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Spicer JD, Cascone T, Wynes MW, Ahn MJ, Dacic S, Felip E, Forde PM, Higgins KA, Kris MG, Mitsudomi T, Provencio M, Senan S, Solomon BJ, Tsao MS, Tsuboi M, Wakelee HA, Wu YL, Chih-Hsin Yang J, Zhou C, Harpole DH, Kelly KL. Neoadjuvant and Adjuvant Treatments for Early Stage Resectable NSCLC: Consensus Recommendations From the International Association for the Study of Lung Cancer. J Thorac Oncol 2024:S1556-0864(24)00627-0. [PMID: 38901648 DOI: 10.1016/j.jtho.2024.06.010] [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: 02/14/2024] [Revised: 06/07/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024]
Abstract
Advances in the multidisciplinary care of early stage resectable NSCLC (rNSCLC) are emerging at an unprecedented pace. Numerous phase 3 trials produced results that have transformed patient outcomes for the better, yet these findings also require important modifications to the patient treatment journey trajectory and reorganization of care pathways. Perhaps, most notably, the need for multispecialty collaboration for this patient population has never been greater. These rapid advances have inevitably left us with important gaps in knowledge for which definitive answers will only become available in several years. To this end, the International Association for the Study of Lung Cancer commissioned a diverse multidisciplinary international expert panel to evaluate the current landscape and provide diagnostic, staging, and therapeutic recommendations for patients with rNSCLC, with particular emphasis on patients with American Joint Committee on Cancer-Union for International Cancer Control TNM eighth edition stages II and III disease. Using a team-based approach, we generated 19 recommendations, of which all but one achieved greater than 85% consensus among panel members. A public voting process was initiated, which successfully validated and provided qualitative nuance to our recommendations. Highlights include the following: (1) the critical importance of a multidisciplinary approach to the evaluation of patients with rNSCLC driven by shared clinical decision-making of a multispecialty team of expert providers; (2) biomarker testing for rNSCLC; (3) a preference for neoadjuvant chemoimmunotherapy for stage III rNSCLC; (4) equipoise regarding the optimal management of patients with stage II between upfront surgery followed by adjuvant therapy and neoadjuvant or perioperative strategies; and (5) the robust preference for adjuvant targeted therapy for patients with rNSCLC and sensitizing EGFR and ALK tumor alterations. Our primary goals were to provide practical recommendations sensitive to the global differences in biology and resources for patients with rNSCLC and to provide expert consensus guidance tailored to the individualized patient needs, goals, and preferences in their cancer care journey as these are areas where physicians must make daily clinical decisions in the absence of definitive data. These recommendations will continue to evolve as the treatment landscape for rNSCLC expands and more knowledge is acquired on the best therapeutic approach in specific patient and disease subgroups.
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Affiliation(s)
- Jonathan D Spicer
- Division of Thoracic Surgery and Upper GI Surgery, Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Tina Cascone
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Murry W Wynes
- Scientific Affairs, International Association for the Study of Lung Cancer, Denver, Colorado
| | - Myung-Ju Ahn
- Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Sanja Dacic
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Enriqueta Felip
- Oncology Department, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Patrick M Forde
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin A Higgins
- Department of Radiation Oncology, Emory University, Winship Cancer Institute, Atlanta, Georgia
| | - Mark G Kris
- Thoracic Oncology Service, Division of Solid Tumor Oncology, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Tetsuya Mitsudomi
- Izumi City General Hospital, Izumi, Osaka, Japan; Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| | - Mariano Provencio
- Medical Oncology Department, Puerta de Hierro University Teaching Hospital, Majadahonda, Spain
| | - Suresh Senan
- Cancer Center Amsterdam, Department of Radiation Oncology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Benjamin J Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ming Sound Tsao
- Department of Pathology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Masahiro Tsuboi
- Department of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California; Stanford Cancer Institute, Stanford, California
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong Provincial People's Hospital and Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
| | - James Chih-Hsin Yang
- Department of Oncology, National Taiwan University Hospital and National Taiwan University Cancer Center, Taipei, Taiwan
| | - Caicun Zhou
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - David H Harpole
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Karen L Kelly
- Scientific Affairs, International Association for the Study of Lung Cancer, Denver, Colorado.
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Kida T, Usuda Y, Kobashi T, Sumitomo M. Acute Exacerbation of Rheumatoid Arthritis-Associated Interstitial Lung Disease After Thoracic Surgery in the Absence of Usual Interstitial Pneumonia Pattern on CT. Cureus 2023; 15:e41155. [PMID: 37525786 PMCID: PMC10386909 DOI: 10.7759/cureus.41155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/02/2023] Open
Abstract
The usual interstitial pneumonia (UIP) pattern observed on chest computed tomography (CT) is considered a risk factor for the development of postoperative acute exacerbation in interstitial lung disease (ILD). However, the risk factors for acute exacerbation in patients with rheumatoid arthritis (RA)-associated ILD have not been adequately investigated. We present a case of postoperative acute exacerbation after thoracic surgery in a 73-year-old man with RA-ILD and non-UIP pattern on chest CT. This case report emphasizes that postoperative acute exacerbation can develop even in the absence of a radiological UIP pattern.
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Affiliation(s)
- Tatsuya Kida
- Anesthesiology, Yokosuka Kyōsai Hospital, Yokosuka, JPN
| | - Yutaka Usuda
- Intensive Care Unit, Yokosuka Kyōsai Hospital, Yokosuka, JPN
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