Adjuvant immunotherapy in early-stage resectable non-small cell lung cancer: A new milestone

Currently, chemotherapy is the standard adjuvant treatment for early-stage non-small cell lung cancer (NSCLC). However, adjuvant cisplatin-based chemotherapy after surgery has been shown to improve 5-year survival rates by only 4-5%. Immunotherapy using immune checkpoint inhibitors (ICIs) has revolutionized the treatment of advanced NSCLC, there is a growing interest in the role of immunotherapy in early-stage NSCLC. Here, we summarize the rationale for adjuvant immunotherapy, including the postoperative immunosuppressive environment and immunological effects of platinum chemotherapy. Many ongoing clinical trials and the related progress in adjuvant immunotherapy in early-stage resectable NSCLC are discussed. Furthermore, we highlight several unresolved challenges, including markers predictive of treatment benefit, the efficacy of treatment for some oncogene-addicted tumors, the optimal combination therapy, the duration of adjuvant immunotherapy, and optimal selection between neoadjuvant and adjuvant immunotherapy. Early findings in some clinical trials are promising, and updated overall survival results will be useful for validating the current role of adjuvant immunotherapy, particularly in the context of perioperative strategy.

Automated summary

Chemotherapy is currently the standard adjuvant treatment for early-stage non-small cell lung cancer (NSCLC), but its effectiveness in improving 5-year survival rates is limited. Immunotherapy using immune checkpoint inhibitors (ICIs) has shown great potential in treating advanced NSCLC, and there is growing interest in its role in early-stage NSCLC. This article summarizes the rationale for adjuvant immunotherapy, ongoing clinical trials, and challenges in the field, and emphasizes the need for further research and validation of the role of adjuvant immunotherapy in early-stage NSCLC.