Journal
JOURNAL FOR IMMUNOTHERAPY OF CANCER
Volume 10, Issue 8, Pages -Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/jitc-2022-005036
Keywords
Immunotherapy; Melanoma; Gastrointestinal Neoplasms; Genital Neoplasms; Female; Head and Neck Neoplasms
Categories
Funding
- NCI CTEP
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The management of locoregionally advanced solid tumors is challenging and typically involves a combination of surgery, radiotherapy, and systemic therapy. Preoperative neoadjuvant systemic therapy, particularly with immunotherapeutic agents, has the potential to improve clinical outcomes. Progress has been made in neoadjuvant immunotherapy for locoregionally advanced resectable solid tumors, leading to ongoing trials and changes in clinical practice. Pathological responses and biospecimens obtained during neoadjuvant studies can guide treatment decisions and future drug development.
Definitive management of locoregionally advanced solid tumors presents a major challenge and often consists of a combination of surgical, radiotherapeutic and systemic therapy approaches. Upfront surgical treatment with or without adjuvant radiotherapy carries the risks of significant morbidities and potential complications that could be lasting. In addition, these patients continue to have a high risk of local or distant disease relapse despite the use of standard adjuvant therapy. Preoperative neoadjuvant systemic therapy has the potential to significantly improve clinical outcomes, particularly in this era of expanding immunotherapeutic agents that have transformed the care of patients with metastatic/unresectable malignancies. Tremendous progress has been made with neoadjuvant immunotherapy in the treatment of several locoregionally advanced resectable solid tumors leading to ongoing phase 3 trials and change in clinical practice. The promise of neoadjuvant immunotherapy has been supported by the high pathologic tumor response rates in early trials as well as the durability of these responses making cure a more achievable potential outcome compared with other forms of systemic therapy. Furthermore, neoadjuvant studies allow the assessment of radiologic and pathological responses and the access to biospecimens before and during systemic therapy. Pathological responses may guide future treatment decisions, and biospecimens allow the conduct of mechanistic and biomarker studies that may guide future drug development. On behalf of the National Cancer Institute Early Drug Development Neoadjuvant Immunotherapy Working Group, this article summarizes the current state of neoadjuvant immunotherapy of solid tumors focusing primarily on locoregionally advanced melanoma, gynecologic malignancies, gastrointestinal malignancies, non-small cell lung cancer and head and neck cancer including recent advances and our expert recommendations related to future neoadjuvant trial designs and associated clinical and translational research questions.
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