Lung cancer is often better treated and may even be cured if it is detected early.
On April 21, 2018, the Chinese Society of Clinical Oncology (CSCO), China’s authoritative professional oncology society, updated its lung cancer guidelines, bringing some good news for patients with early-stage non-small cell lung cancer (NSCLC). lung cancer (NSCLC) patients. They can be briefly summarized in the following three areas:
1) More benefit and less trauma from minimally invasive surgery;
2) further prolonged survival with EGFR-TKI (the full name is “epidermal growth factor receptor-tyrosine kinase inhibitor,” the main class of targeted drugs available today) after surgery;
3) Some stage IIIA patients may be considered for adjuvant therapy prior to surgery, which requires a multidisciplinary expert discussion.
Before going into detail, I would like to introduce you to the “level of evidence” that accompanies the recommendations of the guidelines mentioned below, which signifies the strength of the evidence supporting this recommendation. category 1 evidence is when there is sufficient research evidence and also a consensus among experts (1A) or only minor controversy (1B); category 2 evidence is when the research evidence is not The category 2 evidence refers to research evidence that is not sufficient, but there is a consensus among experts (2A) or little controversy (2B).
I. Minimally invasive surgery – better outcomes, less damage
Surgery is preferred for early-stage lung cancer, with a 10-year survival rate of more than 90% after surgery. The first step in the process is to remove the tumor from the chest. In fact, in recent years, many lung cancer surgeries have been performed thoracoscopically.
The new guidelines recommend that physicians consider minimally invasive techniques, including thoracoscopic or robotic-assisted (Class 2A evidence), for patients who are candidates for surgery.
Minimally invasive surgery is most effective for early-stage lung cancer, taking less time, bleeding less, and recovering faster than traditional surgery. The most advanced single-port thoracoscopic procedure has only one incision and is only 3 cm long, allowing many older patients who were once considered “unfit for surgery” to tolerate minimally invasive surgery.
II. Postoperative targeted therapy – further prolonging survival
At present, EGFR-TKI is a major treatment for advanced lung cancer, but should it be used for patients with early-stage lung cancer? The industry is still inconclusive.
New guidelines recommend that patients with NSCLC with lymph node metastases after surgery who are EGFR mutation positive can take EGFR-targeted drugs after surgery (Class 2B evidence).
This is based on the results of two Chinese studies from 2017 (the ADJUVANT and EVAN studies).
So, how long should you take a targeted drug in this situation? The jury is still out, and most of the available studies use 2 years of maintenance therapy.
III. Some stage IIIA patients may be considered for adjuvant therapy before surgery
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The treatment of stage IIIA NSCLC can be very different. If complete resection is possible, surgery with postoperative chemotherapy is recommended (Class 1 evidence); if surgery is not possible, radical concurrent radiotherapy can be done (Class 2A evidence).
The new guidelines recommend that some patients with stage IIIA NSCLC may be considered by their physicians for adjuvant therapy before surgery, either chemotherapy, combination radiotherapy, or chemotherapy + concurrent radiotherapy (Class 2B evidence).
The current study (INT0139) suggests that progression-free survival (PFS) may be prolonged in patients who receive preoperative adjuvant therapy (12.8 months versus 10.5 months). However, there are several studies that did not reach this conclusion. Therefore, you will need to get your doctor’s opinion on which patients are suitable for this treatment, and sometimes a multidisciplinary expert will need to discuss the decision together.
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Co-reviewed by: Guangdong Provincial People’s Hospital Guangdong Lung Cancer Research Institute Dr. Liao Riqiang, Associate Director Dr. Dong Song Dr. Zhang Chao