Challenges and controversies in resectable non-small cell lung cancer: a clinician's perspective

Ilias Houda; Chris Dickhoff; Carin A Uyl-de Groot; Ronald A M Damhuis; Noemi Reguart; Mariano Provencio; Antonin Levy; Rafal Dziadziuszko; Cecilia Pompili; Massimo Di Maio; Michael Thomas; Alessandro Brunelli; Sanjay Popat; Suresh Senan; Idris Bahce

doi:10.1016/j.lanepe.2024.100841

Challenges and controversies in resectable non-small cell lung cancer: a clinician's perspective

Lancet Reg Health Eur. 2024 Mar 1:38:100841. doi: 10.1016/j.lanepe.2024.100841. eCollection 2024 Mar.

Authors

Affiliations

¹ Department of Pulmonary Medicine, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
² Department of Cardiothoracic Surgery, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands.
³ Erasmus School of Health Policy & Management/Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.
⁴ Department of Research, Netherlands Comprehensive Cancer Organisation, Godebaldkwartier 419, 3511 DT Utrecht, the Netherlands.
⁵ Department of Medical Oncology, Hospital Clínic de Barcelona, C. de Villarroel, 170, 08036 Barcelona, Spain.
⁶ Department of Medical Oncology, Hospital Universitario Puerta De Hierro, C. Joaquín Rodrigo, 1, Majadahonda, 28222 Madrid, Spain.
⁷ Department of Radiation Oncology, International Center for Thoracic Cancers (CICT), Université Paris Saclay, Gustave Roussy, 114 Rue Edouard Vaillant, 94805 Villejuif, France.
⁸ Faculty of Medicine, Department of Oncology and Radiotherapy, Medical University of Gdańsk, 80-210 Gdańsk, Poland.
⁹ Department of Thoracic Surgery, University and Hospital Trust - Ospedale Borgo Trento, P.Le A. Stefani, 1, 37126 Verona, Italy.
¹⁰ Department of Oncology, University of Turin, Medical Oncology 1U, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy.
¹¹ Department of Thoracic Oncology, Thoraxklinik, Heidelberg University Hospital and National Center for Tumor Diseases (NCT), NCT Heidelberg, A Partnership Between DKFZ and Heidelberg University Hospital, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany.
¹² Translational Lung Research Center Heidelberg (TLRC-H), Member of the German Center for Lung Research, Heidelberg, Germany.
¹³ Department of Thoracic Surgery, St. James's University Hospital, Beckett Street, LS9 7TF Leeds, UK.
¹⁴ Lung Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, SW3 6JJ London, UK.
¹⁵ Department of Radiation Oncology, Amsterdam UMC, Location VU Medical Center, Cancer Center Amsterdam, de Boelelaan 1117, 1081HV Amsterdam, the Netherlands.

Abstract

The treatment landscape of resectable early-stage non-small cell lung cancer (NSCLC) is transforming due to the approval of novel adjuvant and neoadjuvant systemic treatments. The European Medicines Agency (EMA) recently approved adjuvant osimertinib, adjuvant atezolizumab, adjuvant pembrolizumab, and neoadjuvant nivolumab combined with chemotherapy, and the approval of other agents or new indications may follow soon. Despite encouraging results, many unaddressed questions remain. Moreover, the transformed treatment paradigm in resectable NSCLC can pose major challenges to healthcare systems and magnify existing disparities in care as differences in reimbursement may vary across different European countries. This Viewpoint discusses the challenges and controversies in resectable early-stage NSCLC and how existing inequalities in access to these treatments could be addressed.

Keywords: Access to primary care; Adjuvant chemotherapy; Biomarkers; Disease-free survival; Europe; Humans; Immune checkpoint inhibitors; Lung neoplasms; Non-small-cell lung cancer; Protein kinase inhibitors; Surgery; United States; United States Food and Drug Administration.

Publication types

Review