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Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Targeted Therapy and Immunotherapy in Early-Stage Non-Small Cell Lung Cancer: Current Evidence and Ongoing Trials
Marco de Scordilli1,2, Anna Michelotti1,2, Elisa Bertoli1,2
1Department of Medicine (DAME), University of Udine, 33100 Udine, Italy.
Abstract:
The scenario of neoadjuvant and adjuvant settings in non-small cell lung cancer (NSCLC) is rapidly evolving. As already happened for the advanced disease, also early stages have entered the era of precision medicine, with molecular analysis and Programmed death-ligand 1 (PD-L1) evaluation that by now can be considered a routine assessment. New treatment options have been recently approved, with osimertinib now part of clinical practice for Epidermal Growth Factor Receptor mutated (EGFRm) patients, and immune checkpoint inhibitors (ICIs) available after FDA approval both in the adjuvant (atezolizumab) and neoadjuvant (nivolumab) setting. No mature data on overall survival benefits are available yet, though. Several clinical trials with specific-tyrosine kinase inhibitors (TKIs) and ICIs are currently ongoing, both with and without concomitant chemotherapy. As therapeutic strategies are rapidly expanding, quite a few questions remain unsettled, such as the optimal duration of adjuvant targeted therapy or the effective benefit of ICIs in early-stage EGFRm or ALK (Anaplastic Lymphoma Kinase) rearranged patients, or the possibility to individuate high-risk patients after surgical resection assessing minimal residual disease (MRD) by ctDNA evaluation. We hereby report already available literature data and summarize ongoing trials with targeted therapy and immunotherapy in early-stage NSCLC, focusing on practice-changing results and new perspectives for potentially cured patients.
Insights
Precision medicine is transforming early-stage non-small cell lung cancer (NSCLC) treatment. New targeted therapies and immunotherapies offer hope, but optimal use and long-term benefits require further research.
Area of Science:
- Oncology
- Pulmonology
- Translational Medicine
Background:
- Early-stage non-small cell lung cancer (NSCLC) treatment is evolving rapidly.
- Molecular analysis and PD-L1 testing are becoming routine in NSCLC care.
- New treatments like osimertinib and immune checkpoint inhibitors (ICIs) are approved for specific NSCLC settings.
Purpose of the Study:
- To review current literature and ongoing trials for targeted therapy and immunotherapy in early-stage NSCLC.
- To highlight practice-changing results and future perspectives for potentially cured NSCLC patients.
Main Methods:
- Literature review of existing data on targeted therapy and immunotherapy in early-stage NSCLC.
- Summary of ongoing clinical trials investigating these treatment modalities.
- Focus on Epidermal Growth Factor Receptor mutated (EGFRm) and Anaplastic Lymphoma Kinase (ALK) rearranged NSCLC.
Main Results:
- Osimertinib is approved for EGFR-mutated NSCLC.
- Immune checkpoint inhibitors (ICIs) like atezolizumab and nivolumab are approved in adjuvant and neoadjuvant settings, respectively.
- Mature overall survival data for these new treatments are still pending.
Conclusions:
- The landscape of early-stage NSCLC treatment is shifting towards precision medicine.
- Ongoing trials aim to address unsettled questions regarding optimal treatment duration, efficacy in specific mutations, and minimal residual disease detection.
- Further research is crucial to establish long-term survival benefits and refine therapeutic strategies for potentially cured NSCLC patients.
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