Emerging precision neoadjuvant systemic therapy for patients with resectable non-small cell lung cancer: current status and perspectives

• Published in: Biomarker research Vol. 11; no. 1; p. 7
• Main Authors: Godoy, Luis A, Chen, Joy, Ma, Weijie, Lally, Jag, Toomey, Kyra A, Rajappa, Prabhu, Sheridan, Roya, Mahajan, Shirish, Stollenwerk, Nicholas, Phan, Chinh T, Cheng, Danny, Knebel, Robert J, Li, Tianhong
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 18.01.2023; BioMed Central; BMC
• Subjects: Adjuvant treatment; Analysis; Cancer; Care and treatment; Crizotinib; Development and progression; Drug approval; Immune checkpoint inhibitor (ICI); Lung cancer, Non-small cell; Neoadjuvant; NSCLC; Precision oncology; Resectable; Review; Targeted therapy; Systemic therapy; Resectable; NSCLC; Precision oncology; Targeted therapy; Immune checkpoint inhibitor (ICI); Neoadjuvant
• ISSN: 2050-7771; 2050-7771
• DOI: 10.1186/s40364-022-00444-7

Over the past decade, targeted therapy for oncogene-driven NSCLC and immune checkpoint inhibitors for non-oncogene-driven NSCLC, respectively, have greatly improved the survival and quality of life for patients with unresectable NSCLC. Increasingly, these biomarker-guided systemic therapies given before or after surgery have been used in patients with early-stage NSCLC. In March 2022, the US FDA granted the approval of neoadjuvant nivolumab and chemotherapy for patients with stage IB-IIIA NSCLC. Several phase II/III trials are evaluating the clinical efficacy of various neoadjuvant immune checkpoint inhibitor combinations for non-oncogene-driven NSCLC and neoadjuvant molecular targeted therapies for oncogene-driven NSCLC, respectively. However, clinical application of precision neoadjuvant treatment requires a paradigm shift in the biomarker testing and multidisciplinary collaboration at the diagnosis of early-stage NSCLC. In this comprehensive review, we summarize the current diagnosis and treatment landscape, recent advances, new challenges in biomarker testing and endpoint selections, practical considerations for a timely multidisciplinary collaboration at diagnosis, and perspectives in emerging neoadjuvant precision systemic therapy for patients with resectable, early-stage NSCLC. These biomarker-guided neoadjuvant therapies hold the promise to improve surgical and pathological outcomes, reduce systemic recurrences, guide postoperative therapy, and improve cure rates in patients with resectable NSCLC.