Management of Resectable Stage III-N2 Non-Small-Cell Lung Cancer (NSCLC) in the Age of Immunotherapy
Stage III non-small-cell lung cancer (NSCLC) with N2 lymph node involvement is a heterogeneous group with different potential therapeutic approaches. Patients with potentially resectable III-N2 NSCLC are those who are considered to be able to receive a multimodality treatment that includes tumour re...
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| Format: | Article |
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MDPI AG
2021-09-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/19/4811 |
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| author | Xabier Mielgo-Rubio Sara Montemuiño Unai Jiménez Javier Luna Ana Cardeña Laura Mezquita Margarita Martín Felipe Couñago |
| author_facet | Xabier Mielgo-Rubio Sara Montemuiño Unai Jiménez Javier Luna Ana Cardeña Laura Mezquita Margarita Martín Felipe Couñago |
| author_sort | Xabier Mielgo-Rubio |
| collection | DOAJ |
| description | Stage III non-small-cell lung cancer (NSCLC) with N2 lymph node involvement is a heterogeneous group with different potential therapeutic approaches. Patients with potentially resectable III-N2 NSCLC are those who are considered to be able to receive a multimodality treatment that includes tumour resection after neoadjuvant therapy. Current treatment for these patients is based on neoadjuvant chemotherapy +/− radiotherapy followed by surgery and subsequent assessment for adjuvant chemotherapy and/or radiotherapy. In addition, some selected III-N2 patients could receive upfront surgery or pathologic N2 incidental involvement can be found <i>a posteriori</i> during analysis of the surgical specimen. The standard treatment for these patients is adjuvant chemotherapy and evaluation for complementary radiotherapy. Despite being a locally advanced stage, the cure rate for these patients continues to be low, with a broad improvement margin. The most immediate hope for improving survival data and curing these patients relies on integrating immunotherapy into perioperative treatment. Immunotherapy based on anti-PD1/PD-L1 immune checkpoint inhibitors is already a standard treatment in stage III unresectable and advanced NSCLC. Data from the first phase II studies in monotherapy neoadjuvant therapy and, in particular, in combination with chemotherapy, are highly promising, with impressive improved and complete pathological response rates. Despite the lack of confirmatory data from phase III trials and long-term survival data, and in spite of various unresolved questions, immunotherapy will soon be incorporated into the armamentarium for treating stage III-N2 NSCLC. In this article, we review all therapeutic approaches to stage III-N2 NSCLC, analysing both completed and ongoing studies that evaluate the addition of immunotherapy with or without chemotherapy and/or radiotherapy. |
| first_indexed | 2024-03-10T07:04:27Z |
| format | Article |
| id | doaj.art-100b5629317b4b95822461d3acdc07c9 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T07:04:27Z |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-100b5629317b4b95822461d3acdc07c92023-11-22T15:52:43ZengMDPI AGCancers2072-66942021-09-011319481110.3390/cancers13194811Management of Resectable Stage III-N2 Non-Small-Cell Lung Cancer (NSCLC) in the Age of ImmunotherapyXabier Mielgo-Rubio0Sara Montemuiño1Unai Jiménez2Javier Luna3Ana Cardeña4Laura Mezquita5Margarita Martín6Felipe Couñago7Department of Medical Oncology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, SpainDepartment of Radiation Oncology, Hospital Universitario Fuenlabrada, 28942 Madrid, SpainDepartment of Thoracic Surgery, Hospital Universitario Cruces, 48903 Barakaldo, Bizkaia, SpainDepartment of Radiation Oncology, Fundación Jiménez Díaz, 28040 Madrid, SpainDepartment of Medical Oncology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, SpainDepartment of Medical Oncology, Hospital Universitari Clínic Barcelona, 08036 Barcelona, SpainDepartment of Radiation Oncology, Hospital Universitario Ramón y Cajal, 28034 Madrid, SpainDepartment of Radiation Oncology, Hospital Universitario Quirónsalud Madrid, 28223 Madrid, SpainStage III non-small-cell lung cancer (NSCLC) with N2 lymph node involvement is a heterogeneous group with different potential therapeutic approaches. Patients with potentially resectable III-N2 NSCLC are those who are considered to be able to receive a multimodality treatment that includes tumour resection after neoadjuvant therapy. Current treatment for these patients is based on neoadjuvant chemotherapy +/− radiotherapy followed by surgery and subsequent assessment for adjuvant chemotherapy and/or radiotherapy. In addition, some selected III-N2 patients could receive upfront surgery or pathologic N2 incidental involvement can be found <i>a posteriori</i> during analysis of the surgical specimen. The standard treatment for these patients is adjuvant chemotherapy and evaluation for complementary radiotherapy. Despite being a locally advanced stage, the cure rate for these patients continues to be low, with a broad improvement margin. The most immediate hope for improving survival data and curing these patients relies on integrating immunotherapy into perioperative treatment. Immunotherapy based on anti-PD1/PD-L1 immune checkpoint inhibitors is already a standard treatment in stage III unresectable and advanced NSCLC. Data from the first phase II studies in monotherapy neoadjuvant therapy and, in particular, in combination with chemotherapy, are highly promising, with impressive improved and complete pathological response rates. Despite the lack of confirmatory data from phase III trials and long-term survival data, and in spite of various unresolved questions, immunotherapy will soon be incorporated into the armamentarium for treating stage III-N2 NSCLC. In this article, we review all therapeutic approaches to stage III-N2 NSCLC, analysing both completed and ongoing studies that evaluate the addition of immunotherapy with or without chemotherapy and/or radiotherapy.https://www.mdpi.com/2072-6694/13/19/4811non-small-cell lung cancerNSCLCN2resectableimmunotherapystage III |
| spellingShingle | Xabier Mielgo-Rubio Sara Montemuiño Unai Jiménez Javier Luna Ana Cardeña Laura Mezquita Margarita Martín Felipe Couñago Management of Resectable Stage III-N2 Non-Small-Cell Lung Cancer (NSCLC) in the Age of Immunotherapy Cancers non-small-cell lung cancer NSCLC N2 resectable immunotherapy stage III |
| title | Management of Resectable Stage III-N2 Non-Small-Cell Lung Cancer (NSCLC) in the Age of Immunotherapy |
| title_full | Management of Resectable Stage III-N2 Non-Small-Cell Lung Cancer (NSCLC) in the Age of Immunotherapy |
| title_fullStr | Management of Resectable Stage III-N2 Non-Small-Cell Lung Cancer (NSCLC) in the Age of Immunotherapy |
| title_full_unstemmed | Management of Resectable Stage III-N2 Non-Small-Cell Lung Cancer (NSCLC) in the Age of Immunotherapy |
| title_short | Management of Resectable Stage III-N2 Non-Small-Cell Lung Cancer (NSCLC) in the Age of Immunotherapy |
| title_sort | management of resectable stage iii n2 non small cell lung cancer nsclc in the age of immunotherapy |
| topic | non-small-cell lung cancer NSCLC N2 resectable immunotherapy stage III |
| url | https://www.mdpi.com/2072-6694/13/19/4811 |
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