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Updated: Aug 14, 2025
Author Spotlight: Advancements in Molecular Biomarker Testing for Non-Squamous Non-Small Cell Lung Cancer
Published on: September 8, 2023
Emerging precision neoadjuvant systemic therapy for patients with resectable non-small cell lung cancer: current
Luis A Godoy1, Joy Chen2, Weijie Ma3
1Division of Thoracic Surgery, Department of Surgery, University of California Davis School of Medicine, Sacramento, CA, USA.
Abstract:
Over the past decade, targeted therapy for oncogene-driven NSCLC and immune checkpoint inhibitors for non-oncogene-driven NSCLC, respectively, have greatly improved the survival and quality of life for patients with unresectable NSCLC. Increasingly, these biomarker-guided systemic therapies given before or after surgery have been used in patients with early-stage NSCLC. In March 2022, the US FDA granted the approval of neoadjuvant nivolumab and chemotherapy for patients with stage IB-IIIA NSCLC. Several phase II/III trials are evaluating the clinical efficacy of various neoadjuvant immune checkpoint inhibitor combinations for non-oncogene-driven NSCLC and neoadjuvant molecular targeted therapies for oncogene-driven NSCLC, respectively. However, clinical application of precision neoadjuvant treatment requires a paradigm shift in the biomarker testing and multidisciplinary collaboration at the diagnosis of early-stage NSCLC. In this comprehensive review, we summarize the current diagnosis and treatment landscape, recent advances, new challenges in biomarker testing and endpoint selections, practical considerations for a timely multidisciplinary collaboration at diagnosis, and perspectives in emerging neoadjuvant precision systemic therapy for patients with resectable, early-stage NSCLC. These biomarker-guided neoadjuvant therapies hold the promise to improve surgical and pathological outcomes, reduce systemic recurrences, guide postoperative therapy, and improve cure rates in patients with resectable NSCLC.
Insights
Precision neoadjuvant therapies, including targeted treatments and immune checkpoint inhibitors, are improving outcomes for early-stage non-small cell lung cancer (NSCLC). Biomarker testing and multidisciplinary collaboration are crucial for successful clinical application.
Area of Science:
- Oncology
- Translational Medicine
- Pulmonology
Background:
- Targeted therapies and immune checkpoint inhibitors have significantly improved survival for unresectable non-small cell lung cancer (NSCLC).
- Neoadjuvant systemic therapies are increasingly utilized in early-stage NSCLC, with recent FDA approval for neoadjuvant nivolumab and chemotherapy.
Purpose of the Study:
- To review the current landscape of diagnosis and treatment for early-stage NSCLC.
- To summarize recent advances, challenges, and perspectives in neoadjuvant precision systemic therapy.
- To highlight the importance of biomarker testing and multidisciplinary collaboration in clinical application.
Main Methods:
- Comprehensive review of current diagnosis and treatment strategies for resectable, early-stage NSCLC.
- Analysis of ongoing phase II/III trials evaluating neoadjuvant therapies.
- Discussion of challenges in biomarker testing, endpoint selection, and multidisciplinary collaboration.
Main Results:
- Neoadjuvant therapies, guided by biomarkers, show promise for improving surgical and pathological outcomes.
- These treatments aim to reduce systemic recurrences and guide postoperative therapy for improved cure rates.
- Clinical application necessitates a paradigm shift in biomarker testing and timely multidisciplinary collaboration.
Conclusions:
- Biomarker-guided neoadjuvant therapies represent a significant advancement in managing resectable NSCLC.
- Successful implementation requires optimized biomarker strategies and robust multidisciplinary team integration.
- Emerging neoadjuvant precision therapies hold the potential to enhance cure rates and patient outcomes.
