For patients with early and mid-stage non-small cell lung cancer (NSCLC), complete tumor resection is not the end point. It is still necessary to be alert to tumor recurrence, metastasis and the occurrence of the second primary tumor .
Postoperative adjuvant treatment is to carry out medication or other forms of treatment after surgery, the purpose is to further improve long-term survival. At present, the most commonly used postoperative adjuvant chemotherapy can improve the 5-year survival rate of by about 5% . However, targeted therapy has opened a new era in the treatment of advanced NSCLC, and the "front wave" of chemotherapy is also being beaten to death on the beach.
For postoperative NSCLC patients, is it necessary to take targeted drugs? How to choose adjuvant chemotherapy and adjuvant targeted therapy?
April 14, 2021 , the National Food and Drug Administration (NMPA) has formally approved 2span strong strong 2 _strong_strong (Osimertinib) is used for the treatment of non-small cell lung cancer (NSCLC) patients with epidermal growth factor receptor (EGFR) exon 19 deletion or exon 21 (L858R) replacement mutation in stage IB-IIIA,The patient must have previously undergone surgical resection, and the doctor will decide whether to accept or not to accept adjuvant chemotherapy.
This is undoubtedly a major event comparable to the "generation change" for operable early and mid-term patients who account for about 30% of NSCLC. The "Patient Guide" has deliberately sorted out common questions about adjuvant targeted therapy for your reference.
01 Why did it recur after the operation?
Before diagnosis and treatment, the primary tumor often releases a large number of cancer cells into the blood circulation. Most of the cancer cells that enter the blood or healthy tissues die early, but there are still a few cells as "latent seeds" Survive in the host tissue. Once these "latent seeds" are activated, their growth capacity is 200 times that of normal cancer cells.
Therefore, even if the tumor is clinically observed that the tumor has disappeared, as long as a small amount of "latent seeds" remain, there is a possibility of tumor recurrence or metastasis.
02 What is the probability of tumor recurrence?
For stage I~II NSCLC after complete resection, about 20%~40% patients will have local or distant recurrence. Patients with tumor staging have a higher risk of recurrence and metastasis, and patients with stage IIIA develop intracranial metastasis earlier than patients with stage II.
More than 50% of tumor recurrence and metastasis occurred in the first 2 years after surgery ,However, the risk of recurrence and metastasis is still high in 3 to 5 years after surgery, and the risk of tumor recurrence and metastasis is not significantly reduced until 5 years after surgery.
In addition to recurrence and metastasis, early and mid-stage postoperative patients should also be alert to the risk of second primary lung cancer. Unlike the risk of recurrence and metastasis decreasing over time, the risk of the second primary tumor is relatively stable, generally 1% to 6% per person per year.
03 Is adjuvant chemotherapy useful?
Adjuvant chemotherapy is currently the most widely used treatment. Although it can bring survival benefits, has relatively limited benefits. is unsatisfactory, and the 5-year survival rate is only increased by about 5%.
And, chemotherapy drugs have greater side effects , adjuvant chemotherapy requires a full assessment of the patient’s condition, poor physical condition, severe liver and kidney dysfunction, or severe comorbidities Adjuvant chemotherapy, active infection, persistent fever, severe bleeding tendency, abnormal hematopoietic function (low hemoglobin, white blood cells, and platelets), etc., are not suitable for adjuvant chemotherapy.
04 Is adjuvant targeted therapy useful?
from the Phase III study of adjuvant treatment of osimertinib (ADAURA), Phase III study of adjuvant treatment of gefitinib (ADJUVANT), Phase III study of adjuvant treatment of icotinib (EVIDENCE) and Ergonomics According to the results of randomized controlled clinical trials such as the Phase II study (EVAN) of lotinib adjuvant therapy,EGFR tyrosine kinase inhibitor (TKI) adjuvant therapy can prolong the disease-free survival of patients with EGFR mutation-positive early and mid-term NSCLC (the time from tumor removal to reappearance of the lesion) , among them, Aoshi Tinib can significantly reduce the risk of brain metastases.
05 I have received chemotherapy, do I still need to take targeted drugs?
Asian population lung adenocarcinoma EGFR gene mutation positive rate is about 50%. For non-small cell lung cancer patients who need postoperative adjuvant treatment, it is recommended that EGFR gene mutation detection be performed simultaneously when the pathological specimens are routinely diagnosed after surgery.
When using EGFR-TKI for adjuvant therapy, either EGFR-TKI single agent or adjuvant chemotherapy followed by EGFR-TKI therapy can be used. The decision needs to be made according to the patient's risk, physical condition and personal wishes.
For EGFR mutation-positive patients who have received adjuvant chemotherapy, they can continue to receive the third-generation EGFR-TKI osimertinib adjuvant therapy, and the start of osimertinib adjuvant therapy should be no later than 26 week. The duration of adjuvant EGFR-TKI treatment after surgery is not less than 2 years.
06 Does everyone need adjuvant therapy?
Previous research found thatStage IA patients receive adjuvant chemotherapy without benefit, and most studies of adjuvant targeted therapy did not include stage IA patients. Therefore, stage IA recommends regular follow-up after surgery. does not recommend adjuvant chemotherapy.
In stage IB, EGFR mutation-negative patients have high-risk factors (poorly differentiated tumors, visceral pleural invasion, vascular invasion, intragastric dissemination), is not recommended in routine 6strong Chemotherapy; EGFR mutation-positive patients may consider using osimertinib as adjuvant therapy.
07 What should I pay attention to in the adjuvant treatment of stage III patients?
stage III NSCLC patients have a higher risk of brain metastasis, and adjuvant osimertinib therapy can reduce the risk of brain metastasis or death 82%, osimertinib is recommended for stage III patients treatment.
Reference source:
Reference source:
. Journal of Modern Urogenital Oncology, 2017, 9(06): 321-324.
[2] Lung Cancer Professional Committee of Chinese Anti-Cancer Association, Lung Cancer Group of Oncology Branch of Chinese Medical Association, Chinese Thoracic Tumor Research Collaborative Group. Ⅰ ~ Guidelines for adjuvant treatment after complete resection of stage ⅢB non-small cell lung cancer (2021 edition) [J]. Chinese Medical Journal,2021,101(16):1132-1142.
[3] CSCO non-small cell lung cancer diagnosis and treatment Guide.
Image source: photo.com
It is not to be used as a commercial promotion of any drug or a recommendation for a diagnosis and treatment plan. All data is for reference only, please follow the guidance of doctors or other professionals for specific medical advice.
.
