Stratégies de traitement périopératoires pour le cancer du poumon en 2025 : un changement de paradigme
Résumé
La prise en charge périopératoire du cancer du poumon non à petites cellules (CPNPC) résécable a considérablement évolué grâce à l’intégration des inhibiteurs de points de contrôle immunitaires et des thérapies ciblées. Cette revue synthétisera les données actuelles issues d’essais cliniques clés, mettant en évidence l’amélioration des résultats de survie obtenue grâce à une chimioimmunothérapie néoadjuvante et périopératoire dans le CPNPC de type oncogène sauvage, ainsi qu’aux inhibiteurs de tyrosine kinase adjuvants dans les tumeurs présentant des altérations du récepteur du facteur de croissance épidermique (EGFR) et de la kinase du lymphome anaplasique (ALK). Bien que l’immunothérapie néoadjuvante ait démontré des taux de réponse pathologique élevés et des avantages de survie à long terme, les stratégies périopératoires peuvent offrir une valeur ajoutée dans certains sous-groupes sélectionnés. Les essais ADAURA et ALINA ont établi l’osimertinib et l’alectinib en tant que nouveaux standards de soins dans le cancer adjuvant lié à une mutation oncogénique. Des questions restent toutefois en suspens concernant la séquence optimale des traitements, leur durée et la sélection des patients. De nouveaux outils, tels que l’ADN tumoral circulant et l’intelligence artificielle, sont prometteurs pour affiner la stratification des risques et orienter les approches thérapeutiques individualisées.
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