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

Area of Science:

• Oncology
• Immunotherapy
• Thoracic Surgery

Background:

• Immune checkpoint inhibitors (ICIs) targeting PD-1, PD-L1, and CTLA-4 have revolutionized advanced non-small cell lung cancer (NSCLC) treatment.
• Their application is expanding to resectable NSCLC, showing promise in neoadjuvant and adjuvant settings.

Purpose of the Study:

• To review the current evidence and clinical trial landscape for immunotherapy in resectable NSCLC.
• To examine unresolved questions regarding optimal timing (neoadjuvant vs. adjuvant) and patient selection for ICI-CT strategies.

Main Methods:

• Critical examination of data from multiple randomized phase III trials.
• Analysis of pathological complete response (pCR), major pathological response (MPR), event-free survival (EFS), disease-free survival (DFS), and overall survival (OS) data.

Main Results:

• Neoadjuvant and adjuvant immunotherapy, especially combined with platinum-based chemotherapy, significantly improves pCR, MPR, EFS, DFS, and OS compared to chemotherapy alone.
• Evidence suggests improved outcomes with combined ICI-CT strategies in the neoadjuvant and adjuvant settings for resectable NSCLC.

Conclusions:

• Immunotherapy, particularly in combination with chemotherapy, represents a significant advancement for resectable NSCLC.
• Further research is crucial to determine optimal treatment sequencing and identify predictive biomarkers for patient selection.