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Neoadjuvant immunotherapy in resectable non-small-cell lung cancer
Lanyi Nora Chen1, Alexander Z Wei1, Catherine A Shu2
1Division of Hematology & Oncology, Columbia University Irving Medical Center, New York, NY, USA.
Therapeutic Advances in Medical Oncology
|April 3, 2023
Summary
Neoadjuvant immunotherapy, particularly chemoimmunotherapy, shows significant promise for resectable non-small-cell lung cancer (NSCLC), improving pathologic responses and surgical outcomes. Further research is ongoing to address remaining questions regarding biomarkers and survival benefits.
Area of Science:
- Oncology
- Immunotherapy
- Thoracic Surgery
Background:
- Immune checkpoint inhibitors have shifted the treatment approach for resectable non-small-cell lung cancer (NSCLC) towards neoadjuvant therapy.
- Neoadjuvant immunotherapy, alone or combined with radiation therapy (RT) or chemotherapy, is being extensively investigated.
Purpose of the Study:
- To review the current evidence and ongoing research regarding neoadjuvant immunotherapy for resectable non-small-cell lung cancer (NSCLC).
- To highlight the efficacy and feasibility of neoadjuvant chemoimmunotherapy and identify outstanding questions in the field.
Main Methods:
- Review of Phase II and III clinical trials (LCMC3, NEOSTAR, Columbia, NADIM, SAKK 16/14, NADIM II, CheckMate-816) evaluating neoadjuvant immunotherapy in resectable NSCLC.
- Analysis of pathologic response rates, surgical outcomes, and treatment feasibility.
Main Results:
- Neoadjuvant immunotherapy has demonstrated meaningful pathologic responses.
- Neoadjuvant chemoimmunotherapy has shown high rates of pathologic response and improved surgical outcomes without compromising surgical timing.
- The CheckMate-816 trial confirmed a benefit of neoadjuvant chemoimmunotherapy over chemotherapy alone for resectable NSCLC.
Conclusions:
- Neoadjuvant chemoimmunotherapy is an effective strategy for resectable NSCLC, improving pathologic and surgical outcomes.
- Outstanding questions remain regarding the correlation between pathologic response and survival, the role of biomarkers (PD-L1, ctDNA), and the use of adjuvant therapies.
- A multidisciplinary approach is crucial for managing resectable NSCLC.
