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Ungvari Z, Fekete M, Buda A, Lehoczki A, Fekete JT, Munkácsy G, Varga P, Ungvari A, Győrffy B. No detectable impact of short-term treatment delays on lung cancer survival. GeroScience 2025:10.1007/s11357-025-01684-9. [PMID: 40332453 DOI: 10.1007/s11357-025-01684-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2025] [Accepted: 04/25/2025] [Indexed: 05/08/2025] Open
Abstract
Timely initiation of treatment is a core principle of oncologic care, especially for aggressive cancers such as lung cancer. However, the real-world impact of short-term delays in treatment initiation on survival outcomes in lung cancer remains unclear. This meta-analysis evaluates the association between treatment delays of 4, 8, and 12 weeks and all-cause mortality in lung cancer patients. A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published between 2000 and 2025. Of 5360 screened records, 15 studies were included, comprising 16 cohorts for overall survival of lung cancer patients. Hazard ratios (HRs) for 4-, 8-, and 12-week treatment delays were estimated using random-effects meta-analyses. Heterogeneity was measured with the I2 statistic, and publication bias was assessed using funnel plots and Egger's test. No significant association was found between treatment delay and survival at any of the time points. Pooled HRs were 1.00 (95% CI, 0.99-1.02) for a 4-week delay, 1.01 (95% CI, 0.99-1.03) for an 8-week delay, and 1.01 (95% CI, 0.98-1.05) for a 12-week delay. Despite high heterogeneity (I2 = 97%), no evidence of publication bias was detected. This meta-analysis found no significant impact of short-term treatment delays (up to 12 weeks) on mortality in lung cancer patients. These findings challenge the assumption that brief delays universally worsen outcomes and underscore the importance of individualized treatment planning and prioritization.
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Affiliation(s)
- Zoltan Ungvari
- Vascular Cognitive Impairment, Neurodegeneration and Healthy Brain Aging Program, Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK, USA
- Oklahoma Center for Geroscience and Healthy Brain Aging, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- International Training Program in Geroscience, Doctoral College, Health Sciences Division/Institute of Preventive Medicine and Public Health, Semmelweis University, Budapest, Hungary
| | - Mónika Fekete
- Institute of Preventive Medicine and Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary
- Jozsef Fodor Center for Prevention and Healthy Aging, Semmelweis University, Budapest, Hungary
- Department of Public Health and Epidemiology, Faculty of Medicine, HUN-REN-DE Public Health Research Group, University of Debrecen, 4012, Debrecen, Hungary
| | - Annamaria Buda
- Institute of Preventive Medicine and Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary
- Jozsef Fodor Center for Prevention and Healthy Aging, Semmelweis University, Budapest, Hungary
- Doctoral College, Health Sciences Division, Semmelweis University, Budapest, Hungary
| | - Andrea Lehoczki
- Institute of Preventive Medicine and Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary
- Jozsef Fodor Center for Prevention and Healthy Aging, Semmelweis University, Budapest, Hungary
- Doctoral College, Health Sciences Division, Semmelweis University, Budapest, Hungary
| | - János Tibor Fekete
- Dept. of Bioinformatics, Semmelweis University, 1094, Budapest, Hungary
- Cancer Biomarker Research Group, Institute of Molecular Life Sciences, HUN-REN Research Centre for Natural Sciences, 1117, Budapest, Hungary
| | - Gyöngyi Munkácsy
- Dept. of Bioinformatics, Semmelweis University, 1094, Budapest, Hungary
- Cancer Biomarker Research Group, Institute of Molecular Life Sciences, HUN-REN Research Centre for Natural Sciences, 1117, Budapest, Hungary
| | - Péter Varga
- Institute of Preventive Medicine and Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary
- Jozsef Fodor Center for Prevention and Healthy Aging, Semmelweis University, Budapest, Hungary
- Doctoral College, Health Sciences Division, Semmelweis University, Budapest, Hungary
| | - Anna Ungvari
- Institute of Preventive Medicine and Public Health, Semmelweis University, Semmelweis University, Budapest, Hungary.
- Jozsef Fodor Center for Prevention and Healthy Aging, Semmelweis University, Budapest, Hungary.
| | - Balázs Győrffy
- Dept. of Bioinformatics, Semmelweis University, 1094, Budapest, Hungary
- Cancer Biomarker Research Group, Institute of Molecular Life Sciences, HUN-REN Research Centre for Natural Sciences, 1117, Budapest, Hungary
- Dept. of Biophysics, Medical School, University of Pecs, 7624, Pecs, Hungary
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2
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Sbeih D, Idkedek M, Abu Akar F. Video-Assisted vs. Robotic-Assisted Thoracoscopic Surgery in Lung Cancer: A Comprehensive Review of Techniques and Outcomes. J Clin Med 2025; 14:1598. [PMID: 40095572 PMCID: PMC11901036 DOI: 10.3390/jcm14051598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2025] [Revised: 02/17/2025] [Accepted: 02/24/2025] [Indexed: 03/19/2025] Open
Abstract
Lung cancer is the primary cause of cancer-related mortality globally; hence, several medical and surgical approaches have been developed for its management. This can be easily recognized with the evolution from the traditional open thoracotomy toward minimally invasive procedures-in particular, video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS)-in treating lung cancer. There has been a lot of controversy around the advantages and limitations of these procedures. VATS has been proven to be beneficial in treating early-stage lung cancer. Yet, the restricted mobility of its instruments, as well as the lack of a three-dimensional visualization of anatomical components, make the new RATS desired. RATS uses advanced technology, which has resulted in an exceptional high-definition, three-dimensional image of the working field. This has also led to fine dissection with great precision and accuracy, better lymph node removal, reduced postoperative recovery time, and better outcomes. Compared to VATS, there is less blood loss, shorter hospital stays, and less pleural effusion drainage. Despite its higher cost due to the expensive surgical systems, training and maintenance fees, and longer operative time, RATS has started to gain more use, potentially enhancing patient outcomes as experience and technological improvements progress.
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Affiliation(s)
- Dina Sbeih
- Faculty of Medicine, Al-Quds University, East Jerusalem 20002, Palestine; (D.S.); (M.I.)
| | - Mayar Idkedek
- Faculty of Medicine, Al-Quds University, East Jerusalem 20002, Palestine; (D.S.); (M.I.)
| | - Firas Abu Akar
- Department of General Surgery, Faculty of Medicine, Al-Quds University, East Jerusalem 20002, Palestine
- Department of Thoracic Surgery, The Edith Wolfson Medical Center, Holon 58100, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Haesevoets S, Arents E, Cops D, Quadflieg K, Criel M, Ruttens D, Daenen M, Stevens D, Surmont V, Demeyer H, Burtin C. The impact of lung surgery, with or without (neo-)adjuvant therapy, on physical functioning in patients with nonsmall cell lung cancer: a scoping review. Eur Respir Rev 2025; 34:240156. [PMID: 39971396 PMCID: PMC11836670 DOI: 10.1183/16000617.0156-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 11/05/2024] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Patients with early stage (I-IIIA) nonsmall cell lung cancer (NSCLC) are typically treated via surgery, often accompanied by (neo-)adjuvant therapy. These interventions impose a significant burden on patients and potentially impact their physical functioning (PF). The impact on PF remains uncertain and existing evidence has not yet been systematically outlined. OBJECTIVE This scoping review aimed to synthesise evidence concerning the effects of lung surgery, with or without (neo-)adjuvant therapy, on the PF of patients with NSCLC. METHODS PubMed, Web of Science and Cochrane databases were systematically searched from inception until 1 July 2023. A comprehensive framework based on the International Classification of Functioning, Disability, and Health was used to define various aspects of PF. Longitudinal studies, reporting PF prior to and after NSCLC treatment, and cross-sectional studies reporting PF after treatment were included. RESULTS 85 included studies assessed the effects of surgery with (n=7) or without (n=78) (neo-) adjuvant therapy on body function (n=29), activity (n=67) and/or participation (n=15). 98% of reported outcomes within the longitudinal studies indicate a decline in PF, with 52% demonstrating significant deteriorations, with follow-up times ranging from immediately post-operative up to 1 year after treatment. Cross-sectional studies show impaired PF in 71% of reported outcomes. CONCLUSION PF of patients with NSCLC tends to deteriorate following lung surgery, irrespective of additional (neo-)adjuvant therapy. While the negative impact of lung surgery on ICF categories of "body function" and "activity" have been described to some depth, insights into the impact on "participation" are lacking.
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Affiliation(s)
- Sarah Haesevoets
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- Shared first authorship
| | - Eva Arents
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Shared first authorship
| | - Dries Cops
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Kirsten Quadflieg
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
| | - Maarten Criel
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
| | - David Ruttens
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
| | - Marc Daenen
- Department Lung Diseases, Ziekenhuis Oost-Limburg, Genk, Belgium
- Faculty of Medicine and Life Science, Hasselt University, Hasselt, Belgium
| | | | | | - Heleen Demeyer
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- Shared last authorship
| | - Chris Burtin
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- BIOMED - Biomedical Research Institute, Hasselt University, Diepenbeek, Belgium
- Shared last authorship
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Zhang X, Zhang Y, Zhang S, Wang S, Yang P, Liu C. Investigate the application of postoperative ctDNA-based molecular residual disease detection in monitoring tumor recurrence in patients with non-small cell lung cancer--A retrospective study of ctDNA. Front Oncol 2023; 13:1098128. [PMID: 37091156 PMCID: PMC10115944 DOI: 10.3389/fonc.2023.1098128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 02/20/2023] [Indexed: 04/25/2023] Open
Abstract
Purpose To evaluate whether postoperative circulating tumor DNA (ctDNA) in plasma of patients with non-small cell lung cancer (NSCLC) can be used as a biomarker for early detection of molecular residual disease (MRD) and prediction of postoperative recurrence. Methods This study subjects were evaluated patients with surgical resected non-small cell lung cancer. All eligible patients underwent radical surgery operation followed by adjuvant therapy. Tumor tissue samples collected during operation were used to detect tumor mutation genes, and blood samples collected from peripheral veins after operation were used to collect ctDNA. Molecular residue disease (MRD) positive was defined as at least 1 true shared mutation identified in both the tumor sample and a plasma sample from the same patient was. Results Positive postoperatively ctDNA was associated with lower recurrence-free survival (RFS).The presence of MRD was a strong predictor of disease recurrence. The relative contribution of ctDNA-based MRD to the prediction of RFS is higher than all other clinicopathological variables, even higher than traditional TNM staging. In addition, MRD-positive patients who received adjuvant therapy had improved RFS compared to those who did not, the RFS of MRD-negative patients receiving adjuvant therapy was lower than that of patients not receiving adjuvant therapy. Conclusions Post-operative ctDNA analysis is an effective method for recurrence risk stratification of NSCLC, which is beneficial to the management of patients with NSCLC.
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Affiliation(s)
- Xuefei Zhang
- Department of Thoracic Surgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Youguo Zhang
- Department of Thoracic Surgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Shanli Zhang
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, China
| | - Sha Wang
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, China
| | - Peng Yang
- Geneseeq Research Institute, Nanjing Geneseeq Technology Inc., Nanjing, Jiangsu, China
| | - Changhong Liu
- Department of Thoracic Surgery, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China
- *Correspondence: Changhong Liu,
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5
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Mangiameli G, Cioffi U, Testori A. Lung Cancer Treatment: From Tradition to Innovation. Front Oncol 2022; 12:858242. [PMID: 35692744 PMCID: PMC9184755 DOI: 10.3389/fonc.2022.858242] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
Lung cancer (LC) is the second most commonly diagnosed cancer and the primary cause of cancer death worldwide in 2020. LC treatment is associated with huge costs for patients and society; consequently, there is an increasing interest in the prevention, early detection with screening, and development of new treatments. Its surgical management accounts for at least 90% of the activity of thoracic surgery departments. Surgery is the treatment of choice for early-stage non-small cell LC. In this article, we discuss the state of the art of thoracic surgery for surgical management of LC. We start by describing the milestones of LC treatment, which are lobectomy and an adequate lymphadenectomy, and then we focus on the traditional and innovative minimally invasive surgical approaches available: video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS). A brief overview of the innovation and future perspective in thoracic surgery will close this mini-review.
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Affiliation(s)
- Giuseppe Mangiameli
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Ugo Cioffi
- Department of Surgery, University of Milan, Milan, Italy
| | - Alberto Testori
- Division of Thoracic Surgery, IRCCS Humanitas Research Hospital, Milan, Italy
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6
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Prieto-Garcia C, Hartmann O, Reissland M, Braun F, Bozkurt S, Pahor N, Fuss C, Schirbel A, Schülein-Völk C, Buchberger A, Calzado Canale MA, Rosenfeldt M, Dikic I, Münch C, Diefenbacher ME. USP28 enables oncogenic transformation of respiratory cells and its inhibition potentiates molecular therapy targeting mutant EGFR, BRAF and PI3K. Mol Oncol 2022; 16:3082-3106. [PMID: 35364627 PMCID: PMC9441007 DOI: 10.1002/1878-0261.13217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/04/2022] [Accepted: 03/29/2022] [Indexed: 11/23/2022] Open
Abstract
Oncogenic transformation of lung epithelial cells is a multistep process, frequently starting with the inactivation of tumour suppressors and subsequent development of activating mutations in proto‐oncogenes, such as members of the PI3K or MAPK families. Cells undergoing transformation have to adjust to changes, including altered metabolic requirements. This is achieved, in part, by modulating the protein abundance of transcription factors. Here, we report that the ubiquitin carboxyl‐terminal hydrolase 28 (USP28) enables oncogenic reprogramming by regulating the protein abundance of proto‐oncogenes such as c‐JUN, c‐MYC, NOTCH and ∆NP63 at early stages of malignant transformation. USP28 levels are increased in cancer compared with in normal cells due to a feed‐forward loop, driven by increased amounts of oncogenic transcription factors such as c‐MYC and c‐JUN. Irrespective of oncogenic driver, interference with USP28 abundance or activity suppresses growth and survival of transformed lung cells. Furthermore, inhibition of USP28 via a small‐molecule inhibitor resets the proteome of transformed cells towards a ‘premalignant’ state, and its inhibition synergizes with clinically established compounds used to target EGFRL858R‐, BRAFV600E‐ or PI3KH1047R‐driven tumour cells. Targeting USP28 protein abundance at an early stage via inhibition of its activity is therefore a feasible strategy for the treatment of early‐stage lung tumours, and the observed synergism with current standard‐of‐care inhibitors holds the potential for improved targeting of established tumours.
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Affiliation(s)
- Cristian Prieto-Garcia
- Protein Stability and Cancer Group, University of Wuerzburg, Department of Biochemistry and Molecular Biology, Wuerzburg, Germany.,Mildred Scheel Early Career Center, Wuerzburg, Germany.,Molecular Signaling Group, Institute of Biochemistry II, Goethe University, Frankfurt, Germany
| | - Oliver Hartmann
- Protein Stability and Cancer Group, University of Wuerzburg, Department of Biochemistry and Molecular Biology, Wuerzburg, Germany.,Mildred Scheel Early Career Center, Wuerzburg, Germany
| | - Michaela Reissland
- Protein Stability and Cancer Group, University of Wuerzburg, Department of Biochemistry and Molecular Biology, Wuerzburg, Germany.,Mildred Scheel Early Career Center, Wuerzburg, Germany
| | - Fabian Braun
- Protein Stability and Cancer Group, University of Wuerzburg, Department of Biochemistry and Molecular Biology, Wuerzburg, Germany.,Mildred Scheel Early Career Center, Wuerzburg, Germany
| | - Süleyman Bozkurt
- Protein quality control, Institute of Biochemistry II, Goethe University, Frankfurt, Germany
| | - Nikolett Pahor
- Protein Stability and Cancer Group, University of Wuerzburg, Department of Biochemistry and Molecular Biology, Wuerzburg, Germany.,Mildred Scheel Early Career Center, Wuerzburg, Germany
| | - Carmina Fuss
- Protein Stability and Cancer Group, University of Wuerzburg, Department of Biochemistry and Molecular Biology, Wuerzburg, Germany.,Mildred Scheel Early Career Center, Wuerzburg, Germany.,Department of Internal Medicine I, Division of Endocrinology and Diabetes, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | - Andreas Schirbel
- Department of Nuclear Medicine, University Hospital, University of Wuerzburg, Wuerzburg, Germany
| | | | | | - Marco A Calzado Canale
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain.,Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Córdoba, Spain.,Hospital Universitario Reina Sofía, Córdoba, Spain
| | - Mathias Rosenfeldt
- Mildred Scheel Early Career Center, Wuerzburg, Germany.,Institut für Pathologie, Universitaetsklinikum Wuerzburg
| | - Ivan Dikic
- Molecular Signaling Group, Institute of Biochemistry II, Goethe University, Frankfurt, Germany.,Buchmann Institute for Molecular Life Sciences, Goethe University Frankfurt, Germany
| | - Christian Münch
- Protein quality control, Institute of Biochemistry II, Goethe University, Frankfurt, Germany
| | - Markus E Diefenbacher
- Protein Stability and Cancer Group, University of Wuerzburg, Department of Biochemistry and Molecular Biology, Wuerzburg, Germany.,Mildred Scheel Early Career Center, Wuerzburg, Germany
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7
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Chiu LC, Lin SM, Lo YL, Kuo SCH, Yang CT, Hsu PC. Immunotherapy and Vaccination in Surgically Resectable Non-Small Cell Lung Cancer (NSCLC). Vaccines (Basel) 2021; 9:689. [PMID: 34201650 PMCID: PMC8310081 DOI: 10.3390/vaccines9070689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Early-stage NSCLC (stages I and II, and some IIIA diseases) accounts for approximately 30% of non-small cell lung cancer (NSCLC) cases, with surgery being its main treatment modality. The risk of disease recurrence and cancer-related death, however, remains high among NSCLC patients after complete surgical resection. In previous studies on the long-term follow-up of post-operative NSCLC, the results showed that the five-year survival rate was about 65% for stage IB and about 35% for stage IIIA diseases. Platinum-based chemotherapy with or without radiation therapy has been used as a neoadjuvant therapy or post-operative adjuvant therapy in NSCLC, but the improvement of survival is limited. Immune checkpoint inhibitors (ICIs) have effectively improved the 5-year survival of advanced NSCLC patients. Cancer vaccination has also been explored and used in the prevention of cancer or reducing disease recurrence in resected NSCLC. Here, we review studies that have focused on the use of immunotherapies (i.e., ICIs and vaccination) in surgically resectable NSCLC. We present the results of completed clinical trials that have used ICIs as neoadjuvant therapies in pre-operative NSCLC. Ongoing clinical trials investigating ICIs as neoadjuvant and adjuvant therapies are also summarized.
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Affiliation(s)
- Li-Chung Chiu
- Division of Thoracic Medicine, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (L.-C.C.); (S.-M.L.); (Y.-L.L.); (S.C.-H.K.); (C.-T.Y.)
- Department of Thoracic Medicine, New Taipei Municipal Tu Cheng Hospital, New Taipei City 23652, Taiwan
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Shu-Min Lin
- Division of Thoracic Medicine, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (L.-C.C.); (S.-M.L.); (Y.-L.L.); (S.C.-H.K.); (C.-T.Y.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Yu-Lun Lo
- Division of Thoracic Medicine, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (L.-C.C.); (S.-M.L.); (Y.-L.L.); (S.C.-H.K.); (C.-T.Y.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Scott Chih-Hsi Kuo
- Division of Thoracic Medicine, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (L.-C.C.); (S.-M.L.); (Y.-L.L.); (S.C.-H.K.); (C.-T.Y.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Cheng-Ta Yang
- Division of Thoracic Medicine, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (L.-C.C.); (S.-M.L.); (Y.-L.L.); (S.C.-H.K.); (C.-T.Y.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
- Department of Internal Medicine, Taoyuan Chang Gung Memorial Hospital, Taoyuan City 33378, Taiwan
- Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
| | - Ping-Chih Hsu
- Division of Thoracic Medicine, Department of Internal Medicine, College of Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan City 33305, Taiwan; (L.-C.C.); (S.-M.L.); (Y.-L.L.); (S.C.-H.K.); (C.-T.Y.)
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan
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