Striving toward Improved Outcomes for Surgically Resectable Non-Small Cell Lung Cancer: the Promise and Challenges of Ne
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LUNG CANCER (H BORGHAEI, SECTION EDITOR)
Striving toward Improved Outcomes for Surgically Resectable Non-Small Cell Lung Cancer: the Promise and Challenges of Neoadjuvant Immunotherapy Ryan D. Gentzler 1
&
David O. Riley 1 & Linda W. Martin 2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Immunotherapy has revolutionized the treatment of non-surgical stage III and stage IV non-small cell lung cancer (NSCLC). Here, we review emerging data on the safety, feasibility, and efficacy of neoadjuvant immunotherapy in the setting of earlier stage surgically resectable lung cancer. Recent Findings Several small studies support the safety and feasibility of neoadjuvant immunotherapy, noting similar perioperative rates of morbidity and mortality compared with historical controls. Data from several phase II trials have shown high rates of major pathologic response (MPR), though it is unclear if this will correlate with a survival benefit. Phase III trials of neoadjuvant immunotherapy alone or in combination with chemotherapy are ongoing. Summary Neoadjuvant immunotherapy offers a promising treatment modality in earlier stage NSCLC patients. Results of ongoing phase II and phase III trials will be essential in determining how to best integrate this treatment modality in the future. Keywords Non-small cell lung cancer . Neoadjuvant . Immunotherapy . Lung resection . Surgery . Major pathologic response
Introduction Despite significant recent advances in treatment strategies, lung cancer remains the most common and lethal cancer worldwide, accounting for 11.6% of all new cancer diagnoses (greater than 2 million cases) and 18.4% of all cancer deaths per year [1]. It is anticipated that over 228,000 new cases of lung cancer will be diagnosed and 135,000 deaths will occur in the USA in 2020 [2]. Of these cases, the vast majority (85%) are classified as non-small cell lung cancer (NSCLC) [3, 4]. Though the majority of new NSCLC diagnoses are stage IV, approximately 40% of new NSCLC cases are stages I–III at presentation, representing a significant group of patients who could be treated with curative intent and benefit This article is part of the Topical Collection on Lung Cancer * Ryan D. Gentzler [email protected] 1
Division of Hematology/Oncology, University of Virginia, PO Box 800716, Charlottesville, VA 22908, USA
2
Division of Thoracic Cardiovascular Surgery, University of Virginia, Charlottesville, VA, USA
from early surgical resection [5]. Efforts to increase lung cancer screening may increase the proportion of patients diagnosed in earlier stages. For patients with pathologically confirmed stage IA NSCLC, 5-year survival rates are as high as 80–90% [6]. Unfortunately, many patients treated with complete surgical resection experience disease recurrence and have poor survival outcomes. In one study, 20% of patients with stages I–II surgically resected had recurrence and 7% developed new primary lung cancers using the AJCC 7th ed. staging system [7]. In this study
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