The emerging role of immunotherapy in resectable non-small cell lung cancer Review
| Authors: | Dunne, E. G.; Fick, C. N.; Isbell, J. M.; Chaft, J. E.; Altorki, N.; Park, B. J.; Spicer, J.; Forde, P. M.; Gomez, D.; Iyengar, P.; Harpole, D. H. Jr; Stinchcombe, T. E.; Liberman, M.; Bott, M. J.; Adusumilli, P. S.; Huang, J.; Rocco, G.; Jones, D. R. |
| Review Title: | The emerging role of immunotherapy in resectable non-small cell lung cancer |
| Abstract: | Background: Despite surgical resection, long-term survival of patients with resectable non-small cell lung cancer (NSCLC) remains poor. Adjuvant chemotherapy, the standard of care for locally advanced NSCLC, provides a marginal 5.4% benefit in survival. Immune checkpoint inhibitors (ICIs) have shown a significant survival benefit in some patients with advanced NSCLC and are being evaluated for perioperative use in resectable NSCLC. Methods: We conducted a literature search using the PubMed online database to identify clinical trials of immunotherapy in resectable NSCLC and studies analyzing biomarkers and immune priming strategies. Results: Building on previous phase I and II trials, randomized phase III trials have shown efficacy of neoadjuvant nivolumab, perioperative pembrolizumab, adjuvant atezolizumab, and adjuvant pembrolizumab in the treatment of NSCLC with improvement of event-free/disease-free survival of 24% to 42%, leading to United States Food and Drug Administration approval of these drugs in the treatment of resectable NSCLC. Three additional phase III trials have also recently reported the use of immunotherapy both before and after surgery, with pathologic complete response rates of 17% to 25%, significantly better than chemotherapy alone. Perioperative ICI therapy has comparable perioperative morbidity to chemotherapy alone and does not impair surgical outcomes. Conclusions: Perioperative immunotherapy, in combination with chemotherapy, is safe and improves outcomes in patients with resectable NSCLC. Questions regarding patient selection, the need for adjuvant ICI therapy after neoadjuvant chemoimmunotherapy, and the duration of perioperative immunotherapy remain to be answered by future trials. © 2024 The Society of Thoracic Surgeons |
| Keywords: | cancer survival; event free survival; cancer surgery; review; drug efficacy; drug safety; nonhuman; patient selection; disease free survival; cancer immunotherapy; food and drug administration; tumor marker; postoperative complication; medline; neoadjuvant chemotherapy; perioperative care; surgical patient; non small cell lung cancer; phase 2 clinical trial (topic); phase 3 clinical trial (topic); phase 1 clinical trial (topic); clinical outcome; immune checkpoint inhibitor; nivolumab; time to treatment; human; circulating tumor dna; pembrolizumab; atezolizumab; tumor mutational burden |
| Journal Title: | Annals of Thoracic Surgery |
| Volume: | 118 |
| Issue: | 1 |
| ISSN: | 0003-4975 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2024-07-01 |
| Start Page: | 119 |
| End Page: | 129 |
| Language: | English |
| DOI: | 10.1016/j.athoracsur.2024.01.024 |
| PUBMED: | 38316378 |
| PROVIDER: | scopus |
| PMCID: | PMC11194155 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: David R. Jones -- Source: Scopus |
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