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Perioperative Immune Checkpoint Inhibition in Early-Stage Non–Small Cell Lung CancerA Review

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Importance  Although cancer-related mortality continues to decline, lung cancer remains the No. 1 cause of cancer deaths in the US. Almost half of the patients with non–small cell lung cancer (NSCLC) are diagnosed with early-stage, local or regional disease and are at high risk of recurrence within 5 years of diagnosis.

Observations  Immune checkpoint inhibitors (ICIs) have improved outcomes for patients with metastatic NSCLC and have recently been tested in multiple clinical trials to determine their efficacy in the neoadjuvant or adjuvant setting for patients with local or regional disease. The landscape for perioperative ICIs in lung cancer is evolving rapidly, with recently reported and soon to mature clinical trials; however, the recent data highlight the potential of ICIs to increase response rates and decrease rates of relapse in early stages of lung cancer. Concurrently, novel applications of cell-free DNA may guide perioperative management strategies.

Conclusions and Relevance  This article reviews the various approaches of incorporating perioperative use of immunotherapeutic agents for the treatment of early stages of NSCLC.

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Article Information

Accepted for Publication: August 30, 2022.

Published Online: November 17, 2022. doi:10.1001/jamaoncol.2022.5389

Correction: This article was corrected on January 19, 2023, to fix data errors and clarify text in the Adjuvant Immunotherapy section.

Corresponding Author: Aaron S. Mansfield, MD, Mayo Clinic, Rochester, 200 First SW, Rochester, MN 55902 (mansfield.aaron@mayo.edu).

Author Contributions: Dr Desai had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Desai and Adashek contributed equally to the work.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Adashek, Reuss.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: Desai, Reuss, Mansfield.

Supervision: Reuss.

Conflict of Interest Disclosures: Dr Reuss reported grants to institution from Genentech/Roche and Verastem; personal fees (advisory board) from Genentech/Roche, Sanofi/Genzyme, and Personalis; and personal fees from AstraZeneca outside the submitted work. Dr West reported personal fees from AstraZeneca and Merck (advisory board, consultant, speaker) and Regeneron (consultant) during the conduct of the study. Dr Mansfield reported grants to institution from Novartis and Verily; other to institution from Rising Tide Foundation (grant reviewer) and Triptych Health Partners (think tank); honoraria to institution for participation in advisory boards from Janssen, BeiGene, Chugai Pharmaceutical (Roche), and Ideology Health; personal fees from Miami International Mesothelioma Symposium (presentation), Antoni van Leeuwenhoek Kanker Instituut (CME presentation), and AXIS Medical Education (CME presentation, to institution); and other from Johnson & Johnson Global Services (steering committee, to institution), Intellisphere LLC (CME presentation, to institution), Answers in CME (CME presentation, to institution), Roche (travel support), AbbVie (advisory board, to institution), AstraZeneca (advisory board, to institution), Bristol Myers Squibb (advisory board, to institution), Genentech/Roche (advisory board, to institution), and Mesothelioma Applied Research Foundation (nonremunerated director) outside the submitted work. No other disclosures were reported.

Disclaimer: Dr West is Web Editor of JAMA Oncology but was not involved in any of the decisions regarding review of the manuscript or its acceptance.

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