The role of neoadjuvant chemotherapy in the combined treatment of locally advanced non-small cell lung cancer and the prerequisites for a personalized approach to it

Lung cancer is the leading cause of morbidity and mortality in the world each year. Despite radical surgical treatment, 5-year survival rate at stages I-II remains unsatisfactory. Objective. To assess whether an overall personalized approach to chemotherapy selection in the preoperative regimen has an impact on overall and relapse-free survival outcomes. Material and Methods. The results of the use of neoadjuvant chemotherapy (NACT) both in Russia and around the world were studied and analyzed. The experience of prescribing personalized NACT is shown in a study conducted in the conditions of the Oncology Research Institute of Tomsk National Research Medical Center, where patients with locally advanced non-small cell lung cancer (NSCLC) of the study group (n=32) underwent combined treatment in the amount of personalized NACT followed by radical surgery and, if necessary, with the additional use of adjuvant chemotherapy. In the control group (n=31), NACT was performed as part of the combined treatment using empirical regimens. Results. The relevance of neoadjuvant drug therapy in the combined treatment of operable NSCLC is reflected and promising directions of treatment using modern antitumor drugs and personalized approaches to it based on the assessment of the level of expression of monoresistance genes are shown. In the main group of patients with advanced NSCLC, the overall 2-year survival rate was 71.9%, which is higher than in the control group (54.8%) and in studies presented in the world literature. Conclusion. The developed method of treating advanced NSCLC using a personalized approach to NACT based on the assessment of monoresistance genes allows improving the long-term results of combined treatment by increasing overall survival and progression-free survival due to greater sensitivity of the tumor to specific chemotherapy drugs.