A Paradigm Shift in Perioperative Treatment for Lung Cancer

Abstract

Perioperative treatment of locally advanced non-small cell lung cancer is undergoing a major transition for the first time in nearly a decade. In the 2020s, drugs that have benefited advanced lung cancers, such as molecularly targeted drugs and immune checkpoint inhibitors, have shifted to perioperative treatment and demonstrated a high therapeutic efficacy. In addition to preoperative nivolumab and pre-and post-operative pembrolizumab, adjuvant atezolizumab, osimertinib, and alectinib have been approved in Japan for perioperative treatment with new agents, and new treatment options are expected to increase in the future. On the other hand, the lack of clear criteria for selecting from these diverse perioperative treatments remains a challenge. Histopathologic response rate of resected lesions and minimal residual disease (MRD) have attracted attention as valid indicators, and more knowledge is expected to be accumulated. In this manuscript, I will refer to latest insights for perioperative treatment in patients with lung cancer including neuroendocrine carcinoma (NEC) observed in many organs.