Background: Approximately 25–30% of non-small-cell lung cancer (NSCLC) patients are diagnosed when the disease is still resectable, although the risk of recurrence is significant. Recently, approaches based on targeted agents or immune checkpoint inhibitors (ICIs) have modified the management of such patients. However, some questions remain unanswered.Objectives: Our aim is to assess the current evidence on approaches involving targeted agents and ICIs in resectable NSCLC, to provide an up-to-date overview of the subject, and to identify areas of current debate,Methods: We analyzed randomized trials on ICIs and targeted therapies in early-stage NSCLC, published or presented at international oncology meetings throughout the last 5 years.Results: Osimertinib and alectinib have shown robust results in the adjuvant setting for molecularly identified patient subgroups, while ICIs have achieved robust data in the neoadjuvant/perioperative setting, with less consistent data on the pure adjuvant approach. Circulating tumor DNA levels may offer a possible biomarker for therapeutic decisions, albeit more prospective data are needed.Conclusions: Targeted agents and ICIs are revolutionizing early-stage NSCLC, similarly to what was observed in advanced disease. Prospective studies designed to compare neoadjuvant, adjuvant, and perioperative approaches and to assess the role of circulating biomarkers are warranted.
背景：约25%-30%的非小细胞肺癌（NSCLC）患者在确诊时仍处于可切除阶段，但复发风险显著。近年来，基于靶向药物或免疫检查点抑制剂（ICIs）的治疗方案已改变此类患者的临床管理策略，但仍有部分问题尚未明确。 目的：本研究旨在评估当前关于可切除NSCLC中靶向药物与ICIs治疗方案的循证依据，提供该领域最新研究进展概览，并明确当前存在争议的领域。 方法：我们系统分析了近五年来在国际肿瘤学会议发表或公布的早期NSCLC免疫检查点抑制剂及靶向治疗随机对照试验。 结果：奥希替尼和阿来替尼在经分子分型筛选的患者亚组的辅助治疗中展现出显著疗效，而免疫检查点抑制剂在新辅助/围手术期治疗中已获得充分证据支持，但在单纯辅助治疗模式中的数据一致性相对不足。循环肿瘤DNA水平可能为治疗决策提供潜在生物标志物，但仍需更多前瞻性数据验证。 结论：靶向药物与免疫检查点抑制剂正在早期NSCLC治疗领域引发革命性变革，其影响程度与晚期疾病中的观察结果相似。未来需要开展前瞻性研究以比较新辅助、辅助及围手术期治疗模式的差异，并评估循环生物标志物的临床价值。
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