Publications
Using immunotherapy the right way in resectable lung cancer
Chitikela, Sindhura; Baa, Annie Kanchan; Malik, Prabhat S. CheckMate 816, Forde et al.[1] reported that neoadjuvant nivolumab with chemotherapy resulted in improved pathological complete response rates and longer event-free survival (EFS) compared to chemotherapy alone. Adjuvant nivolumab for 1 year was not incorporated in CheckMate 816 in contrast to the phase II NADIM (neoadjuvant chemotherapy and nivolumab in resectable non-small cell lung cancer) trial.[2] Despite this, the survival outcomes in CheckMate 816 were comparable to those in other trials where adjuvant immune checkpoint inhibitors (ICIs) were used.[23]
The approval of atezolizumab in the adjuvant setting has revived the debate on the use of immunotherapy in the adjuvant versus neoadjuvant settings in resectable non-small cell lung cancer.[4] It also raises the important question of the optimum duration of immunotherapy in the curative setting which has huge cost implications and is extremely relevant in resource-constrained setups where the access to immunotherapy is limited.[5] The CheckMate 816 regimen that employed only three courses of nivolumab with neoadjuvant chemotherapy certainly offers the most economical way of using ICIs.
It was observed that patients who did not achieve pathological responses and had persisting circulating tumor DNA had poorer EFS.[1] An important question that remains unanswered at this moment is whether these high-risk patients may benefit from the addition of adjuvant ICIs.
