Optimal Use of Targeted Therapy and Immunotherapy in Early-Stage, Resectable Non-Small Cell Lung Cancer

Area of Science:

• Oncology
• Thoracic Surgery
• Clinical Trials

Background:

• Systemic therapies are increasingly used to improve surgical outcomes in non-small cell lung cancer (NSCLC).
• Targeted therapies like osimertinib and alectinib are approved for adjuvant treatment of resected EGFR/ALK-mutated NSCLC.
• Chemoimmunotherapy combinations are standard of care for resectable stage IB-III NSCLC in perioperative settings.

Purpose of the Study:

• To address critical questions regarding the optimal timing and necessity of adjuvant immunotherapy in resectable NSCLC.
• To compare the efficacy of neoadjuvant/perioperative versus adjuvant chemoimmunotherapy.
• To determine if patients achieving a complete response to neoadjuvant immunotherapy benefit from adjuvant immunotherapy.

Main Methods:

• Two National Clinical Trials Network trials are investigating these questions: PROSPECT-Lung (NCT04267848) and INSIGHT (NCT06498635).
• These trials focus on patients with resectable NSCLC across various stages.
• The studies incorporate assessment of pathologic response to neoadjuvant immunotherapy.

Main Results:

• Results from these ongoing trials are pending.
• The trials aim to establish evidence-based guidelines for systemic therapy in resectable NSCLC.
• Key questions regarding treatment sequencing and benefit of adjuvant immunotherapy post-response are being addressed.

Conclusions:

• There is a need to definitively answer which systemic therapy approach is superior for resectable NSCLC.
• Understanding the benefit of adjuvant immunotherapy after neoadjuvant treatment is crucial for patient care.
• Ongoing trials are designed to provide patient-centered answers to optimize treatment strategies.