Onkológia S2/2023

The turbulent evolution of treatment strategies for early-diagnosed NSCLC

Targeted treatment and immunotherapy with immune checkpoint inhibitors (ICIs) are an established treatment for metastatic stages of non-small cell lung cancer (NSCLC) and are beginning to be established in the treatment of early stages. The results of a phase III study led to the registration of 3-year adjuvant treatment with osimertinib in patients with resected early NSCLC with typical EGFR mutations. Registration studies with the ICIs atezolizumab and pembrolizumab in the adjuvant setting significantly increased disease-free survival in patients after surgical resection. Neoadjuvant chemo-immunotherapy with nivolumab significantly increased pathologic complete responses and event-free (recurrence) survival, thereby changing the paradigm of neoadjuvant treatment regimens. Patients with driver genetic alterations EGFR and ALK were either excluded from these (neo)adjuvant studies (atezolizumab and nivolumab) or these alterations were poorly investigated (pembrolizumab), so the status of ICI in this cohort remains undefined. In patients with unresectable stage III NSCLC (with PD-L1 ≥ 1%) consolidation treatment with durvalumab after concurrent chemoradiotherapy is registered, and leads to longer overall survival.

Keywords: non-small cell lung carcer, neoadjuvent treatment, adjuvent treatment, immunotherapy, targeted treatment