Pathological Response and Immune Biomarker Assessment in Non-Small-Cell Lung Carcinoma Receiving Neoadjuvant Immune Checkpoint Inhibitors

Abstract

Lung cancer is the leading cause of cancer incidence and mortality worldwide. Adjuvant and neoadjuvant chemotherapy have been used in the perioperative setting of non-small-cell carcinoma (NSCLC); however, the five-year survival rate only improves by about 5%. Neoadjuvant treatment with immune checkpoint inhibitors (ICIs) has become significant due to improved survival in advanced NSCLC patients treated with immunotherapy agents. The assessment of pathology response has been proposed as a surrogate indicator of the benefits of neaodjuvant therapy. An outline of recommendations has been published by the International Association for the Study of Lung Cancer (IASLC) for the evaluation of pathologic response (PR). However, recent studies indicate that evaluations of immune-related changes are distinct in surgical resected samples from patients treated with immunotherapy. Several clinical trials of neoadjuvant immunotherapy in resectable NSCLC have included the study of biomarkers that can predict the response of therapy and monitor the response to treatment. In this review, we provide relevant information on the current recommendations of the assessment of pathological responses in surgical resected NSCLC tumors treated with neoadjuvant immunotherapy, and we describe current and potential biomarkers to predict the benefits of neoadjuvant immunotherapy in patients with resectable NSCLC.

Different pathological response and histological features following neoadjuvant chemotherapy or chemo-immunotherapy in resected non-small cell lung cancer

“…MPR was defined as residual viable tumor cells in the primary tumor bed and sampled lymph nodes. MPR was reported both as a continuous variable and using the 10% cut-off, whereas pCR was defined as the complete absence of residual viable tumor cells in the primary tumor ( 8 , 9 ).…”

“…However, there are no established guidelines about the assessment of response to neoadjuvant therapy on resected lung cancer specimens. Over the years, different approaches have been used to assess pathological response, including pathological complete response (pCR) and major pathological response (MPR) ( 8 , 9 ). Previous studies have suggested a positive association between pathological response, mainly pCR, and clinical outcome of patients.…”

Extracellular RNA profiles in non-small cell lung cancer plasma

“…This is partly due to the lack of sensitive detection methods for NSCLC ( 5 ). Thus, it is crucial that the biomarkers of NSCLC be explored to improve the 5-year survival rate ( 6 ).…”

The Third Joint Meeting on Lung Cancer of the FHU OncoAge (University Côte d’Azur, Nice, France) and the University of Texas MD Anderson Cancer Center (Houston, TX, USA). Understanding New Therapeutic Options and Promising Predictive Biomarkers for Lung Cancer Patients

“…In this Special Issue, we have brought together several articles focusing on recent topics related to lung cancer in the fields of fundamental, translational, and clinical research [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 ]. Basic research studies are essential to improve our knowledge of lung cancer carcinogenesis.…”

“…Therefore, discoveries from these basic studies can help to develop future therapeutics or new diagnostics, prognostics, or predictive biomarkers [ 5 , 8 , 11 , 12 ]. In particular, tissue and circulating biomarkers from the coding and non-coding regions of the genome that are predictive of the response or resistance to different immunotherapies or targeted therapies are currently being evaluated or used in clinical trials or, more recently, in daily practice [ 1 , 2 , 10 , 13 , 14 , 15 , 16 , 17 ]. Certain biomarkers are also being tested but may be envisaged as optimizing approaches to precision medicine for NSCLC patients [ 5 , 7 , 18 ].…”