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Adjuvant Immunotherapy in Patients with Early-Stage Non-small Cell Lung Cancer and Future Directions

  • Lung Cancer (TA Leal and N Sethakorn, Section Editors)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

While cisplatin-based adjuvant chemotherapy has been the standard of care for the past two decades, the recent introduction of immunotherapy has heralded an important milestone in the adjuvant landscape of early-stage non-small cell lung cancer (NSCLC). The landmark approval of adjuvant atezolizumab based on disease-free survival (DFS) benefit in IMpower010 was swiftly followed by the recent data for use of adjuvant pembrolizumab in PEARLS/KEYNOTE-091, and similar trials involving other immune checkpoint inhibitors are eagerly anticipated. Although both atezolizumab and pembrolizumab demonstrated a significant DFS benefit in the intention-to-treat population, key subgroup analyses have raised questions about the role of predictive biomarkers such as PD-L1 expression and EGFR-mutation status. In this review, we examine the data from the two important trials (IMpower010 and PEARLS/KEYNOTE-091), discuss the controversies surrounding adjuvant immunotherapy including appropriate endpoints, biomarker selection and highlight key considerations in oncogene-driven NSCLC. Finally, we propose future directions including the impact of neoadjuvant therapy on developments in the adjuvant immunotherapy paradigm and role of minimal residual disease (MRD).

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Authors and Affiliations

  1. Division of Medical Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, Singapore, 169610, Singapore

    Stephanie PL Saw MBBS, MRCP, Mei-Kim Ang MBBS, MRCP & Daniel SW Tan BSc, MBBS, PhD

  2. SingHealth Duke-NUS Oncology Academic Clinical Programme, 11 Hospital Crescent, Singapore, 169610, Singapore

    Daniel SW Tan BSc, MBBS, PhD

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  1. Stephanie PL Saw MBBS, MRCP
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Correspondence to Daniel SW Tan BSc, MBBS, PhD.

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Stephanie PL Saw reports personal fees from Pfizer, personal fees from Bayer, non-financial support from MSD, and grants and personal fees from Astra Zeneca, outside the submitted work. Mei-Kim Ang declares that she has no conflict of interest. Daniel SW Tan reports grants and personal fees from Novartis, grants and personal fees from Bayer, personal fees from Boehringer Ingelheim, personal fees from Celgene, grants and personal fees from Astra Zeneca, personal fees from Eli-lilly, personal fees from LOXO, personal fees from Merck, grants and personal fees from Pfizer, personal fees from Roche, personal fees from Takeda, grants from GlaxoSmithKline, and personal fees from Merrimack, outside the submitted work.

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Saw, S.P., Ang, MK. & Tan, D.S. Adjuvant Immunotherapy in Patients with Early-Stage Non-small Cell Lung Cancer and Future Directions. Curr. Treat. Options in Oncol. 23, 1721–1731 (2022). https://doi.org/10.1007/s11864-022-01034-3

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