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作者：SCI天天读
SCI
16 May 2024
Perioperative Immunotherapy for Node-Negative Non-Small Cell Lung Cancer - Current Evidence and Future Directions
（The Annals of Thoracic Surgery; if=4.6）
Shahzad MH, Spicer JD, Rusch VW, Kneuertz PJ.
Correspondence: peter.kneuertz@osumc.edu
Neoadjuvant immunotherapy has gone from an idea to an indication in locally advanced lung cancer. Several phase III trials have demonstrated the superiority of neoadjuvant chemoimmunotherapy compared to chemotherapy in this setting. Although such progress has revolutionized the treatment of locally advanced disease, the unmet needs of stage I and stage II patients without lymph node disease have largely been under-represented in existing trials. Up-front surgery with few patients going on to complete adjuvant therapy remains the norm for most stage I-II patients. Emerging evidence now supports the exploration of supplemental checkpoint blockade in well-selected early-stage, node-negative patients with large tumors and no actionable driver mutations. Although concerns surrounding safety and risk exist, patient selection could be substantially improved using novel biomarker approaches that leverage our understanding of the tumor immune microenvironment of lung cancer. This review provides a comprehensive overview of the opportunities and controversies of perioperative immunotherapy in node-negative lung cancer.
新辅助免疫疗法已经从一种想法变成了局部晚期癌症的适应症。几项III期试验已经证明，与这种情况下的化疗相比，新辅助化学免疫疗法具有优越性。尽管这一进展彻底改变了局部晚期疾病的治疗，但在现有试验中，没有淋巴结疾病的I期和II期患者未满足的需求在很大程度上没有得到充分体现。对于大多数I-II期患者来说，先期手术而很少有患者继续完成辅助治疗仍是常态。现在，新的证据支持对经过严格筛选的早期、结节阴性、肿瘤较大且无可操作驱动基因突变的患者进行辅助检查点阻断治疗。尽管存在对安全性和风险的担忧，但使用新的生物标志物方法，利用我们对癌症肿瘤免疫微环境的理解，可以显著改善患者选择。这篇综述全面概述了无淋巴结转移肺癌围手术期免疫治疗的机会和争议。
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