The following is a summary of “Immune Checkpoint Inhibition in Early-stage non-small cell lung cancer,” published in the June 2024 issue of Pulmonology by Cuppens et al.

The introduction of immune checkpoint inhibitors (ICIs) has marked a paradigm shift in the treatment landscape of non-small cell lung cancer (NSCLC), significantly advancing outcomes across metastatic and locally advanced stages. Despite these transformative advancements, the long-term survival rates, particularly the 5-year survival, continue to be less than optimal. Even among patients diagnosed at early stages, a substantial proportion experience disease recurrence and progression to metastatic disease, highlighting the ongoing challenges in effectively managing NSCLC.

In recent years, the integration of immunotherapy into the management of early-stage NSCLC has shown promising results, supported by a wealth of positive clinical trial data. These trials have investigated the use of ICIs in various treatment settings, including adjuvant, neoadjuvant, and perioperative strategies, aiming to capitalize on the potential benefits of immunotherapy in reducing the risk of recurrence and improving overall survival. Adjuvant therapy, administered after surgical resection, seeks to eradicate residual disease and prevent micrometastases, whereas neoadjuvant therapy aims to downstage tumors, facilitating more effective surgical resection. Perioperative therapy encompasses treatment administered both before and after surgery to optimize outcomes.

Despite the encouraging findings, significant questions remain regarding the optimal sequencing, duration, and combination of ICIs with traditional therapies such as chemotherapy and radiation. Furthermore, challenges persist in identifying predictive biomarkers that accurately stratify patients most likely to benefit from ICIs, optimizing treatment outcomes, and minimizing potential toxicities.

This manuscript critically reviews the current landscape of ICI use in early-stage NSCLC, addressing not only the clinical efficacy and safety profiles derived from key trials but also the multifaceted challenges encountered from the perspectives of clinicians, researchers, and patients. The complexities surrounding treatment decision-making, patient selection criteria, and management of immune-related adverse events (irAEs) are thoroughly examined. By synthesizing the available evidence and highlighting ongoing research efforts, this review aims to inform and guide future directions in the application of ICIs for early-stage NSCLC, with a shared goal of improving long-term survival and enhancing the quality of life for patients facing this challenging disease.

Source: sciencedirect.com/science/article/pii/S0169500224003891