Dr. Menter on Neoadjuvant Immunotherapy in Early-Stage NSCLC

Alexander R. Menter, MD
Published: Thursday, Aug 09, 2018



Alexander R. Menter, MD, oncologist, Kaiser Permanente, discusses the use of neoadjuvant immunotherapy in patients with early-stage non–small cell lung cancer (NSCLC).

There have been many updates in early-stage NSCLC in the past year, one of which was a neoadjuvant immunotherapy study published in the New England Journal of Medicine in May. Though it is not yet a standard of care-changing study, says Menter, it has put a focus on neoadjuvant immunotherapy. The study showed robust responses after just 2 rounds of immunotherapy prior to surgery. It did not significantly delay surgery, says Menter. They also showed that tumor mutational burden correlated with response to nivolumab (Opdivo) monotherapy. Menter notes that this was a pilot study, but it could be paradigm changing.

Although neoadjuvant chemotherapy is not commonly used in lung cancer, having the ability to predict high response rates to combination chemoimmunotherapy or immunotherapy alone will increase interest in sending patients with early-stage disease to treatment prior to surgery. Immunotherapy may also be more effective in patients whose tumors are still intact because there are more antigens for the immunotherapy and the immune system to react against. There are still many unanswered questions, neoadjuvant immunotherapy may be worth considering as a more successful strategy compared with adjuvant therapy, notes Menter.


Alexander R. Menter, MD, oncologist, Kaiser Permanente, discusses the use of neoadjuvant immunotherapy in patients with early-stage non–small cell lung cancer (NSCLC).

There have been many updates in early-stage NSCLC in the past year, one of which was a neoadjuvant immunotherapy study published in the New England Journal of Medicine in May. Though it is not yet a standard of care-changing study, says Menter, it has put a focus on neoadjuvant immunotherapy. The study showed robust responses after just 2 rounds of immunotherapy prior to surgery. It did not significantly delay surgery, says Menter. They also showed that tumor mutational burden correlated with response to nivolumab (Opdivo) monotherapy. Menter notes that this was a pilot study, but it could be paradigm changing.

Although neoadjuvant chemotherapy is not commonly used in lung cancer, having the ability to predict high response rates to combination chemoimmunotherapy or immunotherapy alone will increase interest in sending patients with early-stage disease to treatment prior to surgery. Immunotherapy may also be more effective in patients whose tumors are still intact because there are more antigens for the immunotherapy and the immune system to react against. There are still many unanswered questions, neoadjuvant immunotherapy may be worth considering as a more successful strategy compared with adjuvant therapy, notes Menter.

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Community Practice Connections™: ALK-Positive NSCLC: Emerging Strategies to Inform Sequencing, Optimize Outcomes, and Address Unmet Clinical Needs Along the Disease ContinuumAug 29, 20181.5
Community Practice Connections™: Oncogenic Tumor Board in Advanced NSCLC: Leveraging Actionable Mutations Along the Disease Continuum to Optimize Patient OutcomesAug 30, 20182.0
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