Neoadjuvant Therapy in Early-Stage NSCLC: Biomarker Discovery and the Role of Digital Pathology and Radiomics
This Lancet Oncology review examines renewed interest in neoadjuvant strategies for early-stage non-small-cell lung cancer, driven by targeted therapy and immunotherapy trials. The authors highlight the discordance between RECIST and pathological response as a catalyst for biomarker discovery, and propose that radiomics and digital pathology could enable individualised, risk-stratified treatment approaches.
The original study
Revisiting neoadjuvant therapy in non-small-cell lung cancer.
- Authors
- Saw SPL, Ong BH, Chua KLM, Takano A, Tan DSW
- Journal
- The Lancet. Oncology
- Type
- Journal Article, Research Support, Non-U.S. Gov't, Review
- PMID
- 34735819
Original abstract
Despite the rapidly evolving treatment landscape in advanced non-small-cell lung cancer (NSCLC), developments in neoadjuvant and adjuvant treatments have been nascent by comparison. Establishing overall survival benefit in the early-stage setting has been challenging because of the need for large trials and long-term survival data. Encouraged by improved treatment outcomes with a biomarker-driven approach in advanced NSCLC, and recognising the need to improve survival outcomes in early-stage NSCLC, there has been renewed interest in revisiting neoadjuvant strategies. Multiple neoadjuvant trials with targeted therapy and immunotherapy, either alone or in combination with chemotherapy, have yielded unique insights into traditional response parameters, such as the discordance between RECIST response and pathological response, and expanded opportunities for biomarker discovery. With further standardisation of trial endpoints across studies, coupled with the implementation of novel technologies including radiomics and digital pathology, individual risk-stratified neoadjuvant treatment approaches are poised to make a striking impact on the outcomes of early-stage NSCLC.