From the Guidelines
The gold standard treatment for lung cancer is surgical resection, specifically lobectomy with lymph node sampling, for early-stage non-small cell lung cancer (NSCLC) [ 1 ]. This approach is recommended for patients with stage I and II NSCLC who are willing to accept procedure-related risks. The treatment of lung cancer depends on the type, stage, and individual patient factors. For locally advanced NSCLC, a multimodal approach combining chemotherapy, radiation, and possibly surgery is standard. Advanced or metastatic NSCLC treatment includes systemic therapies like platinum-based chemotherapy combinations, targeted therapies for specific mutations, or immunotherapy.
Some key points to consider in the treatment of lung cancer include:
- Anatomical resection (lobectomy) is preferred over lesser resections such as wedge or segment resection [ 1 ].
- Sub-lobar resection is generally considered acceptable for pure GGO lesions or adenocarcinomas in situ or with minimal invasion [ 1 ].
- Lymph node dissection should conform to IASLC specifications for staging [ 1 ].
- Adjuvant chemotherapy should be offered to patients with resected stage II and III NSCLC [ 1 ].
- The choice of adjuvant therapy should not be guided by molecular analyses such as ERCC1 or mutation testing [ 1 ].
It's worth noting that the evidence from [ 1 ], [ 1 ], and [ 1 ] also support the use of surgical resection as the primary treatment for early-stage NSCLC, but [ 1 ] is the most recent and highest quality study.
In terms of treatment duration, chemotherapy regimens typically range from 4-6 cycles, while targeted and immunotherapies may continue until disease progression or unacceptable toxicity. These approaches are tailored to maximize survival while maintaining quality of life, with treatment selection based on molecular testing results, performance status, and comorbidities.
From the FDA Drug Label
Non-Small Cell Lung Cancer (NSCLC) • adult patients with resectable (tumors ≥4 cm or node positive) non-small cell lung cancer in the neoadjuvant setting, in combination with platinum-doublet chemotherapy. • adult patients with resectable (tumors ≥4 cm or node positive) non-small cell lung cancer and no known EGFR mutations or ALK rearrangements, for neoadjuvant treatment, in combination with platinum-doublet chemotherapy, followed by single-agent OPDIVO as adjuvant treatment after surgery. • adult patients with metastatic non-small cell lung cancer expressing PD‑L1 (≥1%) as determined by an FDA-approved test, with no EGFR or ALK genomic tumor aberrations, as first-line treatment in combination with ipilimumab. • adult patients with metastatic or recurrent non-small cell lung cancer with no EGFR or ALK genomic tumor aberrations as first-line treatment, in combination with ipilimumab and 2 cycles of platinum-doublet chemotherapy. • adult patients with metastatic non-small cell lung cancer and progression on or after platinum-based chemotherapy.
The gold standard treatment of lung cancer is not explicitly stated in the provided drug labels. However, based on the information provided, the treatment options for non-small cell lung cancer (NSCLC) include:
- Neoadjuvant treatment in combination with platinum-doublet chemotherapy for resectable NSCLC
- First-line treatment in combination with ipilimumab for metastatic NSCLC expressing PD-L1 (≥1%) with no EGFR or ALK genomic tumor aberrations
- First-line treatment in combination with ipilimumab and 2 cycles of platinum-doublet chemotherapy for metastatic or recurrent NSCLC with no EGFR or ALK genomic tumor aberrations
- Treatment after platinum-based chemotherapy for metastatic NSCLC 2 2
From the Research
Gold Standard Treatment for Lung Cancer
The gold standard treatment for lung cancer varies depending on the stage and type of cancer.
- For early-stage non-small-cell lung cancer, the gold standard is lobectomy with mediastinal lymph-node dissection or systematic lymph-node sampling 3.
- This recommendation is based on a randomized controlled trial conducted in 1995, which found a superiority for lobectomy over sublobar resection with regard to local recurrence rate and improved survival 3.
- Thoracoscopic lobectomy, a minimally invasive approach, has been established as an alternative to standard thoracotomy approaches and provides advantages such as less pain, shorter hospitalization, and decreased overall costs 4.
- For small cell lung cancer, the treatment approach depends on the stage of the disease.
- For limited-stage small cell lung cancer, surgery or concurrent chemotherapy with platinum-etoposide and radiotherapy is potentially curative in 30% of patients 5.
- For extensive-stage small cell lung cancer, first-line treatment is combined treatment with platinum-etoposide chemotherapy and immunotherapy with programmed cell death 1 ligand 1 (PD-L1) inhibitors 5.
- The extent of resection for early lung cancer remains a matter of debate, with lobectomy remaining the preferred operation and associated with better survival and lower locoregional recurrence 6.
- For advanced or metastatic non-small-cell lung cancer, a platinum-based doublet is considered the standard treatment for patients with good performance status 7.