Adjuvant systemic therapy after radical resection of non‑small cell lung cancer – reality and new possibilities

01/2019

Prof. MUDr. Vítězslav Kolek, DrSc.

Klinika plicních nemocí a tuberkulózy LF UP a FN Olomouc

SUMMARY

Adjuvant chemotherapy (AC) after radical resection is a standard treating method of non-small cell lung cancer (NSCLC) in stage IB (in tumors of 4 cm in diameter), II and IIIA. The recommendation is based on the results of extensive meta-analyzes, which confirmed the reduction in the relative risk of death and an absolute improvement in the 5-year survival rate from 4% to 5%. Due to relatively low profits and side effects, AC use is limited in practice. Combination of vinorelbine with cisplatin is preferred, but carboplatin is used as well, particularly in patients with older age, worse performance status and co-morbidities. Current efforts aim to improve efficacy and patient selection. Prognostic and predictive biomarkers are sought to allow the personalization of adjuvant chemotherapy. In patients with NSCLC after radical surgery, other systemic treatment options are verified. Biologically targeted treatment has not yet been unambiguously put into common practice although two studies have shown improved survival with long-term TK inhibitors in the epidermal growth factor receptor (EGFR) mutation tumors. There are several extensive Phase 3 studies with immunotherapy in patients with different PDL-1 expressions. Their results are expected with great hope.

KEY WORDS

non-small cell lung cancer, adjuvant chemotherapy, biologic treatment, immunotherapy