[Advances in neoadjuvant therapy for EGFR-mutant non-small cell lung cancer].

内容摘要

Epidermal growth factor receptor (EGFR) mutation is the most common driver mutation in non-small cell lung cancer (NSCLC) among Asian populations. For patients with resectable EGFR-mutant NSCLC, the high risk of postoperative recurrence remains a major clinical challenge. The neoadjuvant treatment paradigm has shifted from conventional chemotherapy to precision therapies centered on EGFR-tyrosine kinase inhibitors (TKIs), aiming to downstage tumor and eradicate micrometastases before surgery, thereby improving surgical outcomes and long-term survival. This article systematically reviews the evolution and recent advances in neoadjuvant therapy for EGFR-mutant NSCLC. As of December 2025, osimertinib-based regimens, whether used as monotherapy or in combination with chemotherapy, have emerged as potential options in this field and are supported by high-level evidence-based medicine. The article also discusses the limitations of immunotherapy in the EGFR-mutant NSCLC population and the future development trends of combination strategies, emphasizing that biomarker-guided individualized therapy represents the corner direction moving forward. 表皮生长因子受体（EGFR）突变是亚裔非小细胞肺癌（NSCLC）中最常见的驱动基因突变。对于可切除的EGFR突变NSCLC患者，术后高复发风险是目前的主要挑战。新辅助治疗模式已从传统化疗转向以EGFR-酪氨酸激酶抑制剂为核心的精准治疗，旨在术前缩小肿瘤、清除微转移灶，从而改善手术结局和长期生存。文章系统回顾了EGFR突变NSCLC新辅助治疗的演变历程和最新进展。截至2025年12月，以奥希替尼为基础的方案，无论是单药还是联合化疗方案，已成为该领域的潜在选择之一，并获得高级别循证医学证据支持。文章亦探讨了免疫治疗在EGFR突变NSCLC人群中的局限性以及联合治疗策略的未来发展趋势，并强调基于生物标志物的个体化治疗是未来的核心方向。.