Published online May 24, 2022. doi: 10.5306/wjco.v13.i5.314
Peer-review started: April 28, 2021
First decision: June 7, 2021
Revised: June 24, 2021
Accepted: May 7, 2022
Article in press: May 7, 2022
Published online: May 24, 2022
Processing time: 391 Days and 4.3 Hours
The aim of neoadjuvant treatment in non-small cell lung cancer (NSCLC) is to eliminate micrometastatic disease to facilitate surgical resection. Neoadjuvant chemotherapy (ChT) in localised NSCLC has numerous advantages over other therapeutic modalities and is considered standard treatment in resectable disease. Treatment with immune checkpoint inhibitors (ICI) improves long-term survival in advanced disease and has a better toxicity profile than conventional therapies. These immunotherapy agents (anti-PD1/PD-L1), administered with or without ChT, are currently being evaluated in the preoperative setting, with initial results showing better pathological response rates and more long-term benefits. Importantly, these drugs do not appear to increase the rate of severe adverse effects and/or postoperative complications. However, several questions still need to be resolved, including the identification of predictive biomarkers; comparative studies of immunotherapy alone vs combined treatment with ChT and/or radiotherapy; the optimal duration of treatment; the timing of surgery; the need for adjuvant treatment; appropriate radiologic evaluation and mediastinal staging; and the correlation between pathological response and survival outcomes. Here we review the current evidence for immunotherapy from a multidisciplinary perspective and discuss current and future controversies.
Core Tip: Studies evaluating neoadjuvant immunotherapy in non-small cell lung cancer have reported extraordinary pathological response rates without any increase in postoperative complications. However, before immunotherapy is implemented in routine clinical practice, several issues still need to be resolved. This review analyses the current evidence for immunotherapy from a multidisciplinary perspective and discusses current and future controversies.