Dr Rosner on Personalizing Approaches to Perioperative Therapy in NSCLC

Samuel Rosner, MD, thoracic oncologist, Medical Oncology, assistant professor of medicine, University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center, discusses ongoing efforts to individualize the use of perioperative/neoadjuvant therapeutic approaches in early-stage, resectable non–small cell lung cancer (NSCLC).

The current approach to perioperative treatment is a "one-size-fits-all" treatment paradigms, Rosner begins. Personalizing perioperative treatment approaches for patients with early-stage lung cancer involves leveraging pretreatment biomarkers and molecular profiling, he says.

One approach is to prioritize surgery followed by targeted therapy based on specific molecular alterations identified in each patient's tumor, Rosner details. For example, patients with EGFR sensitizing alterations, as demonstrated in the phase 3 ADAURA trial (NCT02511106), may benefit from surgery followed by chemotherapy plus osimertinib (Tagrisso). Similarly, patients with other targetable alterations, such as ALK rearrangements, may benefit from ALK inhibitors like those studied in the phase 3 ALINA trial (NCT03456076). Collecting this information at the time of diagnosis is vital to effectively tailoring therapy, Rosner emphasizes.

However, there remains a need to explore the use of targeted therapies in the adjuvant setting for other known targetable alterations, such as ROS1 and NTRK, Rosner notes. Basket trials investigating such agents in the perioperative setting may help confirm their efficacy and guide treatment decisions, he says.

For patients without targetable alterations, PD-L1 expression can help guide therapy, Rosner continues. PD-L1 expression levels can inform the use of neoadjuvant chemotherapy and may predict response to treatment, Rosner explains. Augmenting therapies for patients with low PD-L1 expression or other negative prognostic factors is an important area of research to improve outcomes in this population, he adds.

Overall, integrating biomarkers and molecular profiling into perioperative treatment decisions maximizes therapeutic efficacy and minimizes treatment-related toxicity for patients with early-stage lung cancer, he concludes. Ongoing research and clinical trials will continue to refine these approaches and improve outcomes for patients.