The earlier, the better? A review of neoadjuvant immunotherapy in resectable non‐small‐cell lung cancer

Abstract

Immune checkpoint inhibitors (ICIs) have revolutionized the approach to advanced and locally advanced non‐small‐cell lung cancer (NSCLC). Antibodies blocking inhibitory immune checkpoints, such as programmed death 1 (PD‐1) and its ligand (PD‐L1), have remarkable antitumor efficacy and have been approved as a standard first‐ or second‐line treatment in non‐oncogene‐addicted advanced NSCLC. The successful application of immunotherapy in advanced lung cancer has motivated researchers to further evaluate its clinical role as a neoadjuvant setting for resectable NSCLC and for improved long‐term overall survival and curative rates. In this review, we discuss the efforts that incorporate ICIs into the treatment paradigm for surgically resectable lung cancer. We reviewed the early‐phase results from neoadjuvant clinical trials, the landscape of the majority of ongoing phase III trials, and discuss the prospects of ICIs as a curative therapy for resectable lung cancer. We also summarized the potential biomarkers and beneficiaries involved in the current study, as well as the remaining unresolved challenges for neoadjuvant immunotherapy.