The Emerging Role of Immunotherapy in Resectable Non-Small Cell Lung Cancer

Area of Science:

• Oncology
• Immunotherapy
• Surgical Oncology

Background:

• Long-term survival for resectable non-small cell lung cancer (NSCLC) remains poor despite surgical resection.
• Adjuvant chemotherapy offers a marginal survival benefit for locally advanced NSCLC.
• Immune checkpoint inhibitors (ICIs) show promise for advanced NSCLC and are being evaluated in the perioperative setting for resectable disease.

Purpose of the Study:

• To evaluate the efficacy and safety of perioperative immunotherapy in resectable non-small cell lung cancer (NSCLC).
• To review current clinical trial data on immunotherapy for resectable NSCLC.
• To identify key areas for future research in perioperative immunotherapy for NSCLC.

Main Methods:

• Literature search of PubMed for clinical trials of immunotherapy in resectable NSCLC.
• Inclusion of studies on biomarkers and immune priming strategies.
• Analysis of data from randomized phase III trials and reported outcomes.

Main Results:

• Phase III trials demonstrate significant improvements in event-free/disease-free survival (24%-42%) with neoadjuvant/adjuvant ICIs (nivolumab, pembrolizumab, atezolizumab) in NSCLC.
• Pathologic complete response rates of 17%-25% observed with perioperative immunotherapy, exceeding chemotherapy alone.
• Perioperative ICI therapy shows comparable morbidity and does not negatively impact surgical outcomes compared to chemotherapy.

Conclusions:

• Perioperative immunotherapy, combined with chemotherapy, is a safe and effective strategy for improving outcomes in resectable NSCLC.
• Further research is needed to optimize patient selection for perioperative immunotherapy.
• Optimal duration and necessity of adjuvant ICI therapy post-chemoimmunotherapy require further investigation.