Lee Jay M, Brunelli Alessandro, Cummings Amy L, Felip Enriqueta, Shu Catherine A, Solomon Benjamin J, Tsuboi Masahiro, Wakelee Heather, Saqi Anjali, Wu Yi-Long, Li Pao-Chen, Gitlitz Barbara J
Division of Thoracic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Department of Thoracic Surgery, St. James's University Hospital, Leeds, United Kingdom.
JTO Clin Res Rep. 2025 Jun 19;6(9):100866. doi: 10.1016/j.jtocrr.2025.100866. eCollection 2025 Sep.
Phase 3 trials of neoadjuvant, perioperative, and adjuvant immune checkpoint inhibitors combined with chemotherapy (ICI-CT) in resectable early-stage NSCLC (eNSCLC) have reported that all three approaches confer an event-free or disease-free survival benefit over CT alone, with acceptable safety profiles. All three strategies are approved standards of care for eNSCLC. This review provides a detailed analysis of these phase 3 ICI-CT trials and addresses the considerations regarding the selection of each approach, including protocol schema and baseline patient and tumor differences, preoperative staging, surgical outcomes, efficacy end points, safety, treatment disposition, and the programmed death-ligand 1 (PD-L1) efficacy biomarker. The differences between regimens and study populations among these ICI-CT trials hamper cross-trial comparisons and highlight the need for head-to-head trials. Patients achieving pathologic complete response with neoadjuvant ICI-CT have better survival outcomes irrespective of subsequent treatment, but the optimal number of preoperative ICI-CT cycles needed to achieve pathologic complete response has not been defined. The choice between a neoadjuvant or perioperative versus adjuvant treatment approach involves a risk-benefit assessment of the potential for preoperative attrition to surgery, postoperative attrition to ICI-CT, and the anticipated toxicity profile. Current limitations of invasive lymph node staging mean that adjuvant ICI remains an important treatment strategy, but preoperative node staging is imperative. Future studies that identify the safety and toxicity contributions of each treatment phase in perioperative trials will confirm whether a pre- or postoperative ICI approach is superior, whether there is added benefit to adjuvant after neoadjuvant ICI-CT, and which patients will benefit the most from each approach.
新辅助、围手术期和辅助免疫检查点抑制剂联合化疗(ICI-CT)用于可切除早期非小细胞肺癌(eNSCLC)的3期试验报告称,与单纯化疗相比,这三种方法均能带来无事件生存或无病生存获益,且安全性可接受。这三种策略均为eNSCLC的批准治疗标准。本综述详细分析了这些3期ICI-CT试验,并探讨了每种方法选择时的考虑因素,包括方案模式、患者和肿瘤基线差异、术前分期、手术结果、疗效终点、安全性、治疗安排以及程序性死亡配体1(PD-L1)疗效生物标志物。这些ICI-CT试验中方案和研究人群的差异妨碍了跨试验比较,并凸显了进行头对头试验的必要性。接受新辅助ICI-CT治疗后达到病理完全缓解的患者,无论后续治疗如何,生存结果都更好,但实现病理完全缓解所需的术前ICI-CT周期最佳数量尚未确定。新辅助或围手术期与辅助治疗方法之间的选择涉及对术前手术失约可能性、术后ICI-CT失约可能性以及预期毒性特征进行风险效益评估。目前侵袭性淋巴结分期的局限性意味着辅助ICI仍然是一种重要的治疗策略,但术前淋巴结分期至关重要。未来确定围手术期试验中每个治疗阶段安全性和毒性贡献的研究,将证实术前或术后ICI方法是否更优、新辅助ICI-CT后辅助治疗是否有额外获益,以及哪些患者将从每种方法中获益最多。
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