# Unlocking the potential of immunotherapy for patients with resectable non–small cell lung cancer

## TL;DR

This paper reviews how immunotherapy is being used for early-stage lung cancer and highlights the need for better guidelines and biomarkers to personalize treatment.

## Contribution

The paper evaluates current immunotherapy data and challenges in resectable NSCLC to guide treatment decisions and future research directions.

## Key findings

- Eight Phase III trials show benefits of (chemo)-immunotherapy in resectable NSCLC.
- Optimal timing of immunotherapy (neoadjuvant, adjuvant) remains undefined due to limited data maturity.
- Predictive biomarkers and response assessments are needed to personalize treatment.

## Abstract

Following positive results in advanced and metastatic non–small cell lung cancer (NSCLC), there has been a move toward the application of immunotherapy in the treatment of locally advanced, resectable, oncogene driver–negative disease. To date, there have been eight Phase III trials across the adjuvant, neoadjuvant, and perioperative settings that demonstrate benefit with (chemo)-immunotherapy in patients with resectable NSCLC. Given the wealth of immunotherapy treatment regimens both available and under investigation in this setting, there is a need to determine the optimal timing of immunotherapy treatment (neoadjuvant, perioperative, or adjuvant) across disease stages to aid clinical decision-making. Established treatment guidelines often diverge, highlighting the need for a multidisciplinary team approach and consensus decision-making based on the latest evidence in the resectable setting. Finally, there is an unmet need surrounding the role of key predictive factors and response assessments, to assist clinicians in selecting patients for immunotherapy regimens. The aim of this review is to evaluate the current data and key considerations surrounding immunotherapy for the treatment of resectable NSCLC, including key parameters to inform de-escalating and escalating treatment approaches.

*In the absence of actionable EGFR and ALK alterations. MRD, minimal residual disease; NSCLC, non–small cell lung cancer; PD-L1, programmed death-ligand 1.Flowchart titled “Immunotherapy for Resectable NSCLC” showing three columns: “Unmet need,” “Informing treatment choice: Current perspective,” and “Unlocking personalized treatment". The first column lists issues such as like multiple treatment settings and limited data maturity that have led to the optimal treatment for resectable NSCLC remaining undefined. The second column highlights current challenges such as insufficient predictors of response and suboptimal response assessment. The third column suggests more mature data and improved predictive biomarkers will help lead to personalized treatment approaches.

*In the absence of actionable EGFR and ALK alterations. MRD, minimal residual disease; NSCLC, non–small cell lung cancer; PD-L1, programmed death-ligand 1.