Advancements and perspectives of neoadjuvant immunotherapy in resectable non-small cell lung cancer

Neoadjuvant immunotherapy has emerged as a cornerstone of therapy for resectable non-small cell lung cancer (NSCLC). Advantages over adjuvant therapy include possibly higher efficacy given the higher neoantigen load and intact lymphatics, tumor downstaging with more R0 resections, earlier assessment of response or futility, and cost effectiveness. Furthermore, by allowing a window of opportunity, it accelerates the drug development process. However, many pertinent questions remain unanswered. Biomarkers predicting maximal benefit from these agents require further research; impact on surgical safety is less understood; and it is unclear whether patients achieving pathological complete response require further therapy. A number of trials are ongoing to answer these questions, making this a rapidly evolving area of oncology. This narrative review details the currently available evidence in context of clinically important questions, and also explores possible future directions for research. For comprehensiveness, chemotherapy and targeted therapy in resectable NSCLC have also been addressed briefly.