Professor Yuming Zhu: Osimertinib is approved for adjuvant treatment indications, guarding patients' benefits throughout the process

*Only for medical professionals to read and reference ADAURA research results to write a new chapter in adjuvant therapy to benefit more Chinese lung cancer patients.
Surgery is the first choice for the treatment of early lung cancer.
However, postoperative recurrence and metastasis are still a common challenge for doctors and patients.

The comprehensive diagnosis and treatment model of surgical resection combined with postoperative adjuvant targeted therapy has attracted widespread attention.

Based on the results of ADAURA research, osimertinib was recommended by the National Comprehensive Cancer Network (NCCN) guidelines and was approved by the U.
S.
Food and Drug Administration (FDA) for the adjuvant treatment of early-stage non-small cell lung cancer (NSCLC) patients with EGFR mutations Indications.

This indication was recently approved by the National Medical Products Administration (NMPA).

In view of this, the "medical community" specially invited Professor Zhu Yuming, the administrative director of thoracic surgery of Shanghai Pulmonary Hospital, to express his views on related topics.

Professor Zhu Yuming's wonderful video uses the smallest incision and the least lung resection, which brings the least pain to the patient.
For early and mid-term patients, surgery is the first choice for diagnosis and treatment.

In recent years, minimally invasive surgery has developed rapidly.
For example, thoracoscopic surgery has developed from the earliest four-port surgery to the current single-port surgery, which guarantees the same curative effect with the smallest wound and the least pain.

The more sophisticated Da Vinci surgical robot can perform complex surgical operations through the use of minimally invasive methods, and at the same time increase the angle of view through stereo imaging technology, which has certain advantages for some complex operations.

The Da Vinci surgical robot "inner wrist" is more flexible than a laparoscope, and can operate around the target organ at different angles, so it can perform more delicate operations.

In recent years, breakthroughs have been made in the pathology of lung cancer.
Today, lung cancer is divided into multiple subtypes, and different subtypes have different therapeutic effects, such as highly differentiated adherent lung adenocarcinoma and micropapillary lung adenocarcinoma.
In contrast, the efficacy of the micropapillary type is worse. Professor Zhu Yuming mentioned: "The lesions discovered today are getting smaller and smaller.
For very small nodules less than one centimeter and not highly malignant, according to the traditional concept, lobectomy and lymph node dissection are required, but is it necessary to carry out such a large scale? What about surgery? This is a hot topic that has been widely discussed in the field of early lung cancer in recent years.
For the current level of technology, wedge resection or segmental resection of such tiny nodules can achieve the same curative effect.

"Target Compared with traditional chemotherapy, targeted drugs have obvious advantages for patients with mutations.
For early and mid-term patients, targeted drugs are mostly used in postoperative adjuvant therapy.

For patients above stage II, adjuvant treatment is generally required.
The traditional adjuvant treatment is chemotherapy.
However, most patients are afraid of the side effects of chemotherapy.
Damage to liver and kidney function and hair loss are not only for patients.
It is physically and psychologically hurt.

Therefore, the use of targeted drug adjuvant therapy has less impact on patients' physiology and psychology, and patients are more acceptable.

Professor Zhu Yuming mentioned: “For patients who are at an early stage and have a better prognosis, we generally do not recommend adjuvant therapy.

However, for patients with early risk factors, such as patients with poor pathological types, micropapillary and solid patients Without adjuvant therapy, there is a certain risk of metastasis.
Choosing chemotherapy for adjuvant therapy is a heavier psychological burden for patients at such an early stage.
Targeted drug therapy only requires patients to take medication daily, which affects the liver, kidney and important organs.
The damage is small, most of which are skin or gastrointestinal adverse reactions, and the patient's acceptance is high.

Therefore, for early and mid-stage lung cancer patients with positive driver genes, it is recommended to use targeted drug adjuvant therapy.

"Osimertinib is approved for adjuvant therapy.
Indications and escort for patients Based on the results of the ADAURA study, osimertinib became the world’s first adjuvant targeted therapy for lung cancer approved and included in the NCCN guidelines.
In the field of targeted drugs and immunologic drugs, osimertinib Ni is a rare drug approved for adjuvant treatment indications.
The results of the ADAURA study showed that in patients with stage II-IIIB (T3N2, AJCC8) NSCLC, compared with placebo, the median disease-free survival of the osimertinib group The period (DFS) was significantly prolonged, and the risk of disease recurrence or death was reduced by 83% (P<0.
0001). The patient's 3-year DFS rate was 80% with osimertinib and 28% with placebo.

In the overall study population [stage IB to stage IIIB (T3N2, AJCC8) NSCLC patients], the 3-year DFS rates of osimertinib and placebo were 79% and 41%.

Professor Zhu Yuming pointed out: “The clinical use of drugs emphasizes evidence-based medicine evidence, and osimertinib is recommended by NCCN guidelines and approved by NMPA for postoperative adjuvant treatment indications for patients with EGFR mutations.
This is for oncologists, Including our thoracic surgeons and patients, it means that it can be put into clinical use.

I believe that compared with ordinary chemotherapy, the clinical use of osimertinib must be beneficial to patients with EGFR gene mutations.

"Personalized precision treatment becomes the future direction of adjuvant therapy.
For the future development direction of early and mid-stage lung cancer adjuvant therapy, Professor Zhu Yuming said: "I believe that the future will still be guided by precision and individualized treatment, and different choices will be made according to the patient's situation in the future.
Different drugs are used for treatment.
The current methods used for adjuvant therapy include chemotherapy and targeted therapy, and immunotherapy may be available in the future.

Chemotherapy is a unified regimen for small cell and non-small cell lung cancer and has strong toxic side effects.
Genetic testing is now very good.
Generally, it can guide more precise treatment, so targeted drugs may become one of the preferred options in the future.

"Expert Profile Professor Yuming Zhu, Chief Physician of Shanghai Pulmonary Hospital Affiliated to Tongji University, Executive Director of Thoracic Surgery, Chinese Medical Association Thoracic and Cardiovascular Member of the Thoracic Surgery Group of the Surgery Branch Member of the Thoracic Surgery Branch of the Chinese Society of Integrative Medicine Vice Chairman, Chairman of the Lung Cancer Surgery Group of the Thoracic Tumor Professional Committee of Shanghai Anti-Cancer Association * This article is only used to provide scientific information to medical professionals and does not represent the views of this platform