Ravasin Alice, Gatteschi Lavinia, Massa Valentina, Iannopollo Mauro, Voltolini Luca, Gonfiotti Alessandro
Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy.
Oncology Unit, San Jacopo Hospital, Oncology Department, Central Tuscany AUSL, 51100 Pistoia, Italy.
Cancers (Basel). 2025 Jun 23;17(13):2099. doi: 10.3390/cancers17132099.
Adjuvant treatment for resectable non-small cell lung cancer (NSCLC) has seen significant advancements following the introduction of immune checkpoint inhibitors (ICIs). These therapies, which enhance the immune system's ability to recognize and target cancer cells, have demonstrated substantial improvements in disease-free survival (DFS) following surgical resection. Recent studies have shown that ICIs can extend DFS, particularly for patients with high Programmed Death-Ligand 1 (PD-L1) expression but also for those with lower levels of PD-L1, suggesting a broader potential for their application. In the IMpower010 trial, atezolizumab improved DFS compared to best supportive care (BSC) in resected stage II-IIIA NSCLC, with a hazard ratio (HR) of 0.66 (95% CI 0.50-0.88) for patients with PD-L1 expression ≥1% and 0.79 (95% CI 0.64-0.96) for the overall stage II-IIIA population. In the PEARLS/KEYNOTE-091 trial, pembrolizumab also demonstrated a DFS benefit over a placebo for patients with stage IB-IIIA disease (HR 0.76; 95% CI 0.63-0.91), with a median DFS of 53.6 months versus 42.0 months. Despite these promising results, challenges remain regarding the optimal selection of patients, particularly in identifying the most effective biomarkers and determining the ideal duration of treatment. While ICIs are generally well-tolerated, immune-related adverse events, although manageable, require careful monitoring, especially when ICIs are used in combination with chemotherapy. Ongoing research is focused on optimizing treatment duration and exploring combination therapies, with the objective of further improving long-term survival outcomes. The integration of immunotherapy in the adjuvant setting represents a significant advancement in the management of resectable NSCLC. This review aims to provide an overview of the current evidence supporting the use of ICIs in the adjuvant treatment of NSCLC, focusing on treatment efficacy, safety profiles, and ongoing research into biomarkers and combination therapies.
随着免疫检查点抑制剂（ICI）的引入，可切除非小细胞肺癌（NSCLC）的辅助治疗取得了显著进展。这些疗法可增强免疫系统识别和靶向癌细胞的能力，已证明在手术切除后无病生存期（DFS）有实质性改善。最近的研究表明，ICI可延长DFS，特别是对于程序性死亡配体1（PD-L1）高表达的患者，对于PD-L1水平较低的患者也是如此，这表明其应用潜力更大。在IMpower010试验中，与最佳支持治疗（BSC）相比，阿替利珠单抗改善了可切除II-IIIA期NSCLC患者的DFS，PD-L1表达≥1%的患者的风险比（HR）为0.66（95%CI 0.50-0.88），II-IIIA期总体人群的HR为0.79（95%CI 0.64-0.96）。在PEARLS/KEYNOTE-091试验中，帕博利珠单抗也显示出对IB-IIIA期疾病患者的DFS优于安慰剂（HR 0.76；95%CI 0.63-0.91），中位DFS为53.6个月对42.0个月。尽管有这些令人鼓舞的结果，但在患者的最佳选择方面仍存在挑战，特别是在确定最有效的生物标志物和理想的治疗持续时间方面。虽然ICI通常耐受性良好，但免疫相关不良事件虽然可控，但需要仔细监测，尤其是当ICI与化疗联合使用时。正在进行的研究集中在优化治疗持续时间和探索联合疗法，目标是进一步改善长期生存结果。免疫疗法在辅助治疗中的应用是可切除NSCLC管理的一项重大进展。本综述旨在概述支持ICI用于NSCLC辅助治疗的当前证据，重点关注治疗疗效、安全性概况以及对生物标志物和联合疗法的正在进行的研究。
