Curative Therapies for Non-Small Cell Lung Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (30 April 2025) | Viewed by 5880

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Guest Editor
Department of Oncology, Marshall University Chief of Radiation Oncology, Edwards Comprehensive Cancer Center, Huntington, WV, USA
Interests: lung cancer; radiotherapy; surgery; immunotherapy
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Special Issue Information

Dear Colleagues,

On behalf of Cancers, I would like to announce a call for articles for a Special Issue entitled “Curative Therapies for Non-Small Cell Lung Cancer”. In this rapidly changing world of lung cancer therapeutics, we are seeing patients live much longer lives. At Cancers, we recognize that during the last decade, we have observed a remarkable increase in patient survival due to the better selection and refinement of techniques for surgery and radiotherapy, as well as the growing armamentarium of systemic therapies including tyrosine kinase inhibitors for actionable mutations, immunotherapy with or without chemotherapy, and anti-angiogenic therapy combined with immunotherapy.

We will be considering all options for “curative” therapy, including neo-adjuvant/adjuvant therapy for resectable disease, treatments for locally advanced disease, local therapies for oligometastatic disease (de novo, recurrent or persistent), as well as the long-term curative potential of systemic therapies.

Dr. John Michael Varlotto
Guest Editor

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Keywords

  • radiotherapy
  • surgery
  • early-stage NSCLC
  • oligometastases
  • immunotherapy

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Published Papers (4 papers)

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Research

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12 pages, 3611 KiB  
Article
Changes in Staging and Management of Non-Small Cell Lung Cancer (NSCLC) Patients Following the Implementation of Low-Dose Chest Computed Tomography (LDCT) Screening at Kaohsiung Medical University Hospital
by Chin-Ling Chen, Jui-Sheng Hsu, Yi-Wen Shen, Chih-Hsiang Hsu, Shih-Yu Kao, Wei-An Lai, Cheng-Hao Chuang, Yu-Wei Liu, Jui-Ying Lee, Shah-Hwa Chou, Jen-Yu Hung, Inn-Wen Chong and Chih-Jen Yang
Cancers 2024, 16(22), 3727; https://doi.org/10.3390/cancers16223727 - 5 Nov 2024
Cited by 3 | Viewed by 1228
Abstract
Background: Low-dose computed tomography (LDCT) has been widely adopted for lung cancer screening due to its proven ability to reduce lung cancer mortality, especially among high-risk populations. Methods: This retrospective study aims to evaluate the impact of LDCT screening on non-small cell lung [...] Read more.
Background: Low-dose computed tomography (LDCT) has been widely adopted for lung cancer screening due to its proven ability to reduce lung cancer mortality, especially among high-risk populations. Methods: This retrospective study aims to evaluate the impact of LDCT screening on non-small cell lung cancer (NSCLC) staging at Kaohsiung Medical University Hospital (KMUH) from 2011 to 2020, following the introduction of LDCT in 2013. The study examines the correlation between LDCT screening volume and changes in the distribution of NSCLC stages, particularly early-stage (stages 0 and I) and late-stage (stage IV) diagnoses. Additionally, it explores the differences in histopathological subtypes, focusing on adenocarcinoma and squamous cell carcinoma, and assesses the impact of early detection on five-year survival rates. Results: The results show a significant increase in early-stage NSCLC diagnoses, particularly in adenocarcinoma cases, where early-stage diagnoses rose from 10.4% in 2010 to 38.7% in 2019. However, the number of stage IV cases remained stable, indicating that LDCT may not substantially reduce late-stage diagnoses. Pearson’s correlation analysis demonstrated a strong positive correlation between LDCT screening and early-stage NSCLC detection, particularly for adenocarcinoma (p < 0.001), though the early detection of squamous cell carcinoma and small cell carcinoma remained limited. Conclusions: The study concludes that LDCT screening plays a crucial role in improving early NSCLC detection and five-year survival rates. Future research should focus on optimizing screening strategies to capture more at-risk populations and enhance the detection of harder-to-diagnose subtypes like squamous cell carcinoma. Full article
(This article belongs to the Special Issue Curative Therapies for Non-Small Cell Lung Cancer)
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17 pages, 947 KiB  
Article
Outcomes of Multimodal Treatment in Elderly Patients with Localized Non-Small Lung Cancer from a Radiation Oncology Point of View: Special Focus on Low-Dose Cisplatin
by Niklas Josua Alt, Julian Muster, David Alexander Ziegler, Stephanie Bendrich, Sandra Donath, Andrea Hille, Mahalia Zoe Anczykowski, Carla Marie Zwerenz, Friederike Braulke, Alexander von Hammerstein-Equord, Tobias Raphael Overbeck, Hannes Treiber, Manuel Guhlich, Rami El Shafie, Stefan Rieken, Martin Leu and Leif Hendrik Dröge
Cancers 2024, 16(2), 327; https://doi.org/10.3390/cancers16020327 - 11 Jan 2024
Cited by 2 | Viewed by 1903
Abstract
Identification of the optimal treatment strategy is challenging in elderly with localized non-small cell lung cancer (NSCLC). Concurrent chemotherapy with low-dose cisplatin represents an option for elderly. Outcomes (1) in elderly (≥70 years, n = 158) vs. younger patients (n = 188) [...] Read more.
Identification of the optimal treatment strategy is challenging in elderly with localized non-small cell lung cancer (NSCLC). Concurrent chemotherapy with low-dose cisplatin represents an option for elderly. Outcomes (1) in elderly (≥70 years, n = 158) vs. younger patients (n = 188) and (2), independently of age, in definitive radiochemotherapy, with low-dose cisplatin (n = 125) vs. cisplatin/vinorelbine (n = 76) were studied. Elderly included more males, had a lower Karnofsky index, more comorbidities, and lower stages. Low-dose cisplatin patients (vs. cisplatin/vinorelbine) had higher age, more comorbidities, and lower stages. We observed reduced dermatitis and dysphagia and increased anemia and thrombocytopenia in elderly vs. younger patients, without increased ≥grade 3 toxicities. Low-dose cisplatin was less toxic than cisplatin/vinorelbine. Survival outcomes were lower in elderly vs. younger and comparable between low-dose cisplatin and cisplatin/vinorelbine. In elderly, gender, Karnofsky index, stage, and multimodal treatment (including additional surgery/systemic therapy) were identified as prognostic factors. In conclusion, we found evidence for an acceptable toxicity profile and the need for improvement of outcomes in elderly with localized NSCLC. Multimodal strategies (including additional surgery/systemic treatment) showed favorable outcomes and should be reasonably considered in elderly who are deemed fit enough. Low-dose cisplatin should be discussed on an individual basis due to favorable toxicity and outcomes. Full article
(This article belongs to the Special Issue Curative Therapies for Non-Small Cell Lung Cancer)
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Review

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18 pages, 2361 KiB  
Review
Chemotherapy-Free Treatment with Radiotherapy and Immunotherapy for Locally Advanced Non-Small Cell Lung Cancer
by M. Zeeshan Ozair, Balazs Halmos, Angelica D’Aiello, Jaewon Yun, Andrea R. Filippi, Andreas Rimner, Steven H. Lin, Charles B. Simone II and Nitin Ohri
Cancers 2025, 17(9), 1524; https://doi.org/10.3390/cancers17091524 - 30 Apr 2025
Viewed by 517
Abstract
Background: Concurrent chemoradiotherapy (CRT) followed by immunotherapy is a standard treatment for locally advanced non-small cell lung cancer (LA-NSCLC), yet many patients are ineligible due to treatment-related toxicity or poor functional status. Chemotherapy-free approaches using radiotherapy (RT) and immunotherapy may offer a safer [...] Read more.
Background: Concurrent chemoradiotherapy (CRT) followed by immunotherapy is a standard treatment for locally advanced non-small cell lung cancer (LA-NSCLC), yet many patients are ineligible due to treatment-related toxicity or poor functional status. Chemotherapy-free approaches using radiotherapy (RT) and immunotherapy may offer a safer and equally effective alternative in select patient populations. Methods: A comprehensive literature review was conducted using PubMed, Google Scholar, and relevant conference proceedings focusing on trials between 2000 and 2024. Studies investigating chemotherapy-free regimens combining RT and immunotherapy in LA-NSCLC were analyzed, with emphasis on clinical outcomes, biomarker use, treatment sequencing, radiation dose/fractionation, and safety. Results: Multiple Phase I/II trials reported promising efficacy with one-year progression-free survival (PFS) ranging from 39% to 76%. Toxicity was generally acceptable, though higher-grade adverse events were more frequent in older, frail populations. Trials integrating PD-L1 expression, tumor mutational burden (TMB), and circulating tumor DNA (ctDNA) showed potential for improved patient stratification. Variation in immunotherapy timing (induction, concurrent, or consolidation) and radiation schedules highlight the need for optimization. Conclusions: Chemotherapy-free regimens represent a promising treatment strategy for patients with LA-NSCLC, especially those that are ineligible for standard CRT. Biomarker-driven patient selection and the rational integration of RT and immunotherapy are critical to improving outcomes. Randomized trials are warranted to establish the efficacy and safety of these emerging approaches. Full article
(This article belongs to the Special Issue Curative Therapies for Non-Small Cell Lung Cancer)
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21 pages, 1777 KiB  
Review
Evaluation of Anti-Angiogenic Therapy Combined with Immunotherapy and Chemotherapy as a Strategy to Treat Locally Advanced and Metastatic Non-Small-Cell Lung Cancer
by Mahmoud Abdallah, Rick Voland, Malcolm Decamp, John Flickinger, Toni Pacioles, Muhammad Jamil, Damian Silbermins, Mina Shenouda, Matias Valsecchi, Arvinder Bir, Yousef Shweihat, Juan Bastidas, Nepal Chowdhury, Yury Kachynski, Howide Eldib, Thomas Wright, Ahmad Mahdi, Jowan Al-Nusair, Kemnasom Nwanwene and John Varlotto
Cancers 2024, 16(24), 4207; https://doi.org/10.3390/cancers16244207 - 17 Dec 2024
Viewed by 1355
Abstract
Immunotherapy has made recent improvements in disease-free survival (DFS) and/or overall survival (OS) in all stages of non-small-cell lung cancer (NSCLC). Here, we review the tumor microenvironment and its immunosuppressive effects and discuss how anti-angiogenic therapies may potentiate the anti-carcinogenic effects of immunotherapy. [...] Read more.
Immunotherapy has made recent improvements in disease-free survival (DFS) and/or overall survival (OS) in all stages of non-small-cell lung cancer (NSCLC). Here, we review the tumor microenvironment and its immunosuppressive effects and discuss how anti-angiogenic therapies may potentiate the anti-carcinogenic effects of immunotherapy. We also review all the past literature and discuss strategies of combining anti-angiogenic therapy and immunotherapy +/− chemotherapy and hypothesize how we can use this strategy for non-small-cell lung cancer in metastatic previously untreated/previously treated settings in previously treated EGFR-mutated NSCLC for the upfront treatment of brain metastases prior to radiation therapy and for the incorporation of this strategy into stage III unresectable disease. We assert the use of anti-angiogenic therapy and immunotherapy when combined appropriately with chemotherapy and radiotherapy has the potential to increase the long-term survivals in both the stage III and metastatic setting so that we can now consider more patients to experience curative treatment. Full article
(This article belongs to the Special Issue Curative Therapies for Non-Small Cell Lung Cancer)
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