Management of locally advanced non-small cell lung cancer: State of the art and future directions

Da Miao; Jing Zhao; Ying Han; Jiaqi Zhou; Xiuzhen Li; Ting Zhang; Wen Li; Yang Xia

doi:10.1002/cac2.12505

Cancer Communications ›› 2024, Vol. 44 ›› Issue (1) : 23 -46. DOI: 10.1002/cac2.12505

REVIEW

Management of locally advanced non-small cell lung cancer: State of the art and future directions

Da Miao ¹^,²
, Jing Zhao ³
, Ying Han ¹^,⁴
, Jiaqi Zhou ¹^,⁵
, Xiuzhen Li ⁶
, Ting Zhang ⁷
, Wen Li ¹^,⁸
, Yang Xia ¹^,⁸^,^†

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¹. Key Laboratory of Respiratory Disease of Zhejiang Province, Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China

². Department of Oncology, Shaoxing Second Hospital, Shaoxing, Zhejiang, P. R. China

³. Department of Medical Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China

⁴. Department of Chemoradiotherapy, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, P. R. China

⁵. Key Discipline of Jiaxing Respiratory Medicine Construction Project, Jiaxing Key Laboratory of Precision Treatment for Lung Cancer, Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, P. R. China

⁶. Department of Pathology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China

⁷. Department of Radiation Oncology, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, P. R. China

⁸. Cancer Center, Zhejiang University, Hangzhou, Zhejiang, P. R. China

yxia@zju.edu.cn

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Abstract

Lung cancer is the second most common and the deadliest type of cancer worldwide. Clinically, non-small cell lung cancer (NSCLC) is the most common pathological type of lung cancer; approximately one-third of affected patients have locally advanced NSCLC (LA-NSCLC, stage III NSCLC) at diagnosis. Because of its heterogeneity, LA-NSCLC often requires multidisciplinary assessment. Moreover, the prognosis of affected patients is much below satisfaction, and the efficacy of traditional therapeutic strategies has reached a plateau. With the emergence of targeted therapies and immunotherapies, as well as the continuous development of novel radiotherapies, we have entered an era of novel treatment paradigm for LA-NSCLC. Here, we reviewed the landscape of relevant therapeutic modalities, including adjuvant, neoadjuvant, and perioperative targeted and immune strategies in patients with resectable LA-NSCLC with/without oncogenic alterations; as well as novel combinations of chemoradiation and immunotherapy/targeted therapy in unresectable LA-NSCLC. We addressed the unresolved challenges that remain in the field, and examined future directions to optimize clinical management and increase the cure rate of LA-NSCLC.

Keywords

locally advanced / non-small cell lung cancer / neoadjuvant therapy / adjuvant therapy / immunotherapy / targeted therapy

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Da Miao, Jing Zhao, Ying Han, Jiaqi Zhou, Xiuzhen Li, Ting Zhang, Wen Li, Yang Xia. Management of locally advanced non-small cell lung cancer: State of the art and future directions. Cancer Communications, 2024, 44(1): 23-46 DOI:10.1002/cac2.12505

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