Neoadjuvant therapy in non-small cell lung cancer: basis, promise, and challenges
IntroductionSurvival rates for early-stage non-small cell lung cancer (NSCLC) remain poor despite the decade-long established standard of surgical resection and systemic adjuvant therapy. Realizing this, researchers are exploring novel therapeutic targets and deploying neoadjuvant therapies to predi...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-12-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2023.1286104/full |
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| author | Sukumar Kalvapudi Yeshwanth Vedire Sai Yendamuri Sai Yendamuri Joseph Barbi Joseph Barbi |
| author_facet | Sukumar Kalvapudi Yeshwanth Vedire Sai Yendamuri Sai Yendamuri Joseph Barbi Joseph Barbi |
| author_sort | Sukumar Kalvapudi |
| collection | DOAJ |
| description | IntroductionSurvival rates for early-stage non-small cell lung cancer (NSCLC) remain poor despite the decade-long established standard of surgical resection and systemic adjuvant therapy. Realizing this, researchers are exploring novel therapeutic targets and deploying neoadjuvant therapies to predict and improve clinical and pathological outcomes in lung cancer patients. Neoadjuvant therapy is also increasingly being used to downstage disease to allow for resection with a curative intent. In this review, we aim to summarize the current and developing landscape of using neoadjuvant therapy in the management of NSCLC.MethodsThe PubMed.gov and the ClinicalTrials.gov databases were searched on 15 January 2023, to identify published research studies and trials relevant to this review. One hundred and seven published articles and seventeen ongoing clinical trials were selected, and relevant findings and information was reviewed.Results & DiscussionNeoadjuvant therapy, proven through clinical trials and meta-analyses, exhibits safety and efficacy comparable to or sometimes surpassing adjuvant therapy. By attacking micro-metastases early and reducing tumor burden, it allows for effective downstaging of disease, allowing for curative surgical resection attempts. Research into neoadjuvant therapy has necessitated the development of surrogate endpoints such as major pathologic response (MPR) and pathologic complete response (pCR) allowing for shorter duration clinical trials. Novel chemotherapy, immunotherapy, and targeted therapy agents are being tested at a furious rate, paving the way for a future of personalized systemic therapy in NSCLC. However, challenges remain that prevent further mainstream adoption of preoperative (Neoadjuvant) therapy. These include the risk of delaying curative surgical resection in scenarios of adverse events or treatment resistance. Also, the predictive value of surrogate markers of disease cure still needs robust verification. Finally, the body of published data is still limited compared to adjuvant therapy. Addressing these concerns with more large scale randomized controlled trials is needed. |
| first_indexed | 2024-03-09T01:57:58Z |
| format | Article |
| id | doaj.art-a6af7a7155364719a5fa054bb012813c |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-03-09T01:57:58Z |
| publishDate | 2023-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-a6af7a7155364719a5fa054bb012813c2023-12-08T12:10:23ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2023-12-011310.3389/fonc.2023.12861041286104Neoadjuvant therapy in non-small cell lung cancer: basis, promise, and challengesSukumar Kalvapudi0Yeshwanth Vedire1Sai Yendamuri2Sai Yendamuri3Joseph Barbi4Joseph Barbi5Department of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United StatesDepartment of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United StatesDepartment of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United StatesJacobs School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, United StatesDepartment of Thoracic Surgery, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United StatesDepartment of Immunology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United StatesIntroductionSurvival rates for early-stage non-small cell lung cancer (NSCLC) remain poor despite the decade-long established standard of surgical resection and systemic adjuvant therapy. Realizing this, researchers are exploring novel therapeutic targets and deploying neoadjuvant therapies to predict and improve clinical and pathological outcomes in lung cancer patients. Neoadjuvant therapy is also increasingly being used to downstage disease to allow for resection with a curative intent. In this review, we aim to summarize the current and developing landscape of using neoadjuvant therapy in the management of NSCLC.MethodsThe PubMed.gov and the ClinicalTrials.gov databases were searched on 15 January 2023, to identify published research studies and trials relevant to this review. One hundred and seven published articles and seventeen ongoing clinical trials were selected, and relevant findings and information was reviewed.Results & DiscussionNeoadjuvant therapy, proven through clinical trials and meta-analyses, exhibits safety and efficacy comparable to or sometimes surpassing adjuvant therapy. By attacking micro-metastases early and reducing tumor burden, it allows for effective downstaging of disease, allowing for curative surgical resection attempts. Research into neoadjuvant therapy has necessitated the development of surrogate endpoints such as major pathologic response (MPR) and pathologic complete response (pCR) allowing for shorter duration clinical trials. Novel chemotherapy, immunotherapy, and targeted therapy agents are being tested at a furious rate, paving the way for a future of personalized systemic therapy in NSCLC. However, challenges remain that prevent further mainstream adoption of preoperative (Neoadjuvant) therapy. These include the risk of delaying curative surgical resection in scenarios of adverse events or treatment resistance. Also, the predictive value of surrogate markers of disease cure still needs robust verification. Finally, the body of published data is still limited compared to adjuvant therapy. Addressing these concerns with more large scale randomized controlled trials is needed.https://www.frontiersin.org/articles/10.3389/fonc.2023.1286104/fullneoadjuvantpreoperativeNSCLCsystemic therapyimmunotherapychemoimmunotherapy |
| spellingShingle | Sukumar Kalvapudi Yeshwanth Vedire Sai Yendamuri Sai Yendamuri Joseph Barbi Joseph Barbi Neoadjuvant therapy in non-small cell lung cancer: basis, promise, and challenges Frontiers in Oncology neoadjuvant preoperative NSCLC systemic therapy immunotherapy chemoimmunotherapy |
| title | Neoadjuvant therapy in non-small cell lung cancer: basis, promise, and challenges |
| title_full | Neoadjuvant therapy in non-small cell lung cancer: basis, promise, and challenges |
| title_fullStr | Neoadjuvant therapy in non-small cell lung cancer: basis, promise, and challenges |
| title_full_unstemmed | Neoadjuvant therapy in non-small cell lung cancer: basis, promise, and challenges |
| title_short | Neoadjuvant therapy in non-small cell lung cancer: basis, promise, and challenges |
| title_sort | neoadjuvant therapy in non small cell lung cancer basis promise and challenges |
| topic | neoadjuvant preoperative NSCLC systemic therapy immunotherapy chemoimmunotherapy |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2023.1286104/full |
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