC, thereby augmenting the efficacy of neoadjuvant and adjuvant therapies. This article delves into an in-depth elucidation of these consensus recommendations.

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2. Spicer JD, Cascone T, Wynes MW, et al. Neoadjuvant and adjuvant treatments for early stage resectable NSCLC: Consensus recommendations from the International Association for the Study of Lung Cancer. J Thorac Oncol, 2024, 19(10): 1373-1414.
3. Blumenthal GM, Bunn PA, Chaft JE, et al. Current status and future perspectives on neoadjuvant therapy in lung cancer. J Thorac Oncol, 2018, 13(12): 1818-1831.
4. Amin MB, Greene FL, Edge SB, et al. The eighth edition AJCC cancer staging manual: Continuing to build a bridge from a population-based to a more "personalized" approach to cancer staging. CA Cancer J Clin, 2017, 67(2): 93-99.
5. Detterbeck FC, Boffa DJ, Kim AW, et al. The eighth edition lung cancer stage classification. Chest, 2017, 151(1): 193-203.
6. Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol, 2010, 17(6): 1471-1474.
7. Heinke MY, Vinod SK. A review on the impact of lung cancer multidisciplinary care on patient outcomes. Transl Lung Cancer Res, 2020, 9(4): 1639-1653.
8. Huang RS, Mihalache A, Nafees A, et al. The impact of multidisciplinary cancer conferences on overall survival: A meta-analysis. J Natl Cancer Inst, 2024, 116(3): 356-369.
9. Silvestri GA, Gonzalez AV, Jantz MA, et al. Methods for staging non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest, 2013, 143(5 Suppl): e211S-e250S.
10. Farsad M. FDG PET/CT in the staging of lung cancer. Curr Radiopharm, 2020, 13(3): 195-203.
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13. Lüchtenborg M, Riaz SP, Coupland VH, et al. High procedure volume is strongly associated with improved survival after lung cancer surgery. J Clin Oncol, 2013, 31(25): 3141-3146.
14. Martin-Ucar AE, Waller DA, Atkins JL, et al. The beneficial effects of specialist thoracic surgery on the resection rate for non-small-cell lung cancer. Lung Cancer, 2004, 46(2): 227-232.
15. Tong BC, Gu L, Wang X, et al. Perioperative outcomes of pulmonary resection after neoadjuvant pembrolizumab in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg, 2022, 163(2): 427-436.
16. Lim E, Batchelor TJP, Dunning J, et al. Video-assisted thoracoscopic or open lobectomy in early-stage lung cancer. NEJM Evid, 2022, 1(3): EVIDoa2100016.
17. Houda I, Bahce I, Dickhoff C, et al. An international and multidisciplinary EORTC survey on resectability of stage Ⅲ non-small cell lung cancer. Lung Cancer, 2024, 199: 108061.
18. Arrieta O, Zatarain-Barrón ZL, Aldaco F, et al. Lung cancer in Mexico. J Thorac Oncol, 2019, 14(10): 1695-1700.
19. Cardona AF, Mejía SA, Viola L, et al. Lung cancer in Colombia. J Thorac Oncol, 2022, 17(8): 953-960.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesInterpretation of neoadjuvant and adjuvant therapies for early stage resectable non-small cell lung cancer: Consensus recommendations form the International Association for the Study of Lung Cancer

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