文章：

新辅助免疫治疗时代可切除III期非小细胞肺癌治疗策略的最新综述

An Updated Review of Management of Resectable Stage III NSCLC in the Era of Neoadjuvant Immunotherapy

原文发布日期：27 March 2024

DOI: 10.3390/cancers16071302

类型: Article

开放获取: 是

英文摘要：

Immune-checkpoint inhibitors (ICIs) have an established role in the treatment of locally advanced and metastatic non-small cell lung cancer (NSCLC). ICIs have now entered the paradigm of early-stage NSCLC. The recent evidence shows that the addition of ICI to neoadjuvant chemotherapy improves the pathological complete response (pCR) rate and survival rate in early-stage resectable NSCLC and is now a standard of care option in this setting. In this regard, stage III NSCLC merits special consideration, as it is heterogenous and requires a multidisciplinary approach to management. As the neoadjuvant approach is being adopted widely, new challenges have emerged and the boundaries for resectability are being re-examined. Consequently, it is ever more important to carefully individualize the treatment strategy for each patient with resectable stage III NSCLC. In this review, we discuss the recent literature in this field with particular focus on evolving definitions of resectability, T4 disease, N2 disease (single and multi-station), and nodal downstaging. We also highlight the controversy around adjuvant treatment in this setting and discuss the selection of patients for adjuvant treatment, options of salvage, and next line treatment in cases of progression on/after neoadjuvant treatment or after R2 resection. We will conclude with a brief discussion of predictive biomarkers, predictive models, ongoing studies, and directions for future research in this space.

摘要翻译： 

免疫检查点抑制剂（ICIs）在局部晚期和转移性非小细胞肺癌（NSCLC）的治疗中已确立重要地位，目前其应用已延伸至早期NSCLC的治疗领域。最新证据表明，在新辅助化疗基础上联合ICI可提高早期可切除NSCLC患者的病理完全缓解（pCR）率及生存率，现已成为该临床情境下的标准治疗选择之一。其中，III期NSCLC因具有高度异质性且需多学科综合诊疗策略，值得特别关注。随着新辅助治疗模式的广泛应用，新的临床挑战随之显现，可切除性标准也正在被重新审视。因此，针对可切除III期NSCLC患者制定个体化治疗方案显得尤为重要。本文综述该领域最新文献，重点探讨可切除性定义的演变、T4分期病变、N2分期病变（单站与多站）以及淋巴结降期等关键问题。同时，本文剖析该背景下辅助治疗的争议焦点，讨论辅助治疗患者的选择标准、挽救治疗方案，以及新辅助治疗期间/后出现进展或R2切除后的后续治疗策略。最后，本文将对预测性生物标志物、预测模型、当前研究进展及未来研究方向进行简要探讨。

原文链接：

An Updated Review of Management of Resectable Stage III NSCLC in the Era of Neoadjuvant Immunotherapy