Mariano Provencio1, Kathryn Yan2
1Medical Oncology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; 2TLCR Editorial Office, AME Publishing Company
Correspondence to: Kathryn Yan. TLCR Editorial Office, AME Publishing Company. Email: editor@tlcr.org.
Editor’s note
Translational Lung Cancer Research (TLCR) has published a number of special series in recent years, receiving overwhelming responses from academic readers around the world. Our success cannot be achieved without the contribution of our distinguished guest editors. This year TLCR launched a new column, “Interviews with Guest Editors”, to better present our guest editors and to further promote the special series. We also hope to express our heartfelt gratitude for their tremendous effort and to further uncover the stories behind the special series.
The special series “Multimodal Management of Locally Advanced N2 Non-small Cell Lung Cancer” (1) edited by Dr. Mariano Provencio (Figure 1) has attracted many readers since its publication. At this moment, we are honored to have an interview with Dr. Provencio to share his scientific career experience and insights on this special series.
Figure 1 Mariano Provencio
Expert Introduction:
Dr. Provencio is the Chief of the Medical Oncology Department at Hospital Universitario Puerta de Hierro and Full Professor at the Faculty of Medicine of Universidad Autonoma de Madrid. He is also the President of the Spanish Lung Cancer Group (SLCG) and the Spanish Lymphoma Oncology Group (GOTEL) and Corresponding Academic at the Royal National Academy of Medicine.
Dr Provencio has an extensive research activity with more than 200 studies focusing mainly on lung cancer and lymphoma. His main lines of research focus on: the clinical utility of ctDNA for the management of lung cancer patients; the tumor microenvironment and the immune system-tumor relationship with the response and survival; and the application of AI and Big Data tools for the exploitation of clinical and molecular data to improve the survival and quality of life of cancer long survivors.
With the SLCG, Dr Provencio has been a pioneer in establishing the benefit of neoadjuvant chemotherapy plus immunotherapy (CH- I) in NSCLC patients with tumors in operable stages. The SLCG phase II NADIM trial evaluated the combination of neoadjuvant CH-I in operable stage IIIA NSCLC and showed a complete pathological response (pCR) rate of 63 % and overall survival (OS) of 81.9% at 36 months. Results from the NADIM trial were further confirmed by the phase 3 trial CheckMate816, finally leading to the approval of this combination by the FDA in March 2022.
Interview
TLCR: What drove you into the field of medical oncology?
Dr. Provencio: Research and Internal Medicine are two of my main interests which come together in Medical Oncology. It is a field that allows you plenty of room to develop as a physician as it involves treating and managing patients, research, diagnosing and assessing.
TLCR: As you are experienced in this field, do you have any cases that are particularly impressive to you? Could you share one or two with us?
Dr. Provencio: I´ve witnessed several impressive cases over the years. We had a young patient with a cardiac involvement for whom we couldn´t initially even consider the possibility of chemotherapy, radiotherapy or even surgery. He entered the NADIM study and after receiving chemoimmunotherapy he could be treated with surgery and achieved pathological complete response. There are similar cases of patients who were excluded from any radical treatment and who are alive after five years.
TLCR: There are several studies on neoadjuvant treatment in this special series, what do you think are the main advantages of neoadjuvant treatment over adjuvant treatment? How do you think it has changed the field of lung cancer?
Dr. Provencio: The treatment of resectable lung cancer in early or locally advanced stages (I, II and IIIA) has been through a revolution in recent times. New treatments that did not exist previously, such as adjuvant treatments with immunotherapy, have appeared increasing DFS (Disease Free Survival). On the other hand, neoadjuvant treatments for stages I, II and III have also proven to improve DFS.
Both adjuvant and neoadjuvant approaches could be valid. However, each scenario involves distinct groups of patients.
I think adjuvant treatments will continue to be relevant, and probably better defined, for those patients who show pathological incomplete response after neoadjuvant treatment. There will be patients who will need an adjuvant treatment and others, like those who show a pathologic complete response, who won´t.
On the other hand it will probably take longer to start neoadjuvant treatments with patients in early stages. We still have to work on defining which patients benefit most from adjuvant or neoadjuvant therapy, this is important. I think neoadjuvant treatment will play a role with locally advanced patients who traditionally had not been eligible for surgery or for those cases in which surgery was too difficult.
TLCR: What do you see as the most important direction for future studies on non-small cell lung cancer? Are there any particular challenges or obstacles that need to be overcome in order to make progress in this direction?
Dr. Provencio: The most important challenge is to know, through molecular biomarkers and liquid biopsy, which patients are going to benefit from neoadjuvant treatment at an early stage. On the other hand I think one of the most important things in the future is the role of surgery in patients with pathological complete response. In this case it will be key to identify which patients achieve pathological complete response before surgery. There´s still work to do to understand what does surgery contribute for patients with pathological complete response. Lastly, after surgery and with the anatomic pathology report, we need to establish what´s best for patients with pathological complete response. The relevance of adjuvant treatment in those patients that don´t achieve pathological complete response is doubtful. More evidence is needed to define what to do afterwards: Chemo combinations, Inmuno combinations, other treatments…
TLCR: Is the topic of this special series associated with any of your recent research projects? Would you please share some significant researches you are working on?
Dr. Provencio: We work extensively about adjuvant therapy in the NADIM I and II studies and more recently in the APOLLO study, with non-resectable lung cancer patients. We have focused on the clinical potential as well as on the molecular identification of tumors and the relevance of liquid biopsy in establishing which patients achieve pathological complete response.
But we also work actively on adjuvant therapy. We have recently finished the recruitment phase in the NADIM ADJUVANT and we will soon publish the first results.
TLCR: If given an opportunity to update this special series, what would you like to moderate, add or emphasize to provide a more informative series?
Dr. Provencio: This special series is very interesting because it focuses on concrete aspects of early stages and research progress of neoadjuvant therapies to explore their response evaluation aiming to identify stronger predictors of overall survival (OS).
References
- Multimodal Management of Locally Advanced N2 Non-small Cell Lung Cancer Available online: https://tlcr.amegroups.com/post/view/multimodal-management-of-locally-advanced-n2-non-small-cell-lung-cancer