Dr Cummings on the Utility of Adjuvant Immunotherapy Alone in Early-Stage NSCLC

“We’re starting to see that there is a trend to using immunotherapy earlier in a patient’s course when possible. One of the messages that was reinforced by Heather Wakelee, MD, here is that if you don’t get a chance at that neoadjuvant or perioperative approach, it doesn’t mean that you should completely abandon immunotherapy in the adjuvant setting.”

Amy L. Cummings, MD, PhD, director of Inclusive Excellence at the Jonsson Comprehensive Cancer Center, and an assistant professor of medicine in the Division of Hematology/Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, discussed patient selection for adjuvant immunotherapy in resectable non–small cell lung cancer (NSCLC), a topic covered in the Bridging the Gaps in Lung Cancer meeting.

Cummings pointed to a provocative presentation by Patrick Forde, MBBCh, of Johns Hopkins University, at the 2025 ASCO Annual Meeting examining neoadjuvant vs perioperative approaches and their effect on overall outcomes. She noted that although adjuvant trials were among the first reported in the resectable space, the field is increasingly trending toward using immunotherapy earlier in a patient’s treatment course.

Cummings referenced comments from Heather Wakelee, MD, of Stanford Medicine, reinforcing that patients who don’t receive neoadjuvant or perioperative therapy should not be written off from immunotherapy entirely in the adjuvant setting. Drawing on findings from the phase 3 ALCHEMIST trial (NCT04267848), Cummings explained that treatment benefit is not one-size-fits-all; even within the PD-L1–high subgroup, the trend toward improved disease-free survival did not reach statistical significance.

Cummings said this points to a need to better select which patients should receive adjuvant immunotherapy, particularly given the toxicities associated with treatment. She emphasized that adjuvant immunotherapy shouldn’t be treated as an automatic step for every patient. Still, she concluded that it remains a reasonable option for those who didn’t have the opportunity to receive neoadjuvant or perioperative therapy, with better patient selection representing the next challenge for the field.