- Department of Thoracic Surgery Ⅰ, Renmin Hospital of Wuhan University, Wuhan, 430060, P. R. China;
LI Ning,
Email: md.lining@whu.edu.cn;
GENG Qing,
Email: gengqingwhu@whu.edu.cn
With the publication of several phase Ⅱ and Ⅲ clinical studies, the multidisciplinary diagnostic and therapeutic strategies for early resectable non-small cell lung cancer (rNSCLC) are rapidly evolving. These studies have elucidated the significant effects of neoadjuvant and adjuvant therapies on improving the prognosis of rNSCLC patients, while also highlighting the urgent need to revise and refine corresponding treatment protocols and clinical pathways. In response, the International Association for the Study of Lung Cancer has assembled a diverse, multidisciplinary international expert panel to evaluate current clinical trials related to rNSCLC and to provide diagnostic, staging, and treatment recommendations for rNSCLC patients in accordance with the 8th edition of the AJCC-UICC staging system. The consensus recommendations titled "Neoadjuvant and adjuvant treatments for early stage resectable non-small cell lung cancer: Consensus recommendations from the International Associationfor the Study of Lung Cancer" outline 20 recommendations, 19 of which received over 85% agreement from the experts. The recommendations indicate that early rNSCLC patients should undergo evaluation by a multidisciplinary team and complete necessary imaging studies. For stage Ⅱ patients, consideration should be given to either adjuvant therapy following surgery or direct neoadjuvant/perioperative treatment, while stage Ⅲ patients are recommended to receive neoadjuvant chemoimmunotherapy followed by surgery. Postoperatively, adjuvant immunotherapy should be considered based on the expression levels of programmed cell death ligand 1, along with testing for other oncogenic driver mutations. For patients with epidermal growth factor receptor or anaplastic lymphoma kinase mutations sensitive to tyrosine kinase inhibitors, corresponding adjuvant targeted therapy is recommended. These recommendations aim to provide personalized and precise treatment strategies for early rNSCLC patients to enhance the efficacy of neoadjuvant and adjuvant therapies. This article provides an in-depth interpretation of these consensus recommendations.
Citation： HE Zhuokun, LI Ning, GENG Qing. Interpretation of neoadjuvant and adjuvant treatments for early stage resectable non-small cell lung cancer: Consensus recommendations from the International Association for the Study of Lung Cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2025, 32(3): 291-299. doi: 10.7507/1007-4848.202412017 Copy
Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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- 8. Figueiredo VR, Cardoso PFG, Jacomelli M, et al. EBUS-TBNA versus surgical mediastinoscopy for mediastinal lymph node staging in potentially operable non-small cell lung cancer: A systematic review and meta-analysis. J Bras Pneumol, 2020, 46(6): e20190221.
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- 11. Al Zaidi M, Wright GM. Locally advanced non-small cell lung cancer: The place of specialist thoracic surgery in the multidisciplinary team. Transl Lung Cancer Res, 2020, 9(4): 1680-1689.
- 12. Tong BC, Gu L, Wang X, et al. Perioperative outcomes of pulmonary resection after neoadjuvant pembrolizumab in patients with non-small cell lung cancer. J Thorac Cardiovasc Surg, 2022, 163(2): 427-436.
- 13. Mitchell KG, Farooqi A, Ludmir EB, et al. Pulmonary resection is associated with long-term survival and should remain a therapeutic option in oligometastatic lung cancer. J Thorac Cardiovasc Surg, 2021, 161(4): 1497-1504.
- 14. Bendixen M, Kronborg C, Jørgensen OD, et al. Cost-utility analysis of minimally invasive surgery for lung cancer: A randomized controlled trial. Eur J Cardiothorac Surg, 2019, 56(4): 754-761.
- 15. Gainor JF, Shaw AT, Sequist LV, et al. EGFR mutations and ALK rearrangements are associated with low response rates to PD-1 pathway blockade in non-small cell lung cancer: A retrospective analysis. Clin Cancer Res, 2016, 22(18): 4585-4593.
- 16. Yang JC, Lee DH, Lee JS, et al. Phase Ⅲ KEYNOTE-789 study of pemetrexed and platinum with or without pembrolizumab for tyrosine kinase inhibitor-resistant, EGFR-mutant, metastatic nonsquamous non-small cell lung cancer. J Clin Oncol, 2024, 42(34): 4029-4039.
- 17. To KKW, Fong W, Cho WCS. Immunotherapy in treating EGFR-mutant lung cancer: Current challenges and new strategies. Front Oncol, 2021, 11: 635007.
- 18. Mok T S K, Nakagawa K, Park K, et al. Nivolumab (NIVO) plus chemotherapy (chemo) vs chemo in patients (pts) with EGFR-mutated metastatic non-small cell lung cancer (mNSCLC) with disease progression after EGFR tyrosine kinase inhibitors (TKIs) in CheckMate 722. Ann Oncol, 2022, 33(9): S1561-S1562.
- 19. Heymach JV, Harpole D, Mitsudomi T, et al. Perioperative durvalumab for resectable non-small-cell lung cancer. N Engl J Med, 2023, 389(18): 1672-1684.
- 20. He J, Gao S, Reck M, et al. Neoadjuvant durvalumab plus chemotherapy followed by adjuvant durvalumab in resectable EGFR-mutated NSCLC (AEGEAN). J Thorac Oncol, 2023, 18(11): S72-S73.
- 21. Liu Y, Zhang Z, Rinsurongkawong W, et al. Association of driver oncogene variations with outcomes in patients with locally advanced non-small cell lung cancer treated with chemoradiation and consolidative durvalumab. JAMA Netw Open, 2022, 5(6): e2215589.
- 22. Schoenfeld AJ, Arbour KC, Rizvi H, et al. Severe immune-related adverse events are common with sequential PD-(L)1 blockade and osimertinib. Ann Oncol, 2019, 30(5): 839-844.
- 23. Lu S, Wu L, Jian H, et al. Sintilimab plus chemotherapy for patients with EGFR-mutated non-squamous non-small-cell lung cancer with disease progression after EGFR tyrosine-kinase inhibitor therapy (ORIENT-31): Second interim analysis from a double-blind, randomised, placebo-controlled, phase 3 trial. Lancet Respir Med, 2023, 11(7): 624-636.
- 24. Tsuboi M, Herbst RS, John T, et al. Overall survival with osimertinib in resected EGFR-mutated NSCLC. N Engl J Med, 2023, 389(2): 137-147.
- 25. Solomon BJ, Ahn JS, Dziadziuszko R, et al. ALINA: Efficacy and safety of adjuvant alectinib versus chemotherapy in patients with early-stage ALK plus non-small cell lung cancer (NSCLC). Ann Oncol, 2023, 34(2): S1295-S1296.
- 26. Wu YL, Dziadziuszko R, Ahn JS, et al. Alectinib in resected ALK-positive non-small-cell lung cancer. N Engl J Med, 2024, 390(14): 1265-1276.
- 27. Wang Z, Yuan X, Sun K, et al. Optimizing the NGS-based discrimination of multiple lung cancers from the perspective of evolution. NPJ Precis Oncol, 2025, 9(1): 14.
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