Integration of New Systemic Adjuvant Therapies for Non-small Cell Lung Cancer: Role of the Surgeon

BACKGROUND This review describes a new therapeutic landscape in the adjuvant treatment of resectable non-small cell lung cancer (NSCLC) and discusses the role of the surgeon in ensuring the best outcomes within this treatment paradigm. METHODS We conducted a narrative literature review using the search terms non-small cell lung cancer and adjuvant to identify randomized Phase III trials of systemic adjuvant therapy for NSCLC through March 17, 2022. We also searched ClinicalTrials.gov to identify ongoing trials of adjuvant immunotherapies and targeted therapies for NSCLC. RESULTS Three recent randomized Phase III trials reported significant improvements in disease-free survival with adjuvant immune checkpoint inhibitors or targeted therapy in patients with resectable NSCLC: IMpower010 (atezoli-zumab vs best supportive care; NCT02486718), KEYNOTE-091 (PEARLS) (pembrolizumab vs placebo; NCT02504372), and ADAURA (osimertinib vs placebo; NCT02511106). Numerous other Phase III trials evaluating adjuvant immune checkpoint inhibitors and targeted therapies are currently underway, many of which demonstrate an evolution of trial design and end points for adjuvant therapy trials. This rapidly changing treatment landscape requires a shift in the role of the surgeon to facilitate appropriate biomarker screening for planning of the perioperative period and molecular testing of the surgical specimen to guide adjuvant therapy. CONCLUSIONS After decades of stagnation in the management of NSCLC, recent results with immune checkpoint inhibitors and targeted therapies are ushering in a new era of precision medicine in the adjuvant treatment of early-stage NSCLC. Surgeons have an important role in facilitating multidisciplinary care in this rapidly evolving landscape.(Ann Thorac Surg 2023;115:1544-55)(c) 2023 by The Society of Thoracic Surgeons

Automated summary

This review discusses the new therapeutic landscape in the adjuvant treatment of resectable non-small cell lung cancer (NSCLC) and emphasizes the role of the surgeon in ensuring optimal outcomes. Recent Phase III trials have shown significant improvements in disease-free survival with adjuvant immune checkpoint inhibitors or targeted therapy, highlighting the evolving role of the surgeon in biomarker screening and guiding adjuvant therapy.