Neoadjuvant Targeted Therapy in Resectable NSCLC: Current and Future Perspectives.

Area of Science:

• Oncology
• Translational Medicine
• Thoracic Surgery

Background:

• Standard care for early-stage non-small cell lung cancer (NSCLC) involves surgery and adjuvant therapy, but metastatic recurrence remains a significant challenge.
• Targeted therapies (TT) have shown success in advanced NSCLC, prompting investigation into their perioperative use for early-stage disease.
• Currently, only adjuvant osimertinib is approved, with no standard neoadjuvant TTs available for early-stage NSCLC.

Purpose of the Study:

• To review the emerging data on neoadjuvant TTs for early-stage NSCLC.
• To discuss the importance of biomarker testing for identifying suitable candidates for neoadjuvant TTs.
• To address challenges and safety considerations for establishing neoadjuvant TTs as standard of care.

Main Methods:

• Review of current literature and ongoing clinical trials on neoadjuvant TTs in early-stage NSCLC.
• Discussion of biomarker testing strategies and early response markers.
• Analysis of safety profiles in the perioperative setting.

Main Results:

• Initial data suggest neoadjuvant TTs are effective and well-tolerated in patients with EGFR- or ALK-positive early-stage NSCLC.
• Comprehensive biomarker testing is crucial for patient selection.
• Ongoing trials are evaluating the efficacy and safety of various neoadjuvant TTs.

Conclusions:

• Neoadjuvant TTs represent a promising approach to improve outcomes in early-stage NSCLC, particularly for patients with actionable mutations.
• Further data from ongoing trials are essential to determine if neoadjuvant TTs will become the new standard of care.
• Addressing challenges in response marker identification and perioperative safety is key for clinical implementation.