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The Expert Consensus on Perioperative Immunostandardized Treatment of Non-small Cell Lung Cancer was officially released
On May 12, 2024, the "Perioperative Summit Forum on Lung Cancer" hosted by the China Medical Education Association was successfully held, and the first "Expert Consensus on Perioperative Immunostandardized Treatment of Non-small Cell Lung Cancer" (hereinafter referred to as the "Consensus") based on evidence from high-level phase III clinical studies in China was officially released. The Consensus aims to provide a new treatment paradigm and standardized guidance for key issues that need to be solved urgently in the fields of population selection, protocol formulation, pathological evaluation and patient management in the perioperative immunotherapy of lung cancer, so as to help lung cancer patients improve their survival benefits.
Professor Wang Changli from Tianjin Medical University Cancer Hospital, Professor Wang Wenxiang from Hunan Provincial Cancer Hospital, Professor Liu Lunxu from West China Hospital of Sichuan University, Professor Yang Fan from Peking University People's Hospital, Professor Zhang Lanjun from Sun Yat-sen University Cancer Prevention and Treatment Center, Professor Zhang Peng from Shanghai Pulmonary Hospital, Professor Chen Chun from Union Hospital of Fujian Medical University, Professor Hu Jian from the First Affiliated Hospital of Zhejiang University School of Medicine, Professor Jiang Jie from the First Affiliated Hospital of Xiamen University, Professor Huang Yunchao from Yunnan Provincial Cancer Hospital, and China Clinical Oncology Liu Huiqin, director of the editorial department, served as the co-chair of the conference, and conducted in-depth discussions on topics such as perioperative diagnosis and treatment challenges, clinical data and innovative research results of lung cancer in China, and discussed the high-quality development of perioperative treatment of lung cancer in mainland China. More than 50 interdisciplinary experts in the field of lung cancer diagnosis and treatment from all over the country participated in the conference discussion.
Photo 1: The first expert consensus on perioperative immunotherapy for lung cancer based on high-level evidence has been released
Focus on the perioperative diagnosis and treatment dilemma of lung cancer to improve the survival benefits of patients
Lung cancer is one of the malignancies that pose the greatest threat to public health and public health. In 2022, there will be about 1.06 million new cases of lung cancer and about 730,000 deaths in mainland China, ranking first in terms of incidence and mortality among malignant tumors. Among them, non-small cell lung cancer (NSCLC) is the main pathological type of lung cancer, accounting for about 80%-85% of all lung cancer cases. About 30% of NSCLC patients can be surgically resected at the first diagnosis, and they are in the early and middle stages of the disease.
Although surgical resection is an important means of cure for many patients with early-to-mid-stage NSCLC, it is not a one-time solution. In clinical practice, 52% to 75% of patients with stage II-III NSCLC will have local recurrence or distant metastasis within 5 years after surgery. Therefore, perioperative treatment, as an important adjunct to surgery, has become an indispensable part of the whole process management of NSCLC.
The "perioperative period" refers to the period of time from the patient's decision to undergo surgical treatment to the end of the surgery-related treatment, including three stages: preoperative, intraoperative and postoperative. In the past, chemotherapy was the mainstay of perioperative anti-tumor therapy, but the effect on the improvement of 5-year survival rate of patients has not been significant. Exploring more effective perioperative anti-tumor treatment drugs and improving the prognosis of patients with early and mid-stage NSCLC have become clinical problems that need to be solved urgently.
In recent years, immunotherapy regimens represented by PD-1/PD-L1 inhibitors have made breakthroughs in the perioperative treatment of NSCLC. With the positive results of multiple phase III clinical studies, perioperative immunotherapy has been proven to be effective in reducing the risk of postoperative recurrence and improving the survival benefit of patients.
Professor Wang Changli from Tianjin Medical University Cancer Hospital said, "As a surgeon, it is our common goal to help patients with early- and mid-stage NSCLC achieve clinical cure through surgery. With the advent of immunotherapy, the diagnosis and treatment of stage II-III NSCLC has changed from a single operation to a comprehensive treatment model of surgery combined with perioperative drug therapy. How to guide the majority of clinicians to standardize the application, it is necessary to actively seek innovative solutions. The release of the "Consensus" is mainly based on the evidence of eight recent high-level phase III clinical studies, and systematically provides standardized application guidance for common problems in the clinical practice of perioperative immunotherapy, so as to help patients solve practical problems, so that patients can more fully benefit from innovative treatment methods, and contribute to the early realization of the grand vision of 'Healthy China 2030' in mainland China." ”
Professor Huang Yunchao of Yunnan Provincial Cancer Hospital emphasized: "Surgical methods and techniques continue to be streamlined, but they can only solve the local problems of lung cancer. With the in-depth understanding of tumor occurrence and development, we found that tumors are heterogeneous and complex, and a variety of factors will lead to the recurrence of lung cancer after surgery, so it is necessary to formulate an individualized comprehensive treatment plan of surgery combined with perioperative to reduce recurrence and achieve the goal of cure. ”
Professor Zhang Lanjun of the Cancer Center of Sun Yat-sen University pointed out: "Due to the heterogeneity of lung cancer patients, surgery alone cannot solve the patient's problem, we will combine anti-tumor drug treatment before and after surgery, which is perioperative treatment, and perioperative treatment has five major purposes: first, preoperative tumor shrinkage and downstaging, to maximize the chance of radical resection; 2. Improve the rate of R0 resection; 3. Reduce the rate of pneumonectomy; 4. Eliminate micrometastases and effectively reduce the risk of postoperative recurrence of patients; 5. Improve the survival benefit of patients. ”
Professor Liu Lunxu from West China Hospital of Sichuan University said: "Perioperative immunotherapy can significantly reduce the risk of postoperative recurrence and improve the cure rate of patients with NSCLC in the early and middle stages by immune-activating and killing tumor cells. For patients, the treatment path has changed from direct surgery to preoperative and postoperative perioperative immunotherapy, and some patients may worry about the delay of preoperative treatment, so doctors need to let patients understand that surgery combined with perioperative treatment is an organic whole, which is the best treatment plan at present, so that patients can have a positive attitude and better cooperate with doctors. ”
Based on high-level clinical evidence, it provides standardized guidance for the clinical frontline
According to Professor Wang Changli, the consensus released this time was composed of nearly 30 multidisciplinary experts from various provinces and cities across the country, such as thoracic surgery, internal medicine, pathology, etc., and a consensus expert group was formed, and a total of 17 consensus opinions were formed. Guided by this Consensus, clinicians will be able to better develop more standardized and individualized treatment plans for the perioperative treatment of patients with NSCLC in the early and intermediate stages.
Photo 2: Some members of the expert group on the development of the Consensus share the background and key points of the Consensus
Professor Zhang Zhenfa from the Affiliated Cancer Hospital of Tianjin Medical University introduced: "Perioperative immunotherapy, as an emerging treatment method, has great differences in domestic clinical practice, and there are many clinical problems in how to better apply this new treatment method, and there is an urgent need to form consistent guidance and suggestions nationwide, which is also the purpose of the expert consensus, to improve the cure rate of lung cancer patients by guiding the clinical practice of the majority of doctors." ”
Professor Wang Wenxiang from Hunan Provincial Cancer Hospital said: "The consensus evidence is mainly based on eight phase III clinical studies, including two studies led by Chinese doctors. Taking the RATIONALE-315 study as an example, a total of 49 centers across the country participated in the study, and achieved very good results, the first outstanding result was a high complete pathological response rate (pCR) of 41%, which means that the resected tumors of these patients are completely free of viable tumor cells; The second outstanding result was a significant reduction in the risk of recurrence and progression, with a 44% reduction in risk, which means that radical surgery can truly achieve clinical radical cure, which is of great significance to surgical patients. Chinese thoracic surgeons are participating in and leading the frontier of perioperative immunotherapy for lung cancer, contributing China's strength to the majority of lung cancer patients. ”
Liu Huiqin, Director of the Editorial Department of China Clinical Oncology, said: "Medical professional journals are an important carrier for the presentation and exchange of medical achievements, especially after the emergence of new treatment methods in the field. On the other hand, through multi-channel publicity channels, including thematic seminars, online multi-platforms, etc., we will expand our influence and make the consensus better benefit grassroots doctors and patients. ”
After the official release of the "Consensus", the China Medical Education Association will successively carry out a series of activities across the country to "Expert Consensus Tour on Perioperative Immunological Standardized Treatment of Non-small Cell Lung Cancer", through the interpretation of the "Consensus", to guide the application and practice of clinical front-line more extensively, and to help the diagnosis and treatment of NSCLC in mainland China to further move towards standardized and high-quality development.
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