Neoadjuvant therapy refers to treatment with chemotherapy, radiation, targeted therapy, and PD-1/PD-L1 inhibitors before surgery to reduce the size of the tumor to facilitate subsequent surgery.
For resectable NSCLC (stages I, II, and IIIA), recent studies have shown that Nivolumab is far more effective as neoadjuvant therapy than neoadjuvant chemotherapy and has less adverse effects. Currently, the Checkmate 816 study of Nivolumab in combination with Ipilimumab (another class of immune checkpoint inhibitor) as neoadjuvant therapy and the study of Atezolizumab as neoadjuvant therapy (NCT 02927301) are both ongoing. Once results are confirmed, the combination of PD-1/PD-L1 inhibitors and surgery is likely to be recommended by guidelines and enter clinical use.
Co-reviewed by Dr. Wang Zhen, Deputy Chief Physician, Guangdong Provincial People’s Hospital, Guangdong Lung Cancer Institute Xue-Tao Lai, MD