Efficacy of adjuvant therapy and neoadjuvant therapy plus immunotherapy in resectable non-small cell lung cancer

For therapeutic strategies for non-small cell lung cancer (NSCLC), is neoadjuvant chemo/immunotherapy superior to adjuvant chemo/immunotherapy with adjuvant chemotherapy? This is an interesting and practical question

Regarding the question of neoadjuvant treatment cycles, clinical trials also have some new results

In a Phase 3 clinical trial study (CheckMate 816), patients with NSCLC with stage IB-IIIA were randomly assigned neoadjuvant therapy to nivolumab plus platinum chemotherapy, or neoadjuvant therapy to platinum chemotherapy alone, followed by tumor resection

Traditionally, adjuvant chemotherapy after tumor resection is aimed at removing tiny residual diseases and eradicating micrometastases

In another study of patients with early NSCLC (KEYNOTE-091), patients after complete tumor resection and adjuvant chemotherapy were randomized into groups with plus pembrolizumab immunotherapy or placebo

The question of which method is better between neoadjuvant chemotherapy/immunotherapy and adjuvant chemotherapy/immunotherapy in the resectable NSCLC patient population cannot be definitive

Second, adjuvant therapy studies tend to use adjuvant chemotherapy first and then add adjuvant immunotherapy, which is significantly different from

In addition, the use of neoadjuvant chemotherapy/immunotherapy to improve the clinical stage of preoperative patients, the so-called "down-stage", also needs to take into account some preliminary results of current clinical trials

Cross-comparative clinical trials often have many uncertainties, and it is difficult for clinical trial design to consider and comprehensively cover patient individualization factors, so there is a clear and urgent need for relatively accurate predictive and prognostic biomarkers

Circulating tumor DNA (ctDNA) is another available biomarker