Ana Collazo-Lorduy, Virginia Calvo, Ernest Nadal, Mariano Provencio
To our knowledge, this is the first large real-world series from our country including unselected NSCLC patients treated with hypofractionated radiotherapy. Although 55 Gy in 20 fractions is standard in the UK, its use remains limited locally, particularly with conc-RChT. Our findings support hypofractionation as an effective and well-tolerated option, especially in high-volume centres.
Reducing postoperative recurrence remains an unmet need in locally advanced non-small-cell lung cancer (NSCLC), particularly in patients with epidermal growth factor receptor (EGFR)-mutated tumours, who are at higher risk of distant metastases after surgery; particularly brain metastases. Perioperative and neoadjuvant chemoimmunotherapy strategies have improved survival outcomes in unselected populations; however, the evidence in EGFR-mutated NSCLC remains limited because most pivotal trials-including NADIM, NADIM II, CheckMate 816, RATIONALE-315, CheckMate 77T and Neotorch-excluded patients with known EGFR mutations. This gap provides a rationale for exploring the use of anti-angiogenic agents combined with chemoimmunotherapy in a molecular subgroup that is usually less-immunoresponsive. While this strategy has demonstrated efficacy in the metastatic EGFR-mutated setting, as reported in IMpower150, ATTLAS/KCSG-LU19-04 or ORIENT-31 study, prospective evidence in resectable disease is lacking. The Neo-DIANA trial was a multicentre, open-label, non-randomised phase II clinical trial designed to investigate a neoadjuvant regimen combining atezolizumab, chemotherapy and bevacizumab, followed by surgery and adjuvant atezolizumab, in resectable stages IIIA and IIIB EGFR-mutated NSCLC. Because the trial was terminated early due to slow recruitment, no conclusions can be drawn regarding the efficacy of combination therapy in patients with resectable EGFR-mutated NSCLC. Further studies are still needed to explore perioperative strategies that may help reduce postoperative relapses in these patients.