Neoadjuvant Immunotherapy in Resectable Non-Small Cell Lung Cancer. A Narrative Review

Abstract

Lung cancer is one of the most common malignant tumors and it is the leading cause of cancer-related mortality worldwide. For early-stage Non-Small Cell Lung Cancer (NSCLC), surgical resection is the treatment of choice, but the 5-year survival is still unsatisfying, ranging from 60% to 36% depending on the disease stage. Multimodality treatment with adjuvant chemotherapy did not lead to clinically relevant results, improving survival rates by only 5%. Recently, immune checkpoint inhibitors (ICIs) are being studied as neoadjuvant treatment for resectable NSCLC too, after the satisfactory results obtained in stage IV disease. Several clinical trials are evaluating the safety and feasibility of neoadjuvant immunotherapy and their early findings suggest that ICIs could be better tolerated than standard neoadjuvant chemotherapy and more effective in reducing cancer local recurrence and metastasis. The aim of this review is to retrace the most relevant results of the completed and the ongoing clinical trials, in terms of efficacy and safety, but also to face the open challenges regarding ICIs in neoadjuvant setting for resectable NSCLC.

Gut microbes as medical signature for the effectiveness of immunotherapy in patients with advanced non‐small cell lung cancer

“…Immunotherapy has also been investigated as a neoadjuvant 52 . According to various studies, neoadjuvant immunotherapy is a major component of multilingualism treatment for the initial stage as well as resectable NSCLC 53 . For decreasing tumor mass before an operation, neoadjuvant medication offers potential benefits for people with lung cancer.…”

New Approaches in Early-Stage NSCL Management: Potential Use of PARP Inhibitors and Immunotherapy Combination

“…Lately, several clinical trials, to evaluate the safety and feasibility of neoadjuvant ICIs in NSCLC have been developed. Their results propose that ICIs could be better tolerated than standard neoadjuvant chemotherapy and more effective in reducing cancer recurrence and metastasis [ 4 , 6 , 8 , 51 ]. Most of the clinical trials investigating neoadjuvant ICI are still ongoing, and only partial results are available.…”

“…Current studies are focusing, not only on neoadjuvant immunotherapy in monotherapy but also in combination with other therapies (e.g., with radiotherapy) as a part of a multimodal approach, followed by surgery and, sometimes, adjuvant immunotherapy. The endpoints are heterogeneous and rely on the general efficacy of neoadjuvant immunotherapy, throughout survival surrogates (MPR, Major Pathological response, defined as ≤10% viable tumor cells; pCR, pathological Complete Response), safety, and feasibility of therapy [ 8 , 35 , 51 ].…”

Metabolomic Fingerprinting for the Detection of Early-Stage Lung Cancer: From the Genome to the Metabolome

“…Although advances in multimodality therapeutics for lung cancer have been made, the overall five-year survival rate among newly diagnosed lung cancer patients at a late stage remains in the range of 15-17% [26,27]. Although surgical resection is the treatment of choice for early-stage NSCLC, if lung cancer is detected at an early stage, the 5-year survival is reported to range from 36% to 70% [28][29][30]. On the other hand, multimodality treatment with adjuvant chemotherapy has improved survival rates by only 5% [28,30].…”

“…Although surgical resection is the treatment of choice for early-stage NSCLC, if lung cancer is detected at an early stage, the 5-year survival is reported to range from 36% to 70% [28][29][30]. On the other hand, multimodality treatment with adjuvant chemotherapy has improved survival rates by only 5% [28,30]. It should be noted that until the last decade, the five-year overall survival rate for patients with metastatic NSCLC was <5%; however, with an improved understanding of the pathophysiology of lung cancer, the overall survival rate has improved to 25% to 40% [31].…”