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Open Access Clinical Guideline Issue
Uncommon/rare oncogenic drivers in non‐small cell lung cancer: Consensus and contention
Medicine Advances 2023, 1 (4): 293-305
Published: 12 December 2023
Downloads:4

The importance of uncommon/rare oncogenic drivers in non‐small cell lung cancer (NSCLC) was underscored during the 20th China Lung Cancer Summit. These drivers, while present in a significant proportion of NSCLC patients, remain a challenge for diagnosis and therapeutic targeting. In the never‐smokers/low smokers category with mutations such as EGFR and HER2, the efficacy of immune checkpoint inhibitors (ICIs) remains suboptimal, attributed to lower PD‐L1 expression and tumor mutation burden (TMB). However, heavy smokers, often with mutations like KRAS, may derive benefits from ICIs, as supported by trials like CheckMate‐057. With the complex landscape of these drivers and their clinical implications, the summit culminated in six pivotal consensus points, aiming to guide future research and clinical decisions. Despite the advancements, the detection, interpretation, and therapeutic strategies involving these drivers necessitate further exploration and standardization.

Open Access Clinical Guideline Issue
Expert consensus on treatment for stage Ⅲ non-small cell lung cancer
Medicine Advances 2023, 1 (1): 3-13
Published: 24 March 2023
Downloads:33

Stage Ⅲ non-small cell lung cancer (NSCLC) encompasses a group of diseases with high heterogeneity. Such patients should actively receive comprehensive treatments. It is imperative for all stage Ⅲ NSCLC patients to receive consultation with a multiple disciplinary team, which allows the development of a proposal for clinical diagnosis and treatment. In this consensus, stage Ⅲ NSCLC is divided into two types (operable and inoperable) according to different clinical conditions. Resectable NSCLC is further subdivided into two conditions (with or without driver genes). For each clinical scenario, this consensus emphasizes that the foundation of any medical decisions regarding the optimal diagnostic or therapy procedure is scientific evidence from clinical research. Finally, based on the level of evidence and strength of recommendations, this consensus provides recommendations for the management of stage Ⅲ NSCLC from six perspectives. The objective of this consensus is to help clinicians choose the best treatment and promote the standardization of stage Ⅲ NSCLC diagnosis and treatment in China.

Open Access Review Issue
Molecular residual disease: A new clue for individualized approach in non‐small cell lung cancer
Medicine Advances 2023, 1 (1): 79-88
Published: 21 March 2023
Downloads:30

The prognostic value of molecular residual disease (MRD) in non‐small cell lung cancer (NSCLC) cases using high‐depth circulating tumor DNA (ctDNA) sequencing has been well documented. The utility of MRD to direct individualized therapy has increasingly emerged in the clinical trial design of solid tumors, such as escalation or de‐escalation of adjuvant therapy based on MRD. And the efficiency of MRD assay is a key determinant to the success of clinical trials, especially the limitation of detection and predictive value. Here, we review the progress made in evaluating the clinical validity of ctDNA‐MRD test and provide insight into exploiting these developments to future clinical scenarios for improving the individualized therapy of NSCLC.

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