Preoperative and Postoperative Systemic Therapy for Operable Non-Small-Cell Lung Cancer

Abstract

Cisplatin-based adjuvant chemotherapy remains the standard of care for patients with resected stage II or III non-small-cell lung cancer. However, biomarker-informed clinical trials are starting to push the management of early-stage lung cancer beyond cytotoxic chemotherapy. This review explores recent and ongoing studies focused on improving cytotoxic chemotherapy and incorporating targeted and immunotherapies in the management of early-stage, resectable lung cancer. Adjuvant osimertinib for patients with EGFR-mutant tumors, preoperative chemoimmunotherapy, and adjuvant immunotherapy could improve outcomes for selected patients with resectable lung cancer, and ongoing or planned studies leveraging biomarkers, immunotherapy, and targeted therapy may further improve survival. We also discuss the unique barriers associated with clinical trials of early-stage lung cancer and the need for innovative trial designs to overcome these challenges.

FIG 1.

T-association between the OR for pCR and the HR for EFS. Each circle represents a study, and the size of each circle represents the corresponding sample size. EFS, event-free survival; HR, hazard ratio; OR, odds ratio; pCR, pathologic complete response.

FIG 2.

Sample size differences between a traditional time-to-event end point (PFS or OS; in blue) and a binary surrogate end point (PCR; in red) in a phase III study design with power of 80% and two-sided type I error 5%. HR, hazard ratio; OR, odds ratio; OS, overall survival; pCR, pathologic complete response; PFS, progression-free survival.