Abstract
Neoadjuvant Treatment for Resectable, Stage IIIA Non-Small Cell Lung Cancer
Highlights
The treatment of stage IIIA non-small cell lung cancer (NSCLC) remains one of the major areas of controversy in thoracic oncology
Treatment consists of neo-adjuvant chemotherapy or chemoradiotherapy (CHRT) followed by surgery with or without postoperative radiotherapy (RT), definitive CHRT, or neoadjuvant immunotherapy followed by surgery and several other options
Neoadjuvant CHRT seems to be safe and efficient and is associated with an improved pathological outcome, but it has failed to demonstrate any advantage in terms of progression-free survival or overall survival compared to neoadjuvant chemotherapy
Summary
The treatment of stage IIIA non-small cell lung cancer (NSCLC) remains one of the major areas of controversy in thoracic oncology. One pragmatic approach is to classify stage IIIA disease by resectability and operability. The current standard of care for unresectable/inoperable stage IIIA patients is definitive chemoradiation (CHRT) with a platinum doublet which is nowadays frequently followed by consolidation durvalumab [1]. In resectable stage IIIA NSCLC, there is still a considerable debate regarding the best strategy, including surgery with either adjuvant or neoadjuvant chemo- and/or radiotherapy (RT) or definitive concurrent CHRT and several other strategies. Neoadjuvant therapy has several theoretical advantages as in vivo assessment of response to chemotherapy (CHT) or CHRT helping to identify patients who will potentially benefit due to, early treatment of micrometastatic disease, potential downstaging with increasing resectability and the possibility of identification of surrogate clinical and biological markers that may correlate with response to therapy and potential long-term outcome. The present manuscript reviews past studies and it highlights ongoing trials including neoadjuvant immunotherapy
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