The role of immunotherapy in neoadjuvant treatment of non-small cell lung cancer-a narrative review

Background and Objectives: Immune checkpoint inhibitors (ICIs) have undoubtedly reversed the paradigms of treatment of non -small cell lung cancer (NSCLC) in stage III and IV of the disease, and the intention is to transfer good experience from advanced stages into the resectable disease. Their role in the perioperative setting was investigated through trials with mono-immunotherapy and in combination with chemotherapy. The aim is to obtain an overview of data on immunotherapy in the neoadjuvant setting, as detailed as possible from available studies of earlier phases. Methods: We searched the database PubMed, Google Scholar as well as the clincaltrials.gov database for data on clinical trials researching ICIs efficacy in neoadjuvant treatment of NSCLC. The search included the timeframe before August, 31st 2023. Only articles available in English were included. Key Content and Findings: ICI therapy in the neoadjuvant setting has been researched trough several clinical trials, whether as monotherapy or in combination with chemotherapy. The results are promising and suggest a significant benefit of neoadjuvant chemoimmunotherapy compared to neoadjuvant chemotherapy, with good tolerability. The up do date data are still too immature to reach final conclusions about perioperative treatment, especially regarding overall survival (OS), but the approval of nivolumab/paclitaxel/ carboplatin chemoimmunotherapy as the standard of neoadjuvant treatment sufficiently demonstrates the strength of the results so far. Conclusions: New findings on neoadjuvant immunotherapy suggest an advantage of ICIs and chemotherapy combination regimens in terms of efficacy and safety over current standards of care, but many key questions still remain unanswered. However it is safe to presume that upcoming trial results will make further changes in everyday standard of care.