A Canadian Perspective on Perioperative Systemic Therapy in Resectable Non-Small Cell Lung Cancer

TL;DR

This paper reviews how adding cancer treatments before and after surgery can improve outcomes for lung cancer patients in Canada.

Contribution

It provides a Canadian perspective on integrating recent global clinical trial findings into national lung cancer treatment practices.

Findings

Perioperative therapies like immunotherapy and targeted therapy improve survival in early-stage lung cancer.

Checkpoint inhibitors and ctDNA monitoring are emerging tools in lung cancer treatment.

Multidisciplinary care is essential for implementing new therapies in Canada.

Abstract

Lung cancer is the leading cause of cancer death across the globe. The vast majority of cases are a type called non-small cell lung cancer, which includes common subtypes like adenocarcinoma and squamous cell carcinoma. Many patients remain at risk of cancer coming back even after being caught early and surgically removed. Previous studies have shown that adding chemotherapy after surgery helps patients live longer. Recently, major clinical trials have reported that treatments such as immunotherapy and targeted therapy before and/or after surgery (called perioperative therapy) can further improve patients’ chances of living longer without cancer coming back. This review summarizes recent clinical trial data and how they can be integrated into Canadian clinical practice.

The management strategies in resectable non-small cell lung cancer (NSCLC) have changed over the last few years. Despite advancements in surgical techniques and conventional chemotherapy, patients with resectable NSCLC remained at high risk of future recurrence. Clinical trials have demonstrated improvements in response rates, pathological outcomes, and survival with the perioperative approach. Considering the findings of these landmark trials, there is a pressing need to contextualize and incorporate these global developments into the national practice framework. This review outlines key developments from recent clinical trials, with a focus on perioperative strategies in early-stage operable NSCLC from a Canadian perspective. We discuss the integration of checkpoint inhibitors in the perioperative setting for patients without actionable genomic alterations, adjuvant targeted therapies for EGFR and ALK mutant disease, and emerging tools such as ctDNA based minimal residual disease monitoring. The article also addresses the practical challenges of implementing these advances within the Canadian healthcare system, including systemic therapy approvals, barriers, and importance of multidisciplinary care to guide clinicians in optimizing patient outcomes.

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