Navigating Multimodality Therapy in Non-Small Cell Lung Cancer: Neoadjuvant-Only Versus Perioperative Immunotherapy,...

Area of Science:

• Oncology
• Immunotherapy
• Thoracic Surgery

Background:

• Neoadjuvant and perioperative immunotherapy have emerged as transformative treatments for resectable non-small cell lung cancer (NSCLC).
• Immune checkpoint inhibitors (ICIs) targeting the PD-1/PD-L1 axis, combined with chemotherapy, show superior pathologic response rates compared to chemotherapy alone.
• These combinations improve event-free and overall survival in select NSCLC patient populations.

Purpose of the Study:

• To review the current evidence supporting neoadjuvant and perioperative immunotherapy in resectable NSCLC.
• To discuss key biomarkers, unresolved clinical questions, and implications for multidisciplinary care.
• To highlight the evolving role of immunotherapy in curative-intent NSCLC treatment.

Main Methods:

• Review of clinical trial data and scientific literature on immunotherapy in resectable NSCLC.
• Analysis of pathologic response rates, survival outcomes, and biomarker data.
• Discussion of clinical decision-making, treatment sequencing, and multidisciplinary care integration.

Main Results:

• PD-1/PD-L1 inhibitors plus chemotherapy demonstrate higher pathologic complete and major pathologic response rates than chemotherapy alone.
• These regimens translate to improved event-free survival and, in some cases, overall survival.
• Biomarkers like PD-L1 expression and ctDNA dynamics are emerging but require further validation for routine use.

Conclusions:

• Neoadjuvant and perioperative immunotherapy represent significant advancements in resectable NSCLC treatment.
• Optimal sequencing, duration, and patient selection require further investigation.
• Multidisciplinary care, including accurate staging, biomarker testing, and surgical expertise, is crucial for maximizing treatment benefits.