Current Status of Immunotherapy in Resectable Lung Cancer

Lung cancer is the foremost cause of cancer-related mortality globally, with India accounting for a considerable share of the disease burden. Despite progress in surgical techniques and adjuvant therapies, outcomes for both non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) remain suboptimal, particularly in advanced stages. The introduction of immunotherapy has significantly altered the therapeutic landscape. While initially employed in metastatic and unresectable disease, immunotherapy is now gaining traction in the perioperative management of resectable NSCLC. Pivotal trials such as IMpower010, CheckMate 816, and KEYNOTE-091 have demonstrated meaningful improvements in outcomes, prompting a shift in treatment protocols. This evolution necessitates a broader scope of treatment through incorporation immunologic response assessment into operative planning, management of immune-related toxicities, and multidisciplinary coordination. Furthermore, emerging modalities including cancer vaccines, tumour-infiltrating lymphocyte therapy, and personalised immunotherapy strategies are pushing the boundaries of conventional surgical paradigms. This review critically examines current evidence supporting immunotherapy in lung cancer with particular emphasis on surgical implications. The integration of immunotherapy into surgical oncology represents a significant advancement, offering opportunities for improved outcomes while presenting new challenges in patient selection, timing, and multidisciplinary management. As India confronts a rising incidence of lung cancer, the role of immunotherapy with surgery holds promise for the future, transforming patient care.