Dr Das on the Use of Neoadjuvant and Adjuvant Chemoimmunotherapy Regimens in NSCLC

Devika Das, MD, MSHQS, clinical assistant professor of hematology and oncology, University of Alabama at Birmingham (UAB) Medicine, discusses the use of neoadjuvant and adjuvant chemoimmunotherapy for patients with resectable non–small cell lung cancer (NSCLC), and emphasizes the importance of multidisciplinary collaboration when incorporating these regimens into treatment approaches.

It is vital that surgeons, specialists, and community oncologists all work collaboratively to determine the best treatment approach for patients with early-stage or advanced NSCLC, Das begins. This multidisciplinary approach is especially important because it may allow patients to receive neoadjuvant chemoimmunotherapy regimens, such as nivolumab (Opdivo) plus platinum-based chemotherapy, Das says. This regimen gained FDA approval in March 2022 based on findings from the phase 3 CheckMate 816 trial (NCT02998528) in patients with stage IB to IIIA NSCLC.

In this trial, the neoadjuvant chemoimmunotherapy regimen produced a pathologic complete response rate of 24.0% vs 2.2% with chemotherapy alone across all patient subgroups, Das reports. Differences in PD-L1 expression, disease stage, and histology did not affect this outcome. Moreover, patients treated with neoadjuvant chemoimmunotherapy achieved a median event-free survival of 31.6 months vs 20.8 months with chemotherapy alone, she adds. Despite concerns regarding the effect of neoadjuvant chemoimmunotherapy on the difficulty of surgical resection and surgical outcomes, the agent was shown to be safe and effective, Das states. 

However, many patients with NSCLC will still undergo surgery before being referred to a medical oncology clinic in either the community or at academic centers, Das continues. For these patients who miss the window for neoadjuvant chemoimmunotherapy, the approval of adjuvant chemotherapy options is especially important, she states. Based on data from the phase 3 IMpower010 trial (NCT02486718) the FDA approved adjuvant atezolizumab (Tecentriq) following resection and platinum-based chemotherapy for patients with stage II to IIIA NSCLC expressing PD-L1 on 1% or more of tumor cells in October 2021. According to an interim analysis of overall survival (OS) data, adjuvant atezolizumab produced a 5-year OS rate of 76.8% vs 67.5% in the best supportive care arm for patients who had a PD-L1 expression of 1% or greater.