SCI

11 July 2024

Neoadjuvant and Adjuvant Treatment for Early-Stage Resectable Non-small Cell Lung Cancer (NSCLC): Consensus Recommendations from the International Association for the Study of Lung Cancer (IASLC)

（Journal of Thoracic Oncology; IF：21.0）

  • Spicer JD, Cascone T, Wynes MW, Ahn M-J, Dacic S, Felip E, Forde PM, Higgins KA, Kris MG, Mitsudomi T, Provencio M, Senan S, Solomon BJ, Tsao MS, Tsuboi M, Wakelee HA, Wu Y-L, Chih-Hsin Yang J, Zhou C, Harpole DH, Kelly KL, Neoadjuvant and Adjuvant Treatment for Early-Stage Resectable Non-small Cell Lung Cancer (NSCLC): Consensus Recommendations from the International Association for the Study of Lung Cancer (IASLC), Journal of Thoracic Oncology (2024), doi: https://doi.org/10.1016/j.jtho.2024.06.010

  • Correspondence to: Karen L. Kelly, MD, International Association for the Study of Lung Cancer. 1775 N. Sherman Street, Suite 1600, Denver, Colorado, 80203. United States. Office phone 720.598.1953, E-mail Karen.Kelly@iaslc.org

Abstract 摘要

Advances in the multidisciplinary care of early-stage resectable non-small cell lung cancer (rNSCLC) are emerging at an unprecedented pace. Numerous phase 3 trials produced results that have transformed patient outcomes for the better, yet these findings also require important modifications to the patient treatment journey trajectory and re-organization of care pathways. Perhaps most notably, the need for multispecialty collaboration for this patient population has never been greater. These rapid advances have inevitably left us with important gaps in knowledge for which definitive answers will only become available in several years. To this end, the IASLC commissioned a diverse multidisciplinary international expert panel to evaluate the current landscape and provide diagnostic, staging, and therapeutic recommendations for patients with rNSCLC, with particular emphasis on patients with AJCC/UICC TNM 8th edition stage II and III disease. Using a team-based approach, we generated 19 recommendations, of which all but one achieved greater than 85% consensus amongst panel members. A public voting process was initiated, which successfully validated and provided qualitative nuance to our recommendations. Highlights include: 1) the critical importance of a multidisciplinary approach to the evaluation of patients with rNSCLC driven by shared clinical decision making of a multispecialty team of expert providers; 2) biomarker testing for rNSCLC; 3) a preference for neoadjuvant chemoimmunotherapy for stage III rNSCLC; 4) equipoise regarding the optimal  management of patients with stage II between up-front surgery followed by adjuvant therapy and neoadjuvant/perioperative strategies; and 5) the robust preference for adjuvant targeted therapy for patients with rNSCLC and sensitizing EGFR and ALK tumor alterations. Our primary goals were to provide practical recommendations sensitive to the global differences in biology and resources for patients with rNSCLC, and to provide expert consensus guidance tailored to the individualized patient needs, goals, and preferences in their cancer care journey as these are areas where physicians must make daily clinical decisions in the absence of definitive data. These recommendations will continue to evolve as the treatment landscape for rNSCLC expands and more knowledge is acquired on the best therapeutic approach in specific patient and disease subgroups.

早期可切除的非小细胞肺癌(rNSCLC)的多学科治疗正以前所未有的速度出现。大量的三期试验产生了改善患者预后的结果，但这些发现也需要对患者治疗和护理过程进行重要修改。也许最值得注意的是，这一患者群体对多专业合作的需求从未如此之大。这些快速的进步不可避免地给我们留下了重要的知识空白，而这些空白的明确答案要在几年后才能得到。为此，IASLC委托了一个多学科的国际专家小组来评估目前的情况，并为rNSCLC患者提供诊断、分期和治疗建议，特别强调AJCC/UICC TNM第8版II期和III期疾病患者。采用以团队为基础的方法，我们提出了19项建议，其中除一项外，其余建议在小组成员中获得了85%以上的共识。启动了公众投票程序，成功地验证了我们的建议，并为其提供了定性的细微差别。重点包括:1)多学科方法对rNSCLC患者评估的关键重要性，由多学科专家团队共同做出临床决策;2) rNSCLC的生物标志物检测;3)首选新辅助化疗免疫治疗III期rNSCLC;4)对于II期患者的最佳管理，在前期手术后辅助治疗和新辅助/围手术期策略之间保持平衡;5) 对于非小细胞肺癌和敏感性EGFR和ALK肿瘤改变的患者，对辅助靶向治疗有强烈偏好。我们的主要目标是为rNSCLC患者提供对生物学和资源的全球差异敏感的实用建议，并根据患者的个性化需求、目标和癌症护理过程中的偏好提供专家共识指导，因为这些是医生必须在缺乏明确数据的情况下做出日常临床决策的领域。随着rNSCLC治疗领域的扩展以及对特定患者和疾病亚组的最佳治疗方法的更多了解，这些建议将继续发展。


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