Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Mar 27;30(4):3684-3696.
doi: 10.3390/curroncol30040280.

Immunotherapy in Early-Stage Non-Small Cell Lung Cancer (NSCLC): Current Evidence and Perspectives

Chiara Lazzari  1 , Calogera Claudia Spagnolo  2 , Giuliana Ciappina  2 , Martina Di Pietro  2 , Andrea Squeri  2 , Maria Ilenia Passalacqua  2 , Silvia Marchesi  3 , Vanesa Gregorc  1 , Mariacarmela Santarpia  2
Affiliations
Review

Immunotherapy in Early-Stage Non-Small Cell Lung Cancer (NSCLC): Current Evidence and Perspectives

Chiara Lazzari et al. Curr Oncol. .

Abstract

Lung cancer is the leading cause of cancer deaths in the world. Surgery is the most potentially curative therapeutic option for patients with early-stage non-small cell lung cancer (NSCLC). The five-year survival for these patients remains poor and variable, depending on the stage of disease at diagnosis, and the risk of recurrence following tumor resection is high. During the last 20 years, there has been a modest improvement in the therapeutic strategies for resectable NSCLC. Immune checkpoint inhibitors (ICIs), alone or in combination with chemotherapy, have become the cornerstone for the treatment of metastatic NSCLC patients. Recently, their clinical development has been shifted in the neoadjuvant and adjuvant settings where they have demonstrated remarkable efficacy, leading to improved clinical outcomes. Based on the positive results from phase III trials, ICIs have become a therapeutic option in neoadjuvant and adjuvant settings. On October 2021 the Food and Drug Administration (FDA) approved atezolizumab as an adjuvant treatment following surgery and platinum-based chemotherapy for patients with NSCLC whose tumors express PD-L1 ≥ 1%. In March 2022, nivolumab in combination with platinum-doublet chemotherapy was approved for adult patients with resectable NSCLC in the neoadjuvant setting. The current review provides an updated overview of the clinical trials exploring the role of immunotherapy in patients with early-stage NSCLC, focusing on the biological rationale for their use in the perioperative setting. We will also discuss the role of potential predictive biomarkers to personalize therapy and optimize the incorporation of immunotherapy into the multimodality management of stage I-III NSCLC.

Keywords: NSCLC; adjuvant; early stage; immune checkpoint inhibitors; immunotherapy; lung cancer; neoadjuvant; predictive biomarkers.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
ICIs in the neoadjuvant setting: biological rationale. Anti-PD-L1: anti-programmed cell death-1; MHC: major histocompatibility complex; NSCLC: non-small cell lung cancer; PD-1: programmed cell death protein; PD-L1/2: programmed death ligand 1/2; TCR: T cell receptor.
See this image and copyright information in PMC

References

    1. Ganti A.K., Klein A.B., Cotarla I., Seal B., Chou E. Update of Incidence, Prevalence, Survival, and Initial Treatment in Patients With Non-Small Cell Lung Cancer in the US. JAMA Oncol. 2021;7:1824–1832. doi: 10.1001/jamaoncol.2021.4932. - DOI - PMC - PubMed
    1. Pignon J.P., Tribodet H., Scagliotti G.V., Douillard J.Y., Shepherd F.A., Stephens R.J., Dunant A., Torri V., Rosell R., Seymour L., et al. Lung adjuvant cisplatin evaluation: A pooled analysis by the LACE Collaborative Group. J. Clin. Oncol. 2008;26:3552–3559. doi: 10.1200/JCO.2007.13.9030. - DOI - PubMed
    1. Martin J., Ginsberg R.J., Venkatraman E.S., Bains M.S., Downey R.J., Korst R.J., Kris M.G., Rusch V.W. Long-term results of combined-modality therapy in resectable non-small-cell lung cancer. J. Clin. Oncol. 2002;20:1989–1995. doi: 10.1200/JCO.2002.08.092. - DOI - PubMed
    1. Goldstraw P., Chansky K., Crowley J., Rami-Porta R., Asamura H., Eberhardt W.E., Nicholson A.G., Groome P., Mitchell A., Bolejack V., et al. The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer. J. Thorac. Oncol. 2016;11:39–51. doi: 10.1016/j.jtho.2015.09.009. - DOI - PubMed
    1. Albain K.S., Swann R.S., Rusch V.W., Turrisi A.T., 3rd, Shepherd F.A., Smith C., Chen Y., Livingston R.B., Feins R.H., Gandara D.R., et al. Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: A phase III randomised controlled trial. Lancet. 2009;374:379–386. doi: 10.1016/S0140-6736(09)60737-6. - DOI - PMC - PubMed