For a better adjuvant strategy for resected lung cancer—lessons from treatment failure patterns of the ADJUVANT trial (CTONG 1104)

Surgical resection is a mainstay treatment for most patients with early-stage non-small cell lung cancer (NSCLC). With the recent improvements in the 5-year survival rates after lung cancer surgery (1), many thoracic surgeons are becoming interested in less invasive surgical techniques, such as sublobar resection for smaller NSCLC (2) or robotic (3) and uniportal (4) approaches to reduce the invasiveness of the chest wall. However, in patients with pathological stage II to III disease, the risk of post-surgical recurrence is still problematic even when complete locoregional control is thought to have been achieved. Currently, doublet chemotherapy [vinorelbine plus cisplatin (VP)] is usually administered as a standard adjuvant treatment for these patients (5); however, the clinical benefit is small, increasing the 5-year survival rate by only 5.4% (6). In the advanced disease setting, molecular targeted therapies [tyrosine kinase inhibitors (TKIs)] and immune checkpoint inhibitors have shown higher efficacy and lower toxicity than doublet chemotherapies (7). This has encouraged the start of clinical trials using TKIs or immune checkpoint inhibitors in the adjuvant setting for patients with earlier-stage lung cancer (8)