Journal: Respirology (Carlton, Vic.)
This review focuses on how modern systemic therapies are reshaping management of resectable non-small cell lung cancer (NSCLC).
Key points:
- Rationale: Most deaths after “curative” surgery arise from micrometastatic disease present at diagnosis. Systemic perioperative therapy (adjuvant and neoadjuvant) is aimed at eradicating this microscopic residual disease to reduce relapse and improve survival.
- Precision oncology:
- Tyrosine kinase inhibitors (TKIs) have already transformed outcomes in advanced oncogene-driven NSCLC.
- Similar benefit is now being seen in resectable, molecularly defined subsets—especially EGFR- and ALK-mutated tumors—where adjuvant TKIs reduce recurrence compared with historical platinum chemotherapy.
- Immunotherapy:
- Immune checkpoint inhibitors (ICIs) in the perioperative setting improve pathological responses and survival.
- ICIs are establishing a new curative-intent paradigm in both neoadjuvant and adjuvant strategies.
- Evolving treatment algorithms:
- Management of resectable NSCLC is moving toward personalized, biomarker-driven approaches that integrate targeted therapy and immunotherapy with surgery.
- The review highlights emerging strategies including:
- Biomarker-based patient selection (driver mutations, PD-L1, and other signatures)
- Risk-adapted treatment intensity to reduce both relapse and overtreatment
- Multimodal regimens combining surgery, systemic therapy, and potentially radiation.
Overall, the article synthesizes the biological justification and current clinical evidence supporting perioperative systemic therapy in NSCLC and outlines how tailored, multimodal approaches may further improve cure rates while minimizing unnecessary toxicity.