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Bertolaccini L, Casiraghi M, Bardoni C, Diotti C, Chiari M, Mazzella A, de Marinis F, Spaggiari L. Revamping Non-Small Cell Lung Cancer Treatments in Stages II and III: Preparing Healthcare for Cutting-Edge Immuno-Oncology Regimens. Cancers (Basel) 2024; 16:2842. [PMID: 39199613 PMCID: PMC11352981 DOI: 10.3390/cancers16162842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/28/2024] [Accepted: 08/13/2024] [Indexed: 09/01/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) poses a significant challenge in clinical oncology, necessitating continual refinement of treatment approaches in stages II and III. Recent advancements have highlighted the potential of neoadjuvant therapy in optimising patient outcomes. Biomarker testing guides neoadjuvant therapy decisions, including epidermal growth factor receptor (EGFR) mutation and programmed death-ligand 1 (PD-L1) expression testing. Neoadjuvant therapy aims to improve oncological outcomes by treating micrometastatic disease and assessing tumour response before surgery. Disease-free survival is a surrogate endpoint for overall survival in both neoadjuvant and adjuvant settings. Multidisciplinary collaboration is crucial for individualised treatment planning and optimising patient care. The management of NSCLC requires a comprehensive approach, integrating expertise across disciplines and tailoring treatment strategies to individual patient needs. Neoadjuvant therapy shows promise in improving long-term outcomes, with biomarker testing guiding treatment decisions. Challenges such as defining borderline resectability and differentiating pseudoprogression highlight the need for ongoing research and collaboration.
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Affiliation(s)
- Luca Bertolaccini
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
| | - Monica Casiraghi
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
- Department of Thoracic Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
| | - Claudia Bardoni
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
| | - Cristina Diotti
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
| | - Matteo Chiari
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
| | - Antonio Mazzella
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
| | - Filippo de Marinis
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy;
| | - Lorenzo Spaggiari
- Department of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, Via Ripamonti 435, 20141 Milan, Italy; (M.C.); (C.B.); (C.D.); (M.C.); (A.M.); (L.S.)
- Department of Thoracic Oncology, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy
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Volpe S, Zaffaroni M, Piperno G, Vincini MG, Zerella MA, Mastroleo F, Cattani F, Fodor CI, Bellerba F, Bonaldi T, Bonizzi G, Ceci F, Cremonesi M, Fusco N, Gandini S, Garibaldi C, Torre DL, Noberini R, Petralia G, Spaggiari L, Venetis K, Orecchia R, Casiraghi M, Jereczek-Fossa BA. Multi-omics integrative modelling for stereotactic body radiotherapy in early-stage non-small cell lung cancer: clinical trial protocol of the MONDRIAN study. BMC Cancer 2023; 23:1236. [PMID: 38102575 PMCID: PMC10722797 DOI: 10.1186/s12885-023-11701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/30/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Currently, main treatment strategies for early-stage non-small cell lung cancer (ES-NSCLC) disease are surgery or stereotactic body radiation therapy (SBRT), with successful local control rates for both approaches. However, regional and distant failure remain critical in SBRT, and it is paramount to identify predictive factors of response to identify high-risk patients who may benefit from more aggressive approaches. The main endpoint of the MONDRIAN trial is to identify multi-omic biomarkers of SBRT response integrating information from the individual fields of radiomics, genomics and proteomics. METHODS MONDRIAN is a prospective observational explorative cohort clinical study, with a data-driven, bottom-up approach. It is expected to enroll 100 ES-NSCLC SBRT candidates treated at an Italian tertiary cancer center with well-recognized expertise in SBRT and thoracic surgery. To identify predictors specific to SBRT, MONDRIAN will include data from 200 patients treated with surgery, in a 1:2 ratio, with comparable clinical characteristics. The project will have an overall expected duration of 60 months, and will be structured into five main tasks: (i) Clinical Study; (ii) Imaging/ Radiomic Study, (iii) Gene Expression Study, (iv) Proteomic Study, (v) Integrative Model Building. DISCUSSION Thanks to its multi-disciplinary nature, MONDRIAN is expected to provide the opportunity to characterize ES-NSCLC from a multi-omic perspective, with a Radiation Oncology-oriented focus. Other than contributing to a mechanistic understanding of the disease, the study will assist the identification of high-risk patients in a largely unexplored clinical setting. Ultimately, this would orient further clinical research efforts on the combination of SBRT and systemic treatments, such as immunotherapy, with the perspective of improving oncological outcomes in this subset of patients. TRIAL REGISTRATION The study was prospectively registered at clinicaltrials.gov (NCT05974475).
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Affiliation(s)
- Stefania Volpe
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy.
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy.
| | - Mattia Zaffaroni
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy.
| | - Gaia Piperno
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Maria Giulia Vincini
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Maria Alessia Zerella
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Federico Mastroleo
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, 28100, Italy
| | - Federica Cattani
- Unit of Medical Physics, European Institute of Oncology (IEO) IRCCS, Milan, 20141, Italy
| | - Cristiana Iuliana Fodor
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Federica Bellerba
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, 20139, Italy
| | - Tiziana Bonaldi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, 20139, Italy
| | - Giuseppina Bonizzi
- Biobank for Translational and Digital Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Francesco Ceci
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Division of Nuclear Medicine, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Marta Cremonesi
- Unit of Radiation Research, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, 20139, Italy
| | - Cristina Garibaldi
- Unit of Radiation Research, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Davide La Torre
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- SKEMA Business School, Université Côte d'Azur, Sophia Antipolis, France
| | - Roberta Noberini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCCS, Milan, 20139, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Lorenzo Spaggiari
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Konstantinos Venetis
- Unit of Radiation Research, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Roberto Orecchia
- Scientific Directorate, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Monica Casiraghi
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
- Division of Thoracic Surgery, IEO, European Institute of Oncology IRCCS, Milan, 20141, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, Milan, 20141, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, 20122, Italy
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