Neoadjuvant immune checkpoint inhibitor therapy in resectable non-small cell lung cancer.

Only a minority of lung cancers are resectable at diagnosis, and many of these will eventually relapse. Adjuvant chemotherapy in this setting has a modest survival advantage, and there is significant need for new approaches to improve cure rates. Checkpoint inhibitor immunotherapy has transformed the prognosis for advanced lung cancer, and is increasingly being used in the neoadjuvant setting alone, or in combination with cytotoxic chemotherapy. While this has demonstrated convincing improvements in event-free survival and pathologic response, questions remain over optimal duration of therapy, predictive and prognostic biomarkers, response assessment and combination with other modalities. In addition, these results must be considered in the context of recent positive studies of adjuvant immunotherapy. Here, we summarise preclinical context and clinical trials in this space, discuss areas of controversy and pitfalls, and consider future challenges.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: M.R.C. and C.D. have no relevant disclosures. P.M.F. has received research funding to Johns Hopkins University from AstraZeneca, Bristol Myers Squibb, Novartis, Corvus and Kyowa. He has also served as a consultant for Amgen, AstraZeneca, Bristol Myers Squibb, Daiichi Sankyo, Genentech, G1 Therapeutics, Iteos, Janssen, Merck, Surface Oncology, Mirati, Novartis and Sanofi, and as a DSMB member for Polaris and Flame Therapeutics.
(Copyright © 2023. Published by Elsevier B.V.)