Non-small cell lung cancer in China

Abstract

In China, lung cancer is a primary cancer type with high incidence and mortality. Risk factors for lung cancer include tobacco use, family history, radiation exposure, and the presence of chronic lung diseases. Most early-stage non-small cell lung cancer (NSCLC) patients miss the optimal timing for treatment due to the lack of clinical presentations. Population-based nationwide screening programs are of significant help in increasing the early detection and survival rates of NSCLC in China. The understanding of molecular carcinogenesis and the identification of oncogenic drivers dramatically facilitate the development of targeted therapy for NSCLC, thus prolonging survival in patients with positive drivers. In the exploration of immune escape mechanisms, programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitor monotherapy and PD-1/PD-L1 inhibitor plus chemotherapy have become a standard of care for advanced NSCLC in China. In the Chinese Society of Clinical Oncology's guidelines for NSCLC, maintenance immunotherapy is recommended for locally advanced NSCLC after chemoradiotherapy. Adjuvant immunotherapy and neoadjuvant chemoimmunotherapy will be approved for resectable NSCLC. In this review, we summarized recent advances in NSCLC in China in terms of epidemiology, biology, molecular pathology, pathogenesis, screening, diagnosis, targeted therapy, and immunotherapy.

Keywords: clinical guidelines; clinical trials; epidermal growth factor receptor (EGFR) mutation; immunotherapy; non-small cell lung cancer; programmed cell death protein 1 (PD-1); programmed death-ligand 1 (PD-L1); screening; targeted therapy.

FIGURE 1

Carcinogenic mechanisms of smoking in lung cancer. Abbreviations: PAHs, polycyclic aromatic hydrocarbons; NNK, nitrosamine 4‐(methylnitrosamino)‐1‐(3‐pyridyl)‐1‐butanone.

FIGURE 2

List of environmental factors, genetic susceptibility, and other risk factors for lung cancer. Abbreviations: COPD, chronic obstructive pulmonary disease.

FIGURE 3

Flow chart for management and follow‐up recommendation of lung nodules in China. Abbreviations: GGN, ground‐glass nodules; MDT, multidisciplinary team; PET‐CT, positron emission tomography‐computed tomography; PS, part‐solid nodules; S, solid nodules; #, increasing diameter ≥ 2 mm.

FIGURE 4

OS and PFS of patients with unresectable NSCLC after first‐line immunotherapy in phase 3 randomized controlled trials. Abbreviations: ITT, intention‐to‐treat; NR, not reach; NSCLC, non‐small cell lung cancer; OS, overall survival; PD‐L1, programmed death‐ligand 1; PFS, progression‐free survival; #, phase III clinical trials on innovative immune checkpoint inhibitors from China.

FIGURE 5

China National Medical Products Administration approved treatment regimens in advanced NSCLC. Abbreviations: ALK, anaplastic lymphoma kinase; EGFR, epidermal growth factor receptor; IC, immune cell; ICI, immune checkpoint inhibitor; MET, MET proto‐oncogene, receptor tyrosine kinase; NSCLC, non‐small cell lung cancer; PD‐1, programmed cell death protein 1; PD‐L1, programmed death‐ligand 1; RET, transfection proto‐oncogene gene; ROS1, ROS proto‐oncogene 1,receptor tyrosine kinase; sq, squamous; TC, tumor cell.

FIGURE 6

Mechanisms of immune escape in NSCLC. Abbreviations: ALK, anaplastic lymphoma kinase; CTLA4, cytotoxic T‐lymphocyte‐associated protein 4; EGFR, epidermal growth factor receptor; HLA, human leukocyte antigen; NSCLC, non‐small cell lung cancer; PD‐1, programmed cell death protein 1; PD‐L1, programmed death‐ligand 1; Treg, regulatory T cell.