Emerging Role of Molecular Testing in the Management of Non-Metastatic Non-Small Cell Lung Cancer.

Abstract

Advances in targeted therapies and immune checkpoint inhibitors have significantly enhanced survival rates for patients with metastatic non-small cell lung cancer (NSCLC). For non-metastatic NSCLC, addition of immune checkpoint inhibitors post-chemoradiotherapy has improved outcomes in stage III disease and during the perioperative phase for stages IB-IIIA. Recently, adjuvant osimertinib and alectinib therapy have demonstrated improved survival for patients with EGFR or ALK alterations, respectively, and they have been established as standard therapies. Furthermore, osimertinib has proven effective when administered following chemoradiotherapy in stage III NSCLC. These studies highlight the necessity to assess EGFR and ALK status to guide treatment decisions for almost all NSCLC patients, regardless of whether they will undergo curative surgery, chemoradiotherapy, or as palliative chemotherapy. This review summarizes recent trials on perioperative and post-chemoradiation therapy and argues that molecular testing is required for non-metastatic NSCLC to improve patient outcomes.