Role and impact of immune checkpoint inhibitors in neoadjuvant treatment for NSCLC

In the last decade, immune-checkpoint inhibitors (ICIs) have become the backbone of therapy in advanced, non-oncogene driven, non-small cell lung cancer (NSCLC). More recently, they have been approved by the FDA in the adjuvant NSCLC setting based on positive disease-free survival results. In the neoadjuvant setting, emerging results signal that a therapeutic paradigm shift may be imminent. Yet, it is difficult to ascertain the benefit of neoadjuvant therapy, as the desired result is an improvement in overall survival, which can take many years to mature. In this review, we explore the role and impact of neoadjuvant therapy, data on neoadjuvant chemotherapy, the rationale and potential predictive biomarkers, as well as current and ongoing trials in the setting of neoadjuvant ICIs.