Immunotherapy in resectable NSCLC: Answering the question or questioning the answer?

Area of Science:

• Oncology
• Immunotherapy
• Genomics

Background:

• Immunotherapy is emerging as a key treatment modality in the perioperative setting for resectable non-small cell lung cancer (NSCLC).
• A significant number of clinical trials are actively investigating the expanding evidence base for managing resectable NSCLC with immunotherapy.
• Optimizing treatment strategies, including the timing and combination of neoadjuvant and adjuvant therapies, is critical for improving patient outcomes.

Purpose of the Study:

• To determine the optimal perioperative treatment patterns for resectable non-small cell lung cancer (NSCLC) using immunotherapy.
• To identify specific patient populations who are most likely to benefit from different perioperative immunotherapy strategies.
• To emphasize the importance of integrating genomic testing and circulating tumor DNA (ctDNA) monitoring in clinical trial design.

Main Methods:

• Review of current clinical trials evaluating immunotherapy in the perioperative setting for resectable NSCLC.
• Analysis of decision-making processes involving multi-disciplinary teams.
• Assessment of the role of tissue and plasma genomic testing in guiding therapeutic choices.
• Consideration of integrating circulating tumor DNA (ctDNA) monitoring into clinical trial design.

Main Results:

• The evidence base for perioperative immunotherapy in resectable NSCLC is rapidly expanding through numerous clinical trials.
• Identifying the optimal treatment sequence (neoadjuvant, adjuvant, or combination) is a critical next step.
• Genomic testing (tissue and plasma) and ctDNA monitoring are essential tools for personalized treatment decisions and trial design.

Conclusions:

• The perioperative setting presents a vital platform for leveraging immunotherapy in resectable NSCLC.
• A multi-disciplinary approach incorporating advanced genomic testing is necessary to personalize treatment strategies.
• Efficient integration of ctDNA monitoring into clinical trials is crucial for guiding treatment and improving efficacy.