DOI QR코드

DOI QR Code

Recent Advances in Adjuvant Therapy for Non-Small-Cell Lung Cancer

  • Mi-Hyun Kim (Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Soo Han Kim (Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Min Ki Lee (Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine) ;
  • Jung Seop Eom (Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine)
  • Received : 2023.06.27
  • Accepted : 2023.11.11
  • Published : 2024.01.31

Abstract

After the successful development of targeted therapy and immunotherapy for the treatment of advanced-stage non-small cell lung cancer (NSCLC), these innovative treatment options are rapidly being applied in the adjuvant setting for early-stage NSCLC. Some adjuvants that have recently been approved include osimertinib for epidermal growth factor receptor-mutated tumors and atezolizumab and pembrolizumab for selected patients with resectable NSCLC. Numerous studies on various targeted therapies and immunotherapy with or without chemotherapy are currently ongoing in the adjuvant setting. However, several questions regarding optimal strategies for adjuvant treatment remain unanswered. The present review summarizes the available literature, focusing on recent advances and ongoing trials with targeted therapy and immunotherapy in the adjuvant treatment of early-stage NSCLC.

Keywords

Acknowledgement

We would like to thank Editage (www.editage.com) for English language editing.

References

  1. National Cancer Center. Annual report of cancer statistics in Korea in 2020 [Internet]. Goyang: National Cancer Center; 2020 [cited 2023 Nov 15]. Available from: https://ncc.re.kr/cancerStatsList.ncc. 
  2. Jung KW, Kang MJ, Park EH, Yun EH, Kim HJ, Kong HJ, et al. Prediction of cancer incidence and mortality in Korea, 2023. Cancer Res Treat 2023;55:400-7.  https://doi.org/10.4143/crt.2023.448
  3. Kang MJ, Won YJ, Lee JJ, Jung KW, Kim HJ, Kong HJ, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2019. Cancer Res Treat 2022;54:330-44.  https://doi.org/10.4143/crt.2022.128
  4. Bade BC, Dela Cruz CS. Lung cancer 2020: epidemiology, etiology, and prevention. Clin Chest Med 2020;41:1-24.  https://doi.org/10.1016/j.ccm.2019.10.001
  5. Fischer B, Lassen U, Mortensen J, Larsen S, Loft A, Bertelsen A, et al. Preoperative staging of lung cancer with combined PET-CT. N Engl J Med 2009;361:32-9.  https://doi.org/10.1056/NEJMoa0900043
  6. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin 2021;71:7-33.  https://doi.org/10.3322/caac.21654
  7. National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology: non-small cell lung cancer, version 3.2023 [Internet]. Fort Washington: NCCN; 2023 [cited 2023 Nov 15]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/nscl.pdf. 
  8. Wu YL, Tsuboi M, He J, John T, Grohe C, Majem M, et al. Osimertinib in resected EGFR-mutated non-small-cell lung cancer. N Engl J Med 2020;383:1711-23.  https://doi.org/10.1056/NEJMoa2027071
  9. Felip E, Altorki N, Zhou C, Csoszi T, Vynnychenko I, Goloborodko O, et al. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase 3 trial. Lancet 2021;398:1344-57.  https://doi.org/10.1016/S0140-6736(21)02098-5
  10. Jeon DS, Kim HC, Kim SH, Kim TJ, Kim HK, Moon MH, et al. Five-year overall survival and prognostic factors in patients with lung cancer: results from the Korean Association of Lung Cancer Registry (KALC-R) 2015. Cancer Res Treat 2023;55:103-11.  https://doi.org/10.4143/crt.2022.264
  11. Sekihara K, Hishida T, Yoshida J, Oki T, Omori T, Katsumata S, et al. Long-term survival outcome after postoperative recurrence of non-small-cell lung cancer: who is 'cured' from postoperative recurrence? Eur J Cardiothorac Surg 2017;52:522-8.  https://doi.org/10.1093/ejcts/ezx127
  12. Pignon JP, Tribodet H, Scagliotti GV, Douillard JY, Shepherd FA, Stephens RJ, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol 2008;26:3552-9.  https://doi.org/10.1200/JCO.2007.13.9030
  13. Strauss GM, Herndon JE 2nd, Maddaus MA, Johnstone DW, Johnson EA, Harpole DH, et al. Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol 2008;26:5043-51.  https://doi.org/10.1200/JCO.2008.16.4855
  14. Butts CA, Ding K, Seymour L, Twumasi-Ankrah P, Graham B, Gandara D, et al. Randomized phase III trial of vinorelbine plus cisplatin compared with observation in completely resected stage IB and II non-small-cell lung cancer: updated survival analysis of JBR-10. J Clin Oncol 2010;28:29-34.  https://doi.org/10.1200/JCO.2009.24.0333
  15. U.S. Food and Drug Administration. FDA approves osimertinib as adjuvant therapy for non-small cell lung cancer with EGFR mutations [Internet]. Silver Spring: FDA; 2020 [cited 2023 Nov 15]. Available from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-osimertinib-adjuvant-therapy-non-small-cell-lung-cancer-egfr-mutations. 
  16. Zhong WZ, Wang Q, Mao WM, Xu ST, Wu L, Wei YC, et al. Gefitinib versus vinorelbine plus cisplatin as adjuvant treatment for stage II-IIIA (N1-N2) EGFR-mutant NSCLC: final overall survival analysis of CTONG1104 phase III trial. J Clin Oncol 2021;39:713-22.  https://doi.org/10.1200/JCO.20.01820
  17. Tada H, Mitsudomi T, Misumi T, Sugio K, Tsuboi M, Okamoto I, et al. Randomized phase III study of gefitinib versus cisplatin plus vinorelbine for patients with resected stage II-IIIA non-small-cell lung cancer with EGFR mutation (IMPACT). J Clin Oncol 2022;40:231-41.  https://doi.org/10.1200/JCO.21.01729
  18. Yue D, Xu S, Wang Q, Li X, Shen Y, Zhao H, et al. Erlotinib versus vinorelbine plus cisplatin as adjuvant therapy in Chinese patients with stage IIIA EGFR mutation-positive non-small-cell lung cancer (EVAN): a randomised, open-label, phase 2 trial. Lancet Respir Med 2018;6:863-73.  https://doi.org/10.1016/S2213-2600(18)30277-7
  19. Pennell NA, Neal JW, Chaft JE, Azzoli CG, Janne PA, Govindan R, et al. SELECT: a phase II trial of adjuvant erlotinib in patients with resected epidermal growth factor receptor-mutant non-small-cell lung cancer. J Clin Oncol 2019;37:97-104.  https://doi.org/10.1200/JCO.18.00131
  20. He J, Su C, Liang W, Xu S, Wu L, Fu X, et al. Icotinib versus chemotherapy as adjuvant treatment for stage II-IIIA EGFR-mutant non-small-cell lung cancer (EVIDENCE): a randomised, open-label, phase 3 trial. Lancet Respir Med 2021;9:1021-9.  https://doi.org/10.1016/S2213-2600(21)00134-X
  21. Liu SY, Zhang JT, Wu YL. What we have learned from adjuvant therapy for resected EGFR-mutant non-small-cell lung cancer. J Clin Oncol 2022;40:217-20.  https://doi.org/10.1200/JCO.21.02443
  22. Herbst RS, Wu YL, John T, Grohe C, Majem M, Wang J, et al. Adjuvant osimertinib for resected EGFR-mutated stage IB-IIIA non-small-cell lung cancer: updated results from the phase III randomized ADAURA trial. J Clin Oncol 2023;41:1830-40.  https://doi.org/10.1200/JCO.22.02186
  23. Tsuboi M, Herbst RS, John T, Kato T, Majem M, Grohe C, et al. Overall survival with osimertinib in resected EGFR-mutated NSCLC. N Engl J Med 2023;389:137-47.  https://doi.org/10.1056/NEJMoa2304594
  24. Wu YL, John T, Grohe C, Majem M, Goldman JW, Kim SW, et al. Postoperative chemotherapy use and outcomes from ADAURA: osimertinib as adjuvant therapy for resected EGFR-mutated NSCLC. J Thorac Oncol 2022;17:423-33.  https://doi.org/10.1016/j.jtho.2021.10.014
  25. de Scordilli M, Michelotti A, Bertoli E, De Carlo E, Del Conte A, Bearz A. Targeted therapy and immunotherapy in early-stage non-small cell lung cancer: current evidence and ongoing trials. Int J Mol Sci 2022;23:7222. 
  26. Chen MF, Chaft JE. Early-stage anaplastic lymphoma kinase (ALK)-positive lung cancer: a narrative review. Transl Lung Cancer Res 2023;12:337-45.  https://doi.org/10.21037/tlcr-22-631
  27. Sands J, Mandrekar SJ, Oxnard GR, Kozono DE, Hillman SL, Dahlberg SE, et al. ALCHEMIST: adjuvant targeted therapy or immunotherapy for high-risk resected NSCLC. J Clin Oncol 2020;38(15 suppl):TPS9077. 
  28. Solomon BJ, Ahn JS, Barlesi F, Dziadziuszko R, Nishio M, Shaw AT, et al. ALINA: a phase III study of alectinib versus chemotherapy as adjuvant therapy in patients with stage IB-IIIA anaplastic lymphoma kinase-positive (ALK+) non-small cell lung cancer (NSCLC). J Clin Oncol 2019;37(15 suppl):TPS8569. 
  29. ClinicalTrials.gov. A study comparing adjuvant alectinib versus adjuvant platinum-based chemotherapy in patients with ALK positive non-small cell lung cancer [Internet]. Bethesda: U.S. National Library of Medicine; 2018 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT03456076. 
  30. ClinicalTrials.gov. Ensartinib as adjuvant treatment in anaplastic lymphoma kinase (ALK) positive non-small cell lung cancer [Internet]. Bethesda: U.S. National Library of Medicine; 2022 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT05341583. 
  31. ClinicalTrials.gov. Adjuvant chemotherapy with or without intercalated icotinib [Internet]. Bethesda: U.S. National Library of Medicine; 2019 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT03983811. 
  32. ClinicalTrials.gov. Erlotinib hydrochloride in treating patients with stage IB-IIIA non-small cell lung cancer that has been completely removed by surgery (an ALCHEMIST treatment trial) [Internet]. Bethesda: U.S. National Library of Medicine; 2014 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT02193282. 
  33. ClinicalTrials.gov. A global study to assess the effects of osimertinib in participants with EGFRm stage IA2-IA3 NSCLC following complete tumour resection (ADAURA2) [Internet]. Bethesda: U.S. National Library of Medicine; 2021 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT05120349. 
  34. ClinicalTrials.gov. Almonertinib versus placebo as adjuvant therapy in resected stage II-IIIB non-small cell lung cancer with EGFR-sensitive mutations [Internet]. Bethesda: U.S. National Library of Medicine; 2020 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT04687241. 
  35. ClinicalTrials.gov. Efficacy and safety of almonertinib combined with or without chemotherapy as an adjuvant treatment for stage II-IIIA non-small cell lung carcinoma following complete tumour resection (APEX) [Internet]. Bethesda: U.S. National Library of Medicine; 2021 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT04762459. 
  36. ClinicalTrials.gov. To assess the efficacy and safety of furmonertinib versus placebo, in patients with epidermal growth factor receptor mutation positive stage II-IIIA non-small cell lung carcinoma, following complete tumour resection with or without adjuvant chemotherapy (FORWARD) [Internet]. Bethesda: U.S. National Library of Medicine; 2021 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT04853342. 
  37. O'Brien M, Paz-Ares L, Marreaud S, Dafni U, Oselin K, Havel L, et al. Pembrolizumab versus placebo as adjuvant therapy for completely resected stage IB-IIIA non-small-cell lung cancer (PEARLS/KEYNOTE-091): an interim analysis of a randomised, triple-blind, phase 3 trial. Lancet Oncol 2022;23:1274-86.  https://doi.org/10.1016/S1470-2045(22)00518-6
  38. Lampridis S, Scarci M. Perioperative systemic therapies for non-small-cell lung cancer: recent advances and future perspectives. Front Surg 2023;9:1126486. 
  39. Wakelee H, Altorki N, Felip E, Vallieres E, Vynnychenko IO, Akopov A, et al. PL03. 09 IMpower010: overall survival interim analysis of a phase III study of atezolizumab vs best supportive care in resected NSCLC. J Thorac Oncol 2022;17:S2. 
  40. U.S. Food and Drug Administration. FDA approves atezolizumab as adjuvant treatment for non-small cell lung cancer [Internet]. Silver Spring: FDA; 2023 [cited 2023 Nov 15]. Available from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-atezolizumab-adjuvant-treatment-non-small-cell-lung-cancer. 
  41. Ministry of Food and Drug Safety. Drud details for Tecentriq (atezolizumab) [Internet]. Cheongju: Ministry of Food and Drug Safety; 2017 [cited 2023 Nov 15]. Available from: https://nedrug.mfds.go.kr/pbp/CCBBB01/getItem-DetailCache?cacheSeq=201700266aupdateTs2023-06-05%2017:00:03.630018b. 
  42. U.S. Food and Drug Administration. FDA approves pembrolizumab as adjuvant treatment for non-small cell lung cancer [Internet]. Silver Spring: FDA; 2023 [cited 2023 Nov 15]. Available from: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-pembrolizumab-adjuvant-treatment-non-small-cell-lung-cancer. 
  43. Tang WF, Ye HY, Tang X, Su JW, Xu KM, Zhong WZ, et al. Adjuvant immunotherapy in early-stage resectable non-small cell lung cancer: a new milestone. Front Oncol 2023;13:1063183. 
  44. ClinicalTrials.gov. Double blind placebo controlled controlled study of adjuvant MEDI4736 in completely resected NSCLC [Internet]. Bethesda: U.S. National Library of Medicine; 2014 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT02273375. 
  45. ClinicalTrials.gov. Nivolumab after surgery and chemotherapy in treating patients with stage IB-IIIA non-small cell lung cancer (an ALCHEMIST treatment trial) (ANVIL) [Internet]. Bethesda: U.S. National Library of Medicine; 2015 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT02595944. 
  46. ClinicalTrials.gov. Testing the addition of a type of drug called immunotherapy to the usual chemotherapy treatment for non-small cell lung cancer (an ALCHEMIST treatment trial [Internet]. Bethesda: U.S. National Library of Medicine; 2020 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT04267848. 
  47. ClinicalTrials.gov. Phase III study to determine the efficacy of durvalumab in combination with chemotherapy in completely resected stage II-III non-small cell lung cancer (NSCLC) (MERMAID-1) [Internet]. Bethesda: U.S. National Library of Medicine; 2020 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT04385368. 
  48. ClinicalTrials.gov. Phase III study to determine efficacy of durvalumab in stage II-III non-small cell lung cancer (NSCLC) after curative intent therapy (MERMAID-2) [Internet]. Bethesda: U.S. National Library of Medicine; 2020 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT04642469. 
  49. ClinicalTrials.gov. New adjuvant trial of chemotherapy vs chemo-immunotherapy (NADIM-ADJUVANT) [Internet]. Bethesda: U.S. National Library of Medicine; 2020 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT04564157. 
  50. ClinicalTrials.gov. Adjuvant toripalimab plus chemotherapy for EGFR/ALK mutation negative stage II-IIIB (N2) NSCLC (LungMate-008) [Internet]. Bethesda: U.S. National Library of Medicine; 2021 [cited 2023 Nov 15]. Available from: https://clinicaltrials.gov/ct2/show/NCT04772287.