Adjuvant therapy in non-small cell lung cancer: is targeted therapy joining the standard of care?

Abstract

ABSTRACT Introduction Surgical resection is the standard of care (SOC) in non-small cell lung cancer (NSCLC) for early-stage. The 5-year overall survival (OS) rates with the use of adjuvant chemotherapy remain low. In advance NSCLC, tailored strategies have become the gold standard. We hope to translate these benefits into preventing recurrences and increasing survival in early-stage NSCLC. Areas covered EGFR mutated populations are the most common druggable molecular drivers in advance NSCLC. EGFR tyrosine kinase inhibitors (TKIs) are the SOC in this setting, and we discuss their emerging role as adjuvant therapy. Expert opinion The results of the first adjuvant clinical trial with TKIs showed increased DFS in patients with early-stage NSCLC. Despite that using osimertinib (Osm) as an adjuvant treatment seems promising, several open questions need to be answered. If Osm reaches a significant advantage in OS, undergoing 3 years of treatment is worthwhile, but if there is not an OS benefit then maybe DFS is not enough. In the meantime, should we treat patients with Osm as adjuvant therapy until the OS data is available? There is not an easy answer, but most of us are in favor of giving Osm a chance until we have definitive data or better options in early-stage NSCLC.