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Progress on neoadjuvant immunotherapy in resectable non-small cell lung cancer and potential biomarkers
Xinyu Wu1, Yi Fung Chau1, Hua Bai1
1CAMS Key Laboratory of Translational Research on Lung Cancer, State Key Laboratory of Molecular Oncology, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences Peking Union Medical College, Beijing, China.
Abstract:
Immune checkpoint inhibitors (ICIs) are highly concerned in the treatment of non-small cell lung cancer (NSCLC), represented by inhibitors of programmed death protein 1 (PD-1) and its ligand (PD-L1), and inhibitors of cytotoxic T lymphocyte-associated antigen-4 (CTLA-4). The introduction of immunotherapy in the treatment of perioperative NSCLC has improved the prognosis to a great extent, as demonstrated by several phase II and III clinical trials. The target population for immunotherapy in early-stage NSCLC is still under discussion, and the biomarkers for neoadjuvant immunotherapy population selection are the next pending problem. The predictive efficacy of many potential makers is still being explored, including PD-L1 expression levels, tumor mutation burden, circulating tumor DNA, components of the tumor microenvironment, and several clinical factors. We summarize key findings on the utility of ICIs in clinical trials of preoperative NSCLC patients and conclude analyses of relevant biomarkers to provide a better understanding of potentially predictive biomarkers in neoadjuvant immunotherapy.
Insights
Immune checkpoint inhibitors (ICIs) improve outcomes for non-small cell lung cancer (NSCLC) patients undergoing surgery. Identifying the right patients using biomarkers is key for effective neoadjuvant immunotherapy.
Area of Science:
- Oncology
- Immunology
- Thoracic Surgery
Background:
- Immune checkpoint inhibitors (ICIs), including programmed death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) and cytotoxic T lymphocyte-associated antigen-4 (CTLA-4) inhibitors, are crucial in non-small cell lung cancer (NSCLC) treatment.
- Immunotherapy has significantly improved prognoses in perioperative NSCLC, supported by clinical trial data.
Purpose of the Study:
- To review the efficacy of ICIs in clinical trials for preoperative NSCLC patients.
- To analyze biomarkers for selecting patients eligible for neoadjuvant immunotherapy in early-stage NSCLC.
Main Methods:
- Literature review of phase II and III clinical trials involving ICIs in perioperative NSCLC.
- Analysis of current research on biomarkers for neoadjuvant immunotherapy patient selection.
Main Results:
- ICIs have demonstrated improved outcomes in perioperative NSCLC.
- Biomarker research is ongoing to identify optimal candidates for neoadjuvant immunotherapy.
Conclusions:
- Neoadjuvant immunotherapy shows promise for early-stage NSCLC, but patient selection requires further refinement.
- Understanding predictive biomarkers like PD-L1 expression, tumor mutation burden, and circulating tumor DNA is essential for optimizing treatment strategies.
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