Background: Recent landmark clinical trials have introduced the role of targeted therapy with surgery for resectable non-small cell lung cancers (NSCLCs).Methods: This narrative review summarizes data from recent clinical trials and retrospective studies to highlight the evolving interplay between targeted therapy and resectable NSCLC.Results: For patients with epidermal growth factor receptor (EGFR) mutations, the ADAURA trial demonstrated significant improvements in disease-free and overall survival with adjuvant osimertinib after complete resection. The NeoADAURA trial expanded the role of osimertinib to neoadjuvant treatment as it showed benefit in major pathologic response rates when compared to chemotherapy alone. Neoadjuvant osimertinib may facilitate surgical resection, especially for patients with lymph node involvement. Furthermore, the ALINA trial established the role of adjuvant alectinib, another targeted therapy, for patients with anaplastic lymphoma kinase (ALK) positive resectable NSCLC. Given the evidence for use of these novel targeted therapies in patients with resectable lung cancer, early molecular profiling is critical for patients with NSCLC to help guide pre- and postoperative treatment. The use of targeted therapies may even expand to stage IV NSCLC as clinical trials are ongoing and could possibly redefine the role of surgery in advanced disease.Conclusions: While there are ongoing trials to clarify the optimal timing of targeted therapies and surgical resection, current data supports the use of targeted therapies as part of multimodality care in surgically resectable NSCLC.
背景：近期具有里程碑意义的临床试验确立了靶向治疗联合手术在可切除非小细胞肺癌治疗中的作用。方法：本叙述性综述汇总近期临床试验与回顾性研究数据，重点阐述靶向治疗与可切除非小细胞肺癌之间不断演进的相互作用。结果：对于表皮生长因子受体突变患者，ADAURA试验证实完全切除术后辅助奥希替尼治疗能显著改善无病生存期和总生存期。NeoADAURA试验将奥希替尼的应用扩展至新辅助治疗领域，相较于单纯化疗，该方案在主要病理缓解率方面显示出优势。新辅助奥希替尼治疗可能促进手术切除，尤其对淋巴结受累患者更具价值。此外，ALINA试验确立了另一种靶向药物阿来替尼在间变性淋巴瘤激酶阳性可切除非小细胞肺癌患者中的辅助治疗地位。鉴于这些新型靶向疗法在可切除肺癌患者中应用的证据，早期分子谱分析对指导非小细胞肺癌患者围手术期治疗至关重要。随着相关临床试验的持续推进，靶向治疗的应用范围可能扩展至IV期非小细胞肺癌，甚至可能重新定义手术在晚期疾病治疗中的作用。结论：虽然仍需开展更多临床试验以明确靶向治疗与手术切除的最佳时机，现有数据支持将靶向治疗作为可手术切除非小细胞肺癌多学科综合治疗的组成部分。
The Evolving Interplay Between Targeted Therapy and Surgery for Resectable Lung Cancer
肿瘤(癌症)患者之家