Treatment Decisions for Resectable Non-Small-Cell Lung Cancer: Balancing Less With More?

Area of Science:

• Oncology
• Surgical Oncology
• Radiation Oncology
• Medical Oncology

Background:

• Outcomes for resectable non-small-cell lung cancer (NSCLC) have historically lagged behind other solid tumors.
• Multidisciplinary care advancements have led to significant improvements in patient outcomes.
• Innovations in surgical techniques, radiation therapy, and systemic treatments are transforming the management of early-stage NSCLC.

Approach:

• This review synthesizes key studies on surgical resection, radiation treatment, and systemic therapy for resectable NSCLC.
• It examines advancements in limited resection and minimally invasive surgical techniques.
• The review covers refinements in neoadjuvant and adjuvant radiation therapy strategies.

Key Points:

• The integration of immune checkpoint inhibitors and targeted therapies into neoadjuvant and adjuvant settings has shown promising results.
• Recent regulatory approvals for four regimens (CheckMate-816, IMpower010, PEARLS, ADAURA) highlight the efficacy of novel systemic treatments.
• Biomarker analyses are crucial for personalizing treatment strategies and predicting patient response.

Conclusions:

• Optimal surgical resection, refined radiation techniques, and novel systemic therapies are enhancing survival outcomes for resectable NSCLC.
• Perioperative approaches represent a paradigm shift in managing early-stage NSCLC.
• Future research will focus on further optimizing perioperative strategies and exploring novel therapeutic combinations.