Neoadjuvant Chemoimmunotherapy Followed by Surgery for Non-Small Cell Lung Cancer: Current Evidence and Unmet Needs

Area of Science:

• Oncology
• Thoracic Surgery
• Immunotherapy

Background:

• Neoadjuvant chemoimmunotherapy (nCIT) is a rapidly evolving treatment for resectable non-small cell lung cancer (NSCLC).
• Incorporating nCIT into clinical practice requires understanding current evidence and surgical implications.

Purpose of the Study:

• To review clinical evidence, surgical considerations, and challenges of nCIT in resectable NSCLC.
• To evaluate outcomes and controversies surrounding nCIT for NSCLC.

Main Methods:

• Narrative review of Phase II-III trials (CheckMate 816, KEYNOTE-671, AEGEAN, CheckMate 77 T), meta-analyses, and real-world evidence.
• Evaluation of pathological response, event-free survival, and surgical safety.
• Examination of patient selection, biomarker utility, surgical complexity, and adjuvant therapy roles.

Main Results:

• nCIT significantly improves pathological complete response, major pathological response, and event-free survival versus chemotherapy alone.
• Surgical safety is maintained, with high R0 resection rates and feasibility of minimally invasive surgery.
• Challenges persist in selecting optimal candidates (e.g., Stage II, N2, EGFR-mutant, PD-L1 negative tumors) and managing surgical alterations.

Conclusions:

• nCIT represents a new standard of care for resectable NSCLC, enhancing pathological and survival outcomes while ensuring surgical safety.
• Future research should address patient selection, biomarker integration, and the role of adjuvant immunotherapy for personalized treatment.