Author丨Li Zhiyuan
Layout Designer丨Cecilia Qin
BACKGROUND According to the data released by China's National Cancer Center, in 2022 alone, the number of lung cancer cases in China will be 828 thousand and the number of deaths will be 657 thousands, which means that there will be 13 lung cancer patients die every ten minutes. The same situation has also occurred in other countries around the world, including the United States. In the US, approximately 350 people die from lung cancer every day in 2022. Lung cancer tops the list in terms of both mortality and incidence rate.
Although many countries have been promoting regular physical examinations and early detection and treatment for cancer. Unfortunately, the 5-year survival rate of resettable lung cancer patients from stage IB to stage IIIA is only 68% to 36%, which means that despite postoperative tumor resection, there are still many lung cancer patients who fail treatment. With the development of tumor treatment technology, there are now various tumour treatment methods, including chemotherapy radiation therapy, surgery, targeted therapy, biological therapy, immunotherapy, and new monoclonal antibody therapy.
CHEMOTHERAPY
Chemotherapy, one of the most traditional treatment methods, achieves therapeutic goals by using chemotherapy drugs to kill cancer cells. Chemotherapy is more suitable for malignant tumors that are sensitive to chemotherapy, such as SCLC, while the NSCLC mentioned in this article does not belong to the tumor type that is sensitive to chemotherapy, so chemotherapy is not the first choice when treating NSCLC. Meanwhile, as a cytotoxic drug, the occurrence of side effects is inevitable. Digestive system reactions such as nausea and diarrhoea; Bone marrow suppression such as reduction of white blood cells and platelets; Hair loss is also the most common side effect.
RADIOTHERAPY AND SURGERY
Radiotherapy and surgery: Radiotherapy is a local treatment method that uses radiation to treat tumors. Radiation, including those generated by radioactive isotopes α、β、γ X-rays and various types of X-rays. Approximately 70% of cancer patients require radiation therapy during the treatment process. Like surgery, radiotherapy belongs to local treatment and is only effective for tumors at the treatment site. It is difficult to effectively treat potential metastatic lesions (cancer cells have actually metastasized but cannot be detected and detected clinically due to technical limitations) and cancers that have already undergone clinical metastasis.
THE NEW ONE
Traditional chemotherapy methods have only improved 5-year survival rates by 5.4% and 5%, respectively, in terms of NSCLC adjuvant therapy and neoadjuvant therapy compared to traditional chemotherapy methods. With the progress of research, axitinib has become the first targeted therapeutic drug approved for adjuvant therapy, with Navulizumab and Atilizumab becoming the first immune drugs approved for neoadjuvant therapy and adjuvant therapy, respectively. At the 2023 AACR conference, AEGEAN, as the first phase III study to announce the results of the "neoadjuvant immunity+surgery+adjuvant immunity" treatment model, provided new ideas for the treatment of NSCLC and is expected to greatly improve patient survival.
AEGEAN's study is a randomized, controlled, double-blind, international multicenter phase III clinical trial to evaluate the efficacy and safety of Duvalizumab in a "neoadjuvant immunotherapy + surgical resection + postoperative adjuvant immunotherapy" regimen for resettable IIA IIIB (N2) NSCLC patients without EGFR and ALK mutations. A total of 820 patients were included in the study, randomly assigned 1:1 to the experimental group and the control group (experimental group: neoadjuvant treatment of 1500mg of vallizumab+platinum containing dual drug chemotherapy Q3W, lasting for 4 courses, adjuvant treatment of 1500mg of vallizumab Q4W, lasting for 12 courses; control group: neoadjuvant treatment placebo + chemotherapy, adjuvant treatment placebo). The stratification factors were disease stage (Phase II vs. Phase III) and PD-L1 expression (<1% vs. ≥ 1%). The main endpoints of the study were pCR and EFS, while the key secondary endpoints were MPR, OS, DFS, safety, and quality of life.
Through research, it has been found that compared with the use of neoadjuvant chemotherapy alone, the perioperative use of vallizumab combined with neoadjuvant chemotherapy significantly improves the pCR and EFS of resectable NSCLC patients. This proves that the treatment strategy of neoadjuvant immunity+surgery+adjuvant immunity can effectively improve patient survival and treatment success rate. Meanwhile, according to the research results, the proportion of stage III N2 patients has reached 50%, but the treatment effect has not been affected, which proves that this method also has a good control effect on lymph node metastasis.
We hope that more and more new treatment strategies can demonstrate higher cure rates and patient survival rates, and we also hope that more PD-L1 can be added to the ranks of tumor treatment drugs.
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