Avances en el diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas sin alteraciones genómicas
DOI:
https://doi.org/10.56050/01205498.2310Resumen
El cáncer de pulmón es la principal causa de muerte relacionada con la enfermedad a nivel global. Anteriormente, la única terapia sistémica antitumoral disponible era la quimioterapia, que presentaba una eficacia modesta y alta toxicidad. El desarrollo de los inhibidores de punto de control inmune (ICIs) es un hito esencial en el tratamiento del cáncer de pulmón. En pacientes sin mutaciones conductoras, los inhibidores de PD-L1/PD-1 producen una respuesta clínica duradera que extiende la supervivencia a largo plazo. En esta revisión se resumen los principales avances que han modificado el paradigma del tratamiento del cáncer de pulmón en todas sus etapas, incluida la inmunoterapia con anticuerpos agonistas y antagonistas. Con base en la evidencia reciente, proponemos algoritmos de tratamiento para el cáncer de pulmón de células no pequeñas (CPCNP), considerando problemas clínicos sin resolver, que en la actualidad se estan explorando en estudios clínicos en curso. Es probable que los resultados de estos ensayos clínicos afecten la práctica clínica futura.
Biografía del autor/a
Jairo Zuluaga, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica Tórax, Centro de Tratamiento e Investigación sobre Cáncer (CTIC) Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Leonardo Rojas, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica Tórax, Centro de Tratamiento e Investigación sobre Cáncer (CTIC) Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Lucia Viola, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica Tórax, Centro de Tratamiento e Investigación sobre Cáncer (CTIC) Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Unidad Funcional Oncología Torácica, Fundación Neumológica Colombiana – FNC, Bogotá, Colombia.
Stella Martínez, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica Tórax, Centro de Tratamiento e Investigación sobre Cáncer (CTIC) Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Carlos Carvajal, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica Tórax, Centro de Tratamiento e Investigación sobre Cáncer (CTIC) Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Oscar Arrieta, Instituto Nacional de Cancerología – INCaN, México
Unidad de Tumores Torácicos, Instituto Nacional de Cancerología (INCan), México D.F., México
Andrés F. Cardona, Centro de Tratamiento e Investigación sobre Cáncer (CTIC)
Unidad Funcional Clínica Tórax, Centro de Tratamiento e Investigación sobre Cáncer (CTIC) Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Dirección de Investigación, Ciencia y Educación, Centro de Tratamiento e Investigación sobre Cáncer (CTIC). Luis Carlos Sarmiento Angulo (CTIC), Bogotá, Colombia.
Referencias bibliográficas
Kocher F, Hilbe W, Seeber A, Pircher A, Schmid T, Greil R, et al. Longitudinal analysis of 2293 NSCLC patients: A comprehensive study from the TYROL registry. Lung Cancer.2015;87(2):193-200.
Siegel RL, Miller KD, Wagle NS, Jemal A. Cancer statistics, 2023. CA Cancer J Clin. 2023;73(1):17-48.
Cardona AF, Mejía SA, Viola L, Chamorro DF, Rojas L, Ruíz-Patiño A, et al. Lung Cancer in Colombia. J Thorac Oncol. 2022;17(8):953-60.
Raez LE, Cardona AF, Santos ES, Catoe H, Rolfo C, Lopes G, et al. The burden of lung cancer in Latin-America and challenges in the access to genomic profiling, immunotherapy and targeted treatments. Lung Cancer. 2018; 119:7-13.
Goldstraw P, Chansky K, Crowley J, Rami-Porta R, Asamura H, Eberhardt WEE, et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2016;11(1):39-51.
Cole P, Morrison AS. Basic issues in population screening for cancer. J Natl Cancer Inst. 1980;64(5):1263-72.
Patz EF, Goodman PC, Bepler G. Screening for Lung Cancer. N Engl J Med. 2000;343(22):1627-33.
Manser R, Lethaby A, Irving LB, Stone C, Byrnes G, Abramson MJ, et al. Screening for lung cancer. Cochrane Lung Cancer Group, editor. Cochrane Database Syst Rev [Internet]. 21 de junio de 2013 [consultado 28 de noviembre de 2023];2013(6). Disponible en: http://doi.wiley.com/10.1002/14651858.CD001991.pub3
Van Klaveren RJ, Habbema JDF, Pedersen JH, De Koning HJ, Oudkerk M, Hoogsteden HC. Lung cancer screening by low-dose spiral computed tomography. Eur Respir J.2001;18(5):857-66.
The National Lung Screening Trial Research Team. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. N Engl J Med. 2011;365(5):395-409.
The National Lung Screening Trial Research Team. Results of Initial Low-Dose Computed Tomographic Screening for Lung Cancer. N Engl J Med. 2013;368(21):1980-91.
Horeweg N, Scholten ET, De Jong PA, Van Der Aalst CM, Weenink C, Lammers JWJ, et al. Detection of lung cancer through low-dose CT screening (NELSON): a prespecified analysis of screening test performance and interval cancers. Lancet Oncol. 2014;15(12):1342-50.
De Koning HJ, Van Der Aalst CM, De Jong PA, Scholten ET, Nackaerts K, Heuvelmans MA, et al. Reduced Lung-Cancer Mortality with Volume CT Screening in a Randomized Trial. N Engl J Med. 2020;382(6):503- 13.
Hoffman RM, Atallah RP, Struble RD, Badgett RG. Lung Cancer Screening with Low-Dose CT: a Meta-Analysis. J Gen Intern Med. 2020;35(10):3015-25.
Adams SJ, Stone E, Baldwin DR, Vliegenthart R, Lee P, Fintelmann FJ. Lung cancer screening. The Lancet. 2023;401(10374):390-408.
Seijo LM, Peled N, Ajona D, Boeri M, Field JK, Sozzi G, et al. Biomarkers in Lung Cancer Screening: Achievements, Promises, and Challenges. J Thorac Oncol. 2019;14(3):343-57.
Chiarantano RS, Vazquez FL, Franco A, Ferreira LC, Cristina Da Costa M, Talarico T, et al. Implementation of an Integrated Lung Cancer Prevention and Screening Program Using a Mobile Computed Tomography (CT) Unit in Brazil. Cancer Control. 2022; 29:107327482211213.
Reitsma MB, Kendrick PJ, Ababneh E, Abbafati C, Abbasi-Kangevari M, Abdoli A, et al. Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet. 2021;397(10292):2337-60.
Scagliotti GV, Longo M, Novello S. Nonsmall cell lung cancer in never smokers. Curr Opin Oncol. 2009;21(2):99-104.
Yang P. PS01.02 National Lung Cancer Screening Program in Taiwan: The TALENT Study. J Thorac Oncol. 2021;16(3): S58.
Han B, Chao J, Yao H. Circular RNA and its mechanisms in disease: From the bench to the clinic. Pharmacol Ther. 2018; 187:31-44.
Miller RW, Hutchcraft ML, Weiss HL, Wu J, Wang C, Liu J, et al. Molecular Tumor Board–Assisted Care in an Advanced Cancer Population: Results of a Phase II Clinical Trial. JCO Precis Oncol. 2022;(6): e2100524.
Charo LM, Eskander RN, Sicklick J, Kim KH, Lim HJ, Okamura R, et al. Real-World Data From a Molecular Tumor Board: Improved Outcomes in Breast and Gynecologic Cancers Patients With Precision Medicine. JCO Precis Oncol. 2022;(6):e2000508.
Singh N, Temin S, Baker S, Blanchard E, Brahmer JR, Celano P, et al. Therapy for Stage IV Non–Small-Cell Lung Cancer Without Driver Alterations: ASCO Living Guideline. J Clin Oncol. 2022;40(28):3323-43.
Liang Y, Wakelee HA. Adjuvant chemotherapy of completely resected early stage non-small cell lung cancer (NSCLC). Transl Lung Cancer Res. 2013;2(5):403-10.
Uramoto H, Tanaka F. Recurrence after surgery in patients with NSCLC. Transl Lung Cancer Res. 2014;3(4):242-9.
Simeone JC, Nordstrom BL, Patel K, Klein AB. Treatment patterns and overall survival in metastatic non-small-cell lung cancer in a real-world, US setting. Future Oncol. 2019;15(30):3491-502.
Novello S, Kowalski DM, Luft A, Gümüş M, Vicente D, Mazières J, et al. Pembrolizumab Plus Chemotherapy in Squamous Non–Small-Cell Lung Cancer: 5-Year Update of the Phase III KEYNOTE-407 Study. J Clin Oncol. 2023;41(11):1999-2006.
Garassino MC, Gadgeel S, Speranza G, Felip E, Esteban E, Dómine M, et al. Pembrolizumab Plus Pemetrexed and Platinum in Nonsquamous Non– Small-Cell Lung Cancer: 5-Year Outcomes From the Phase 3 KEYNOTE-189 Study. J Clin Oncol. 2023;41(11):1992-8.
Brahmer JR, Lee JS, Ciuleanu TE, Bernabe Caro R, Nishio M, Urban L, et al. Five-Year Survival Outcomes With Nivolumab Plus Ipilimumab Versus Chemotherapy as First-Line Treatment for Metastatic Non– Small-Cell Lung Cancer in CheckMate 227. J Clin Oncol. 2023;41(6):1200-12.
Altorki N, Wang X, Kozono D, Watt C, Landrenau R, Wigle D, et al. Lobar or Sublobar Resection for Peripheral Stage IA Non–Small-Cell Lung Cancer. N Engl J Med. 2023;388(6):489-98.
Saji H, Okada M, Tsuboi M, Nakajima R, Suzuki K, Aokage K, et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): a multicentre, open-label, phase 3, randomised, controlled, non-infority trial. The Lancet. 2022;399(10335):1607-17.
Ren J, Ren J, Wang K, Tan Q. The consideration of surgery on primary lesion of advanced non-small cell lung cancer. BMC Pulm Med. 2023;23(1):118.
Gomez DR, Tang C, Zhang J, Blumenschein GR, Hernandez M, Lee JJ, et al. Local Consolidative Therapy Vs. Maintenance Therapy or Observation for Patients With Oligometastatic Non–Small-Cell Lung Cancer: Long- Term Results of a Multi-Institutional, Phase II, Randomized Study. J Clin Oncol. 2019;37(18):1558-65.
David EA, Andersen SW, Beckett LA, Melnikow J, Clark JM, Brown LM, et al. Survival benefits associated with surgery for advanced non–small cell lung cancer. J Thorac Cardiovasc Surg. 2019;157(4):1620-8.
McGarry RC, Song G, Des Rosiers P, Timmerman R. Observation-Only Management of Early Stage, Medically Inoperable Lung Cancer. Chest. 2002;121(4):1155-8.
Lanni TB, Grills IS, Kestin LL, Robertson JM. Stereotactic Radiotherapy Reduces Treatment Cost While Improving Overall Survival and Local Control Over Standard Fractionated Radiation Therapy for Medically Inoperable Non-Small-Cell Lung Cancer. Am J Clin Oncol. 2011;34(5):494-8.
Baumann P, Nyman J, Hoyer M, Wennberg B, Gagliardi G, Lax I, et al. Outcome in a Prospective Phase II Trial of Medically Inoperable Stage I Non–Small-Cell Lung Cancer Patients Treated With Stereotactic Body Radiotherapy. J Clin Oncol. 2009;27(20):3290-6.
Timmerman R. Stereotactic Body Radiation Therapy for Inoperable Early Stage Lung Cancer. JAMA. 2010;303(11):1070.
Ma Z, Liu Y, Bao Y, Yuan M, Yang X, Men Y, et al. Higher Lung and Heart Doses Decrease Early and Long-Term Survival, Respectively, in Patients With Non-Small Cell Lung Cancer Undergoing Postoperative Radiation. Adv Radiat Oncol. julio de 2023;8(4):101213.
Le Pechoux C, Pourel N, Barlesi F, Lerouge D, Antoni D, Lamezec B, et al. Postoperative radiotherapy versus no postoperative radiotherapy in patients with completely resected non-small-cell lung cancer and proven mediastinal N2 involvement (Lung ART, IFCT 0503): an open-label, randomised, phase 3 trial. Lancet Oncol. 2022;23(1):104-14.
Hui Z, Men Y, Hu C, Kang J, Sun X, Bi N, et al. Effect of Postoperative Radiotherapy for Patients With pIIIA-N2 Non–Small Cell Lung Cancer After Complete Resection and Adjuvant Chemotherapy: The Phase 3 PORT-C Randomized Clinical Trial. JAMA Oncol. 2021;7(8):1178.
Videtic GMM, Donington J, Giuliani M, Heinzerling J, Karas TZ, Kelsey CR, et al. Stereotactic body radiation therapy for early-stage non-small cell lung cancer: Executive Summary of an-ASTRO Evidence-Based Guideline. Pract Radiat Oncol. 2017;7(5):295-301.
Cooke SA, De Ruysscher D, Reymen B, Lambrecht M, Fredberg Persson G, Faivre-Finn C, et al. 18F-FDG- PET guided vs whole tumour radiotherapy dose escalation in patients with locally advanced non-small cell lung cancer (PET-Boost): Results from a randomised clinical trial. Radiother Oncol. 2023;181:109492.
Tamaki N, Hirata K, Kotani T, Nakai Y, Matsushima S, Yamada K. Four-dimensional quantitative analysis using FDG-PET in clinical oncology. Jpn J Radiol. 2023;41(8):831-42.
Senan S, De Ruysscher D. Critical review of PET-CT for radiotherapy planning in lung cancer. Crit Rev Oncol Hematol. 2005;56(3):345-51.
Preoperative chemotherapy for non-small-cell lung cancer: a systematic review and meta-analysis of individual participant data. The Lancet. 2014;383(9928):1561-71.
Ramnath N, Dilling TJ, Harris LJ, Kim AW, Michaud GC, Balekian AA, et al. Treatment of Stage III Non-small Cell Lung Cancer. Chest. 2013;143(5):e314S-e340S.
Waser NA, Adam A, Schweikert B, Vo L, McKenna M, Breckenridge M, et al. 1243P Pathologic response as early endpoint for survival following neoadjuvant therapy (NEO-AT) in resectable non-small cell lung cancer (rNSCLC): Systematic literature review and meta-analysis. Ann Oncol. 2020;31: S806.
Provencio M, Nadal E, González-Larriba JL, Martínez-Martí A, Bernabé R, Bosch-Barrera J, et al. Perioperative Nivolumab and Chemotherapy in Stage III Non–Small-Cell Lung Cancer. N Engl J Med. 2023;389(6):504-13.
Heymach JV, Harpole D, Mitsudomi T, Taube JM, Galffy G, Hochmair M, et al. Abstract CT005: AEGEAN: A phase 3 trial of neoadjuvant durvalumab + chemotherapy followed by adjuvant durvalumab in patients with resectable NSCLC. Cancer Res. 2023;83(8_Supplement): CT005-CT005.
Forde PM, Spicer J, Lu S, Provencio M, Mitsudomi T, Awad MM, et al. Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med. 2022;386(21):1973-85.
Wakelee H, Liberman M, Kato T, Tsuboi M, Lee SH, Gao S, et al. Perioperative Pembrolizumab for Early-Stage Non–Small-Cell Lung Cancer. N Engl J Med. 2023;389(6):491-503.
Ettinger DS, Wood DE, Akerley W, Bauman JR, Bharat A, Bruno DS, et al. NCCN Guidelines Index Table of Contents Discussion. 2023;
Desai A, Smith CJ, West HJ. Navigating approval pathways for immunotherapy in NSCLC: should criteria be revised? Nat Rev Clin Oncol. 2023;20(7):423-4.
Bryant AK, Chopra Z, Edwards DM, Whalley AS, Bazzell BG, Moeller JA, et al. Adopting Weight-Based Dosing With Pharmacy-Level Stewardship Strategies Could Reduce Cancer Drug Spending By Millions: Study examines possible savings from adopting weight-based dosing for certain cancer drugs. Health Aff (Millwood). 2023;42(7):946-55.
Li Q, Zhang R, Yan H, Zhao P, Wu L, Wang H, et al. Prognostic significance of HER3 in patients with malignant solid tumors. Oncotarget. 2017;8(40):67140- 51.
Pak MG, Shin DH, Lee CH, Lee MK. Significance of EpCAM and TROP2 expression in non-small cell lung cancer. World J Surg Oncol. 2012;10(1):53.
De Miguel M, Umana P, Gomes De Morais AL, Moreno V, Calvo E. T-cell–engaging Therapy for Solid Tumors. Clin Cancer Res. 2021;27(6):1595-603.
Leighl NB, Page RD, Raymond VM, Daniel DB, Divers SG, Reckamp KL, et al. Clinical Utility of Comprehensive Cell-free DNA Analysis to Identify Genomic Biomarkers in Patients with Newly Diagnosed Metastatic Non–small Cell Lung Cancer. Clin Cancer Res. 2019;25(15):4691-700.
Coleman N, Rodon J. Taking Aim at the Undruggable. Am Soc Clin Oncol Educ Book. 2021;(41): e145-52.
De Langen AJ, Johnson ML, Mazieres J, Dingemans AMC, Mountzios G, Pless M, et al. Sotorasib versus docetaxel for previously treated non-small-cell lung cancer with KRASG12C mutation: a randomised, open-label, phase 3 trial. The Lancet. 2023;401(10378):733-46.
Jänne PA, Riely GJ, Gadgeel SM, Heist RS, Ou SHI, Pacheco JM, et al. Adagrasib in Non–Small-Cell Lung Cancer Harboring a KRAS G12C Mutation. N Engl J Med. 2022;387(2):120-31.
Tao Z, Wu X. Targeting Transcription Factors in Cancer: From “Undruggable” to “Druggable”. En: Song Q, Tao Z, editores. Transcription Factor Regulatory Networks [Internet]. New York, NY: Springer US; 2023 [consultado 28 de noviembre de 2023]. p. 107- 31. (Methods in Molecular Biology; vol. 2594). Disponible en: https://link.springer.com/10.1007/978-1-0716-2815-7_9
Cómo citar
Descargas
Publicado
Número
Sección
Licencia
Copyright
ANM de Colombia
Los autores deben declarar revisión, validación y aprobación para publicación del manuscrito, además de la cesión de los derechos patrimoniales de publicación, mediante un documento que debe ser enviado antes de la aparición del escrito. Puede solicitar el formato a través del correo revistamedicina@anmdecolombia.org.co o descargarlo directamente Documento Garantías y cesión de derechos.docx
Copyright
ANM de Colombia
Authors must state that they reviewed, validated and approved the manuscript's publication. Moreover, they must sign a model release that should be sent.
