Multimodality curative-intent treatment in NSCLC: an unprecedented era of change 2017–2025

IF 7.7 1区 医学 Q1 RESPIRATORY SYSTEM
Thorax Pub Date : 2025-09-05 DOI:10.1136/thorax-2025-223096
Matthew Evison, Tanya Ahmed, Meenali Chitnis, Rebecca Ward, Daniel Netto, Laura Cove-Smith, Riyaz Shah, Nicola Steele, Gerard Walls, Doug West, Neal Navani
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引用次数: 0

Abstract

Curative-intent multimodality treatment—combining local treatments such as surgery or radiotherapy with systemic therapy—is the cornerstone of care in stage II–III non-small cell lung cancer (NSCLC). Since 2017, the systemic therapy backbones with multimodality treatment have undergone a dramatic transformation, driven by a series of pivotal, practice-changing clinical trials. Immunotherapy and targeted therapies, previously confined to the advanced/metastatic setting, are now firmly embedded in curative-intent regimens. Maintenance immunotherapy following chemoradiation in unresectable stage III disease, adjuvant tyrosine kinase inhibitors in resected epidermal growth factor receptor/anaplastic lymphoma kinase-positive tumours, neoadjuvant and perioperative chemoimmunotherapy in resectable stage II/III NSCLC and adjuvant chemoimmunotherapy following resection have all become new standards of care. This state-of-the-art review synthesises the key evidence underpinning these developments, highlights their clinical implications and identifies challenges to implementation—particularly the need for redefined clinical pathways, accurate pretreatment staging, timely biomarker testing and coordinated multidisciplinary decision-making. A novel treatment algorithm is proposed to support clinicians in navigating these complex treatment choices. We conclude that immunotherapy and targeted agents have irrevocably altered curative-intent NSCLC care, establishing multiple new standards that sometimes overlap and compete. In the surgical multimodality treatment pathway, neoadjuvant and perioperative chemoimmunotherapy offers the opportunity to increase the uptake of systemic therapy in comparison to adjuvant therapy and is considered by these authors to represent the optimal treatment path for most patients. In this unprecedented era of therapeutic expansion, the greatest challenge is no longer the absence of effective treatments, but the complexity of selecting, sequencing and delivering them, as well as patient optimisation. Lung cancer services must evolve through proactive pathway redesign, integrated diagnostics and new models of multidisciplinary care. High-quality, biomarker-driven and patient-centred care is now achievable for many patients with stage II–III NSCLC—but it will require system-level adaptation to deliver it.
非小细胞肺癌的多模式治疗:前所未有的变革时代2017-2025
以治疗为目的的多模式治疗——将局部治疗如手术或放疗与全身治疗相结合——是II-III期非小细胞肺癌(NSCLC)治疗的基石。自2017年以来,在一系列关键的、改变实践的临床试验的推动下,采用多模式治疗的全身治疗骨干发生了巨大转变。免疫治疗和靶向治疗,以前仅限于晚期/转移性环境,现在坚定地嵌入到治疗意图方案中。不可切除的III期疾病放化疗后的维持免疫治疗,切除的表皮生长因子受体/间变性淋巴瘤激酶阳性肿瘤的辅助酪氨酸激酶抑制剂,可切除的II/III期非小细胞肺癌的新辅助和围手术期化学免疫治疗以及切除后的辅助化学免疫治疗都已成为新的护理标准。这篇最新的综述综合了支持这些发展的关键证据,强调了它们的临床意义,并确定了实施的挑战,特别是需要重新定义临床途径,准确的预处理分期,及时的生物标志物检测和协调的多学科决策。提出了一种新的治疗算法,以支持临床医生导航这些复杂的治疗选择。我们的结论是,免疫治疗和靶向药物已经不可逆转地改变了以治疗为目的的NSCLC治疗,建立了多个有时重叠和竞争的新标准。在外科多模式治疗途径中,与辅助治疗相比,新辅助和围手术期化学免疫治疗提供了增加全身治疗的机会,并且被这些作者认为是大多数患者的最佳治疗途径。在这个前所未有的治疗扩展时代,最大的挑战不再是缺乏有效的治疗方法,而是选择、排序和提供治疗方法的复杂性,以及患者优化。肺癌服务必须通过积极的途径重新设计、综合诊断和多学科治疗的新模式来发展。对于许多II-III期非小细胞肺癌患者来说,高质量、生物标志物驱动和以患者为中心的护理现在是可以实现的,但它需要系统水平的适应来实现。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Thorax
Thorax 医学-呼吸系统
CiteScore
16.10
自引率
2.00%
发文量
197
审稿时长
1 months
期刊介绍: Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.
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