Adjuvant and neo‐adjuvant immunotherapy in resectable non‐small cell lung cancer (NSCLC): Current status and perspectives

Abstract

Surgery followed by adjuvant chemotherapy is the standard of care for selected patients with early‐stage or locally advanced non‐small cell lung cancer (NSCLC). However, many of these patients still experience postoperative recurrence at 5 years. At present, peri‐operative treatment methods are emerging to prevent early relapse, such as targeted therapy and immunotherapy. Investigation on predictive biomarkers of responses to adjuvant and neoadjuvant therapies is also continuously ongoing. Immunotherapy represented by immune checkpoint inhibitors (ICIs), either by monotherapy or in combination with chemotherapy, has shown benefit in promoting pathological responses and prolonging survival for patients with NSCLC without oncogenic mutations. Exploratory studies have also provided evidence regarding the selection of patients who benefit from ICI‐based perioperative treatment. This review focuses on the existing data of current clinical trials of adjuvant and neoadjuvant strategies with ICIs in resectable NSCLC, the exploration of predictive biomarkers, and the perspectives and urgent challenges in the future.

Neoadjuvant and Adjuvant Immunotherapy in Resectable NSCLC

“…A high or low inflammatory signature score was also correlated with EFS, with rates at 36 months of 70% and 50%, respectively, for high and low scores for the immunotherapy arm compared to almost identical numerical rates for the chemotherapy arm (Awad et al, ESMO 2023 [39]). Such analyses harbor great potential regarding decision making in the future, although currently only at the very early stage, and nonetheless, they require more thorough research to be translated and incorporated into clinical practice [75][76][77].…”

MAPK4 facilitates angiogenesis by inhibiting the ERK pathway in non‐small cell lung cancer

“…Non‐small cell lung cancer (NSCLC) is a highly morbid and lethal disease with a poor prognosis that accounts for 85% of all lung cancers [ 1 , 2 ]. Approximately 70% of patients with newly diagnosed NSCLC are over 65 years of age and more than half have metastatic or locally advanced NSCLC [ 3 ]. Despite recent advances in the diagnosis and treatment of NSCLC, the 5‐year overall survival rate remains low [ 4 ], especially in the elderly population.…”