Lead-in: Retracing Revolutionary Footsteps—Grassroots Tour on Standardized Lung Cancer Diagnosis and Treatment Launches, Advancing Progress in Lung Cancer Care!
On September 3, 2020, the "Retracing Revolutionary Footsteps—Lung Cancer Standardized Diagnosis and Treatment Grassroots Tour" was simultaneously held online across nine locations nationwide. Numerous renowned lung cancer experts from leading domestic medical institutions participated virtually to support the initiative, facilitating the dissemination of high-quality academic resources to grassroots communities and benefiting a wide range of lung cancer patients.
Professor Ai Kaixing, President of Shanghai Pulmonary Hospital, delivered the opening remarks on-site: "Lung cancer remains one of the most severe malignant tumors today. Despite continuous advancements in diagnostic and therapeutic techniques, approximately 50% of patients are diagnosed at an advanced stage. Patients are like family; colleagues should never look down on one another. Walking alongside patients with shared compassion, standing by them unwaveringly, extending their lifespan, and enhancing their quality of life are our enduring responsibilities and missions on the path of cancer diagnosis and treatment.This series of academic conferences on standardized lung cancer diagnosis and treatment at the grassroots level invites numerous experts in the field to bring advanced techniques and therapeutic concepts to primary care settings. Through diverse formats including offline lectures, online livestreams, and remote education, it comprehensively advances the "decentralization" of standardized lung cancer care to grassroots institutions, holding extraordinary significance."
President Ai Kaixing
At the conference, Professor Su Chunxia and Professor Wu Chunyan from Shanghai Pulmonary Hospital,Professor Shao Feng from Nanjing Chest Hospital Affiliated to Southeast University School of Medicine, Professor Zhou Rongrong from Xiangya Hospital of Central South University, Professor Song Binbin from Jiaxing First Hospital, and Professor Chen Zhiyong from Longyan First Hospital shared insights and recommendations on standardizing lung cancer diagnosis and treatment at the grassroots level. Their collective wisdom contributed to the downward flow of high-quality resources and the unification of clinical practitioners' diagnostic and therapeutic knowledge.
Professor Su Chunxia: Combating lung cancer requires standardized diagnosis and treatment following guidelines
Professor Su Chunxia emphasized that knowledge in the field of lung cancer—from screening and diagnosis to new drugs and therapies—evolves rapidly. Clinicians must continuously update their knowledge reserves to ensure standardized, high-level diagnosis and treatment, thereby benefiting patients in practice.
The authoritative clinical practice guidelines from the Chinese Society of Clinical Oncology (CSCO) serve as an effective pathway for physicians to stay abreast of developments in lung cancer care. During this lecture tour, Professor Su Chunxia elaborated on numerous updates in the 2020 CSCO Guidelines for Primary Non-Small Cell Lung Cancer.
Imaging and molecular diagnostic techniques such as neck/supraclavicular lymph node ultrasound or CT, electromagnetic navigation bronchoscopy, and immunohistochemical PD-L1 expression testing have gained guideline recommendations or elevated recommendation levels. Detection of NTRK fusion mutations has been incorporated into the guidelines, aligning with the latest trends in targeted therapy.Based on robust data from the PACIFIC study, durvalumab received a Class I recommendation for consolidation therapy following concurrent chemoradiotherapy in patients with unresectable locally advanced disease.
Regarding drug therapy for stage IV driver gene-positive lung cancer patients—the area with the most significant updates—novel EGFR-TKI targeted agents like osimertinib and dacomitinib earned Class I recommendations for first-line treatment (based on 1A evidence).Professor Su Chunxia analyzed relevant clinical research data in her interpretation, noting that the FLAURA study remains the only first-line EGFR-TKI trial demonstrating significant overall survival (OS) benefit.
For the management of EGFR-TKI-resistant patients and those with ALK/ROS1 fusion mutations, the 2020 CSCO guidelines also incorporated substantial updates based on the latest clinical research data. New sections were added covering targeted therapies for rare mutations such as BRAFV600E and NTRK fusions, reflecting the ongoing trend toward increasingly refined and precision-oriented targeted treatments for lung cancer.
Professor Wu Chunyan: Rapid and Accurate Diagnosis is the Foundation of Lung Cancer Management
"Only with a clear diagnosis and testing can we establish a definitive treatment plan for lung cancer," Professor Wu Chunyan opened her lecture with this statement.
Lung cancer diagnosis and treatment have now entered the era of personalized therapy. Pathological diagnosis must also adapt to the specific treatment plans patients receive. For instance, surgical resection clearly provides the large tissue specimens needed for histological examination, whereas tissue biopsy and cytological testing are the primary methods for inoperable patients.
While methods may vary, only by combining quality and speed can the value of pathological diagnosis be fully realized. In China, newly diagnosed lung cancer patients require only 4 days from admission to preliminary treatment plan determination—significantly faster than the 10-14 day average in Western countries. This efficiency owes much to the pathology department, particularly cytological diagnosis.
Cytological diagnosis has increasingly moved "from behind the scenes to the forefront" in recent years, becoming more prevalent in lung cancer pathology. It can determine the histological type in 80% of lung cancer patients. Professor Wu Chunyan noted that Shanghai Pulmonary Hospital has begun testing molecular diagnostics directly on residual cytology samples from liquid-based cytology, optimizing the diagnostic workflow while maintaining accuracy.
Lung cytology samples vary widely in type and collection method, including lymph node/thoracic puncture, percutaneous fine-needle aspiration, bronchoscopy, or bronchoalveolar lavage. Recent years have also seen the emergence of new technologies like electromagnetic navigation bronchoscopy and bronchial airway ultrasound. Cytology sample preparation techniques have also evolved beyond traditional routine smears, such as thin-layer liquid-based cytology.
During molecular testing of cytology specimens, comprehensive quality control is required across pathology, environmental factors, nucleic acids, and operational procedures. Professor Wu Chunyan emphasized that only by strictly adhering to established protocols can methods like genetic testing, molecular diagnostics, and ROSE rapid diagnosis truly demonstrate their value in pathological diagnosis.
Professors Shao Feng, Yang Xintai, and Zhou Rongrong:
Focusing on the diagnostic and therapeutic challenges of locally advanced NSCLC, new treatment opportunities emerge for EGFR mutation-positive patients.>Prof. Shao Feng from Nanjing Chest Hospital Affiliated to Southeast University Medical College, Prof. Yang Xintai from Ji'an Central People's Hospital, and Prof. Zhou Rongrong from Xiangya Hospital of Central South University shared perspectives on standardized diagnosis and treatment of locally advanced EGFR mutation-positive NSCLC from surgical, medical, and radiation oncology viewpoints:
Prof. Shao Feng:Surgical Perspective
Professor Shao Feng noted that approximately one-quarter of NSCLC lung cancer patients in China are diagnosed at stage III. These patients may have missed the optimal window for surgical intervention, representing unresectable locally advanced NSCLC. Furthermore, the significant heterogeneity among stage III lung cancer patients can impact surgical outcomes.
Among them, T3-4 N0-1 patients achieve outcomes comparable to stage II patients with surgery plus adjuvant chemotherapy. However, III A N2 patients exhibit even greater heterogeneity, and surgical feasibility depends on the volume and extent of involved lymph nodes. Professor Shao Feng emphasized, "Stage III NSCLC absolutely requires multidisciplinary discussion and represents the highest level of collaboration between surgery, respiratory medicine, oncology, and radiation oncology."
The CSCO guidelines for operable stage IIIA/IIIB NSCLC treatment outline criteria for N2 patients, including solitary mediastinal lymph node metastasis, non-bulky metastasis, lymph node short axis ≤2cm, and expected complete resection. Palliative or incomplete resection is not recommended. Adjuvant therapy post-surgery is crucial for further improving prognosis.
Platinum-based dual-agent chemotherapy remains the primary adjuvant regimen for resectable locally advanced NSCLC, though it proves ineffective for EGFR mutation-positive patients. Studies like ADJUVANT, EVAN, and the recently promising ADAURA confirm the benefit of postoperative EGFR-TKI therapy, while postoperative radiotherapy may offer advantages only for N2 patients.
Additionally, some locally advanced NSCLC patients fall within the "potentially resectable" category. They may undergo neoadjuvant therapy—including preoperative radiotherapy, chemoradiotherapy, targeted therapy, or immunotherapy—to achieve operability. For EGFR mutation-positive patients, multiple studies have demonstrated the value of EGFR-TKIs, and studies on osimertinib are currently underway.
Professor Yang Xintai: Medical Perspective
Professor Yang Xintai noted that radical concurrent chemoradiotherapy is currently the standard treatment for unresectable locally advanced NSCLC. However, the median survival of approximately 25 months remains unsatisfactory. Consequently, exploring medical treatment approaches such as immunotherapy and targeted therapy represents a current hotspot and frontier in locally advanced NSCLC management.
For patients with EGFR mutation-positive locally advanced NSCLC, radiotherapy combined with EGFR-TKI therapy represents a promising option. The combination of these two treatment modalities possesses known synergistic mechanisms, such as the radiosensitizing effect of EGFR-TKIs and the ability of radiotherapy to partially overcome acquired resistance to EGFR-TKIs.