Current Approaches to Neoadjuvant Immunotherapy in Resectable Non-small Cell Lung Cancer

Parekh, Jay; Parikh, Kaushal; Reuss, Joshua E.; Friedlaender, Alex; Addeo, Alfredo

doi:10.1007/s11912-023-01430-4

Cited by 4 publications

(4 citation statements)

References 75 publications

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“… 31 Based on the inclusion criteria from previous chemotherapy trials and other research findings, it is clear that the majority of patients who benefited from perioperative ICI-based trials had at least stage IB disease (>4 cm) or more advanced. 39 In addition, despite the poor efficacy of anti-PD-1/PD-L1 treatment in most advanced EGFR-mutated NSCLC, specific subpopulations with advanced EGFR-mutated NSCLC could benefit from immunotherapy. 23 Notably, few populations with EGFR/ALK mutations were included in the KEYNOTE-671, AEGEN, Impower 010, and KEYNOTE-091 trials.…”

Section: Discussionmentioning

confidence: 99%

The Value of Perioperative Immunotherapy for Non-Small Cell Lung Cancer: A Pool- and Meta-Analysis

Wu,

Hu,

Zhang

et al. 2024

Technol Cancer Res Treat

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Purpose: This study aimed to analyze the efficacy and safety of neoadjuvant and adjuvant immunotherapies for non-small cell lung cancer (NSCLC). Methods: Electronic literature searches were conducted in PubMed, OVID, Web of SCI, Embase, Cochrane Library, and the Chinese National Knowledge Infrastructure databases. The deadline for literature update and retrieval is February 16, 2024. Studies presented at meetings were also screened. Randomized controlled trials (RCTs) and single-arm trials were included, and the data were extracted according to the inclusion and exclusion criteria. Data analysis was performed using Stata (16.0) software. Results: A total of 5850 patients in 11 RCTs and 6 single-arm trial studies involving neoadjuvant and/or adjuvant immune checkpoint inhibitor (ICI)-based therapies were included. Regarding neoadjuvant therapy, the overall complication rate after surgery reached 35% (95% CI, 0.21-0.49). Higher rates of pathological complete response (OR = 7.83; 95% CI, 5.95-10.31; P < .001) and major pathological response (OR = 5.13; 95% CI, 3.56-7.40; P < .001) were found in the resectable NSCLC patients who received neoadjuvant therapy with ICIs combined with chemotherapy compared with patients treated with chemotherapy alone. Of note, compared with chemotherapy, neoadjuvant ICIs combined with chemotherapy significantly improved the overall survival (OS) (HR = 0.65; 95% CI, 0.52-0.82; P < .001) and event-free survival (EFS) (HR = 0.59; 95% CI, 0.52-0.67; P < .001) in patients with resectable NSCLC. Regarding adjuvant therapy, a lower risk of disease progression or death (HR = 0.78; 95% CI, 0.69-0.90; P < .001) was found in the adjuvant ICI group compared with the adjuvant chemotherapy-alone group. In terms of safety, perioperative immunotherapy combined with chemotherapy did not increase toxicity compared with chemotherapy alone. Conclusion: In patients with resectable NSCLC, perioperative immunotherapy was safe and efficacious. Perioperative immunotherapy combined with chemotherapy improved the pathologic response and EFS/DFS/OS over chemotherapy alone without increasing toxicity.

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Section: Discussionmentioning

confidence: 99%

The Value of Perioperative Immunotherapy for Non-Small Cell Lung Cancer: A Pool- and Meta-Analysis

Wu,

Hu,

Zhang

et al. 2024

Technol Cancer Res Treat

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“…These phases III studies did not only include stage III patients [ 37 ]. In subgroup analyses, stage III patients derived equal or greater benefit from immunotherapy than stage II patients.…”

Section: Management Of Stage III Nsclcmentioning

confidence: 99%

Management of stage III non-small-cell lung cancer: rays of hope

Kim,

Borgeaud,

Addeo

et al. 2024

Exploration of Targeted Anti-Tumor Therapy

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Lung cancer remains the most common cause of cancer death across the world. Non-small-cell lung cancer (NSCLC) represents the most frequent type of lung cancer and is frequently diagnosed at an advanced stage. Stage III NSCLC, which encompasses 30% of cases, refers to a state between localized and metastatic disease, and is associated with poor prognosis. As highlighted in this review, stage III represents a heterogenous group, whose complex management includes multimodal treatment, discussed below, and requires discussion in multidisciplinary teams. The goal of this approach is a maximalist attitude in these patients with locally advanced and non-metastatic disease. However, many issues remain under debate including the optimal sequences of treatment between different treatment modalities, patient selection particularly for surgery, the duration of perioperative treatments and the identification of biomarkers to determine which patients might benefit of specific treatment like immunotherapy and targeted therapies. This review describes the current landscape of management of stage III NSCLC, discussing the critical issue of resectability, and highlighting the recent advancements in the field, particularly the incorporation of immune-checkpoint inhibitors (ICIs) and targeted therapies in this setting.

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“…Besides these, the patients' performance status should be ideal before surgical intervention to undergo neoadjuvant treatment as well as complying optimally upon completion [25]. Last but not least, potential tumor downstaging before definitive surgery has been linked to more conservative surgical approaches and increases the percentage of R0 excisions [26].…”

Section: Neoadjuvant Settingmentioning

confidence: 99%

Neoadjuvant and Adjuvant Immunotherapy in Resectable NSCLC

Bogatsa,

Lazaridis,

Stivanaki

et al. 2024

Cancers

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Non-small cell lung cancer, even when diagnosed in early stages, has been linked with poor survival rates and distant recurrence patterns. Novel therapeutic approaches harnessing the immune system have been implemented in early stages, following the designated steps of advanced NSCLC treatment strategies. Immune-checkpoint inhibitor (ICI) regimens as monotherapy, combinational, or alongside chemotherapy have been intensely investigated as adjuvant, neoadjuvant, and, more recently, perioperative therapeutic strategies, representing pivotal milestones in the evolution of early lung cancer management while holding great potential for the future. The subject of current ongoing research is optimizing treatment outcomes for patient subsets with different needs and identifying biomarkers that could be predictive of response while translating the trials’ endpoints to survival rates. The aim of this review is to discuss all current treatment options with the pros and cons of each, persistent challenges, and future perspectives on immunotherapy as illuminating the path to a new era for resectable NSCLC.

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Current Approaches to Neoadjuvant Immunotherapy in Resectable Non-small Cell Lung Cancer

Cited by 4 publications

References 75 publications

The Value of Perioperative Immunotherapy for Non-Small Cell Lung Cancer: A Pool- and Meta-Analysis

The Value of Perioperative Immunotherapy for Non-Small Cell Lung Cancer: A Pool- and Meta-Analysis

Management of stage III non-small-cell lung cancer: rays of hope

Neoadjuvant and Adjuvant Immunotherapy in Resectable NSCLC

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