Advances in Neoadjuvant and Adjuvant Immunotherapy and Targeted Therapy for Resectable NSCLC

Abstract

Resectable non-small cell lung cancer (NSCLC) is currently treated with cisplatin-based adjuvant chemotherapy following surgical resection. Despite treatment with curative intent, there are high rates of disease recurrence with distant metastases, resulting in a 5-year mortality of 20-60%. Advances in immunotherapy (IO) in stage III and IV have led to improvements in overall survival. Our article reviews important studies utilizing IO in both the neoadjuvant and adjuvant settings for resectable NSCLC. We highlight the results of two phase III randomized studies, Checkmate 816 for neoadjuvant therapy and IMpower 010 for adjuvant therapy. If clinically meaningful event-free survial benefit is observed, Checkmate 816 will likely lead to the first FDA approved regimen for neoadjuvant chemoimmunotherapy in resectable NSCLC. IMpower 010 has led to the FDA approval of adjuvant atezolizumab for resected NSCLC with PD-L1 ≥ 1%. We provide our insight into how the results of these studies should be applied clinically. We also discuss the data and current indications for the use of targeted molecular therapy, including the results of the ADAURA trial for adjuvant osimertinib. We conclude by discussing future considerations.