Neoadjuvant and Adjuvant Treatments for Early Stage Resectable NSCLC: Consensus Recommendations From the International Association for the Study of Lung Cancer

Authors

Jonathan D Spicer
Tina Cascone
Murry W Wynes
Myung-Ju Ahn
Sanja Dacic
Enriqueta Felip
Patrick M Forde
Kristin A Higgins
Mark G Kris
Tetsuya Mitsudomi
Mariano Provencio
Suresh Senan
Benjamin J Solomon
Ming Sound Tsao
Masahiro Tsuboi
Heather A Wakelee
Yi-Long Wu
James Chih-Hsin Yang
Caicun Zhou
David H Harpole
Karen L Kelly

Language

English

Publication Date

10-1-2024

Journal

Journal of Thoracic Oncology

DOI

10.1016/j.jtho.2024.06.010

PMID

38901648

Abstract

Advances in the multidisciplinary care of early stage resectable NSCLC (rNSCLC) are emerging at an unprecedented pace. Numerous phase 3 trials produced results that have transformed patient outcomes for the better, yet these findings also require important modifications to the patient treatment journey trajectory and reorganization of care pathways. Perhaps, most notably, the need for multispecialty collaboration for this patient population has never been greater. These rapid advances have inevitably left us with important gaps in knowledge for which definitive answers will only become available in several years. To this end, the International Association for the Study of Lung Cancer commissioned a diverse multidisciplinary international expert panel to evaluate the current landscape and provide diagnostic, staging, and therapeutic recommendations for patients with rNSCLC, with particular emphasis on patients with American Joint Committee on Cancer-Union for International Cancer Control TNM eighth edition stages II and III disease. Using a team-based approach, we generated 19 recommendations, of which all but one achieved greater than 85% consensus among panel members. A public voting process was initiated, which successfully validated and provided qualitative nuance to our recommendations. Highlights include the following: (1) the critical importance of a multidisciplinary approach to the evaluation of patients with rNSCLC driven by shared clinical decision-making of a multispecialty team of expert providers; (2) biomarker testing for rNSCLC; (3) a preference for neoadjuvant chemoimmunotherapy for stage III rNSCLC; (4) equipoise regarding the optimal management of patients with stage II between upfront surgery followed by adjuvant therapy and neoadjuvant or perioperative strategies; and (5) the robust preference for adjuvant targeted therapy for patients with rNSCLC and sensitizing EGFR and ALK tumor alterations. Our primary goals were to provide practical recommendations sensitive to the global differences in biology and resources for patients with rNSCLC and to provide expert consensus guidance tailored to the individualized patient needs, goals, and preferences in their cancer care journey as these are areas where physicians must make daily clinical decisions in the absence of definitive data. These recommendations will continue to evolve as the treatment landscape for rNSCLC expands and more knowledge is acquired on the best therapeutic approach in specific patient and disease subgroups.

Keywords

Humans, Carcinoma, Non-Small-Cell Lung, Chemotherapy, Adjuvant, Lung Neoplasms, Neoadjuvant Therapy, Neoplasm Staging, Practice Guidelines as Topic, Review Literature as Topic, Adjuvant, Chemotherapy, Immunotherapy, Lung cancer, Neoadjuvant, Radiation, Surgery, Targeted therapy

Published Open-Access

yes

Recommended Citation

Spicer, Jonathan D; Cascone, Tina; Wynes, Murry W; et al., "Neoadjuvant and Adjuvant Treatments for Early Stage Resectable NSCLC: Consensus Recommendations From the International Association for the Study of Lung Cancer" (2024). Faculty, Staff and Student Publications. 5437.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/5437