How can the local advanced non -small cell lung carcinoma be cured?

*For medical professionals for reading reference

The treatment plan is constantly innovating, and patients with local advanced non -small cell lung cancer no longer "sewn".

If patients with early lung cancer are pursuing cure and advanced lung cancer patients are pursuing long survival, then to some extent, patients with local advanced lung cancer are "survival in the gap". Because some people can surgery, some people cannot surgery; if surgery, the choice of postoperative treatment plans is more complicated.

What is the "late stage"?

When diagnosed with non-small cell lung cancer (NSCLC), nearly one-third of patients were local advanced non-small cell lung cancer (LA-NSCLC). Most patients have lost the best surgical treatment opportunities when they are diagnosed. After synchronous chemotherapy, most patients will still relapse, and the 5 -year survival rate is only 15%to 25%[1].

So which part of the patient is LA-NSCLC? In medical specialty, according to the size of the tumor (T), the transfer of the surrounding lymph nodes (N), and the transfer of the distant organs (M), that is, the TNM staging, LA-NSCLC can be divided into IIIA, IIIB, and IIIC Expect. Depending on whether it can be surgery, LA-NSCLC can be divided into removable and irrevised LA-NSCLC. At present, the treatment mode of LA-NSCLC is mainly synchronous chemotherapy, but with the advent of the immune era, some studies have found that the use of immune consolidation treatment after synchronous therapy of LA-NSCLC can increase the survival rate of patients. There are many ideas.

The current status of LA-NSCLC treatment:

Jointly guarding various schemes

The strong heterogeneity of LA-NSCLC will naturally lead to a real problem-the clinical treatment plan is not easy to make decisions. At present, LA-NSCLC, which is diagnosed with phase IIIA-N2 period before surgery, generally adopts a combined treatment mode, including new assisted chemotherapy+surgery, induced radiotherapy+surgery, induced chemotherapy+radiotherapy and other methods.

In 2022, the "Chinese Clinical Oncology Society (CSCO) Non -small Cell Cancer (NSCLC) Diagnosis and Treatment Guidelines" [2] recommended that patients with clinical IIIA and IIIB phase NSCLC can perform surgery+auxiliary chemotherapy or radical chemotherapy. Auxiliary chemotherapy ± radiotherapy + surgery.

It is worth noting that in terms of radiotherapy, even if patients with NSCLC phase III-N22 are accepted, even after receiving postoperative auxiliary radiotherapy, patients are still easier to relapse. For such patients, postoperative radiotherapy is not clearly determined. At present, postoperative radiotherapy is more suitable for multiple hypertrophy of lymph node and accompanied by other prognosis.

In recent years, with the continuous development of targeted therapy and immunotherapy, it has also had good curative effects in removal LA-NSCLC. For patients with surgical IIIA or IIIB (T3N2M0) phase NSCLC lung cancer patients, the layers are T3-4N1 or T4N0 non-lung gully tumor (infringing chest walls, main bronchials, or mediastinals). Summer anti-anti-auxiliary therapy (Limited to PD-L1 TC ≥ 1%). The layered is a clinical N2. Patients who are expected to be unable to cure resection can choose the consolidation therapy after synchronized chemotherapy [2]. The postoperative pathological test is an EGFR sensitive mutation type. It is recommended to use auxiliary targeting therapy. At present, Oshitinib and Ekntinib have obtained EGFR -sensitive mutations NSCLC auxiliary targeted therapy indications, which can help patients improve survival. For NSCLC patients with irregular IIIA, IIIB, and IIIC, it is recommended to discuss the treatment methods suitable for patients for multiple disciplines [2].

Unrepaired LA-NSCLC treatment

Status: Immune blessing

The irregular LA-NSCLC includes irrevocable IIIs2, IIIB, and IIIC stage. The standard treatment mode is synchronized chemotherapy, but after synchronous chemotherapy, the local recurrence rate of patients with non-removed LA-NSCLC patients is about 40%. Nearly half or more patients will appear [1]. For patients with non-surgical LA-NSCLC, such as PS scores 0-1, 2022 "CSCO NSCLC Diagnosis and Treatment Guidelines" recommendation can be synchronized with radical chemotherapy or sequential chemotherapy+radiotherapy. In addition, based on PACIFIC research, PS scores are 0-1, and PD-L1 inhibitory doses of daeuyuki are recommended as consolidating treatment after synchronized chemotherapy. For patients who have not progressed in sequential chemotherapy or synchronous chemotherapy, based on Gemstone-301 studies, Schoglyab can be selected as consolidated treatment after synchronous or sequential chemotherapy.

PACIFIC [3] Study in 713 patients with irregular phase III NSCLC patients. After synchronous chemotherapy, patients who did not develop diseases were randomly divided into two groups according to 2: 1. Maintaining the treatment for 12 months, the research initially reported data from the "New England Medical Magazine" in 2017, and the middle PFS of the immunotherapy group and placebo group was 16.8 months and 5.6 months, respectively. It confirmed that Du Lyu Mipida maintained the effectiveness of the treatment after the iridispped LA-NSCLC radical chemotherapy. The success of Pacific research brings a new treatment model for patients with NSCLC patients in stage III, and successfully extended survival and changed the practice of clinical diagnosis and treatment. PACIFIC's 5 -year -old long -term follow -up data [4] was announced at the 2021 American Clinical Oncology Society (ASCO) conference. The median follow -up of 34.2 months, the median total survival (OS) of the Diaapuli Mipidica group and the placebo group is 47.5 months vs 29.1 months. The 5 -year OS rate of the Duoli Mipidica group and the placebo group was 42.9%VS 33.4%, respectively, indicating that patients with more than 40%of Du Liyouzabi still survived for a long time at 5 years. This model can benefit this part of the patient and the possibility of healing, becoming a new direction worth more exploration in the future.

Gemstone-301 is a multi-center, random, and double-blind stage III clinical trial [5], which aims to evaluate Schurli Mipide as the advancement of disease progress after synchronization or sequential chemotherapy, local advanced period/ Effectiveness and safety of irregular period of non -small cells in non -small cell lung cancer. The test results show that Schurli Meticuke's PFS that has a significant improvement of the Blind Independent Center for consolidation treatment (BICR) evaluates (BICR) evaluation (BICR). Compared with the combined chemotherapy, Schurge Micometer combined with chemotherapy reduces the risk of disease progress or death by 50% by 50%. [MPFS: 7.82 vs. 1.0.50 (95% CI: 0.39, 0.64), P <0.0001].

The success of immunotherapy in LA-NSCLC's consolidation is significantly improved to improve the prognosis of patients with phase III lung cancer compared with traditional radiotherapy and chemotherapy, and at the same time, it has also opened a precedent for maintaining consolidation treatment. However, each patient is a separate individual. Different patients have different reactions to biological agents. Clinically, the plan must be formulated in accordance with the actual situation of the patient to help patients benefit more.

references:

[1]. Yan Lanfang, Wu Yun, the current status and outlook of local advanced non -small cell lung cancer treatment [J], cancer progress, October 19 (19), 2021

[2]. China Clinical Oncology Society (CSCO) non -small cell lung cancer (NSCLC) diagnosis and treatment guide (2022)

[3]. Mantoniasj, Villegas A, Daniel D, et al. Overall SurvivalWith Durvalumab after Chemoradiotherapy in Stage ⅢNSCLC [J]. N ENGL J Med, 2018, 379 (24): 2342-2350.

[4].David R. Spigel,et al. Five-year survival outcomes withdurvalumab after chemoradiotherapy inunresectable stage llNSCLC: An update from the PACIFIC trial. 2021 ASCO,Abstract8511.

[5].Qing Zhou, Ming Chen, Ou Jiang, et al. Sugemalimab versus placebo after concurrent or sequential chemoradiotherapy in patients with locally advanced, unresectable, stage III non-small-cell lung cancer in China (GEMSTONE-301): interim Results of a randomised, double-black, multicentre, pHase 3 trial. Lancet oncol. 2022; 23 (2): 209-219: 209-219: 209-219

CN-94414, valid period of 2023-8-24

*The interview/writing of this article is supported by Astrikang for reference for medical and health professionals

*This article is only used to provide scientific information to medical people, and does not represent the viewpoint of this platform

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