Immunotherapy in the peri-operative treatment of patients with early-stage NSCLC

One of the main talking points during the 2024 European Lung Cancer Conference was the integration of immunotherapy in the peri-operative treatment of patients with early-stage non-small cell lung cancer (NSCLC). In recent years, several clinical trials have convincingly demonstrated the potential benefit of immune checkpoint inhibitors as part of the adjuvant, neo-adjuvant, or perioperative treatment for patients with early-stage NSCLC. However, while these data have generated lots of enthusiasm, they also led to new challenges in daily clinical practice.

In this interview, Prof Dr Mariana Brandao, medical oncologist at the Institut Jules Bordet, Brussels is joined by Dr Nan Wu, thoracic surgeon at the Beijing Union Medical College Hospital in Beijing, China to discuss some of these practical challenges.

From their talk it once again became clear that neoadjuvant chemo-immunotherapy is associated with a high rate of pathological complete responses in patients with early-stage NSCLC. However, evaluating the response to this neoadjuvant therapy proves to be challenging, mainly due to diverging results from a response evaluation on (PET)-CT imaging after neoadjuvant therapy and the final pathological analysis of the resected sample. Many research groups are currently looking at ways to optimize medical imaging techniques to facilitate a better response evaluation before surgery. In addition to this, also the potential of circulating tumour DNA clearance is being explored as a way to follow-up patients. However, until these techniques have been validated, pathological response evaluation remains the gold standard in determining the patient prognosis.

In addition to this, the interview underscored the importance of multidisciplinary co-operation between medical oncologists, pulmonologists, thoracic surgeons, and radiotherapists. These multidisciplinary discussions are crucial to determine the resectability of a given tumour, to assess whether surgery or radiotherapy is the best therapeutic approach and to evaluate the response following neoadjuvant chemo-immunotherapy.