The goal of neoadjuvant immunotherapy, like for neoadjuvant chemotherapy, would be to decrease the tumor size, improve the likelihood of complete resection, and eliminate any micro metastases.
Immunotherapy before surgery has the added benefit of providing an intact lymphatic system around the tumor and more neoantigens for the adaptive immune system to encounter and process.
Preoperative treatment allows for pathological evaluation of the tumor response after immunotherapy.
A concern with neoadjuvant immunotherapy is the potential for adverse effects to delay surgery and increase the risk of progression.
Adverse events from immuno therapy may also cause complete resection to be more challenging.
Neoadjuvant or adjuvant chemotherapy confers a modest benefit over surgery alone for resectable non-small cell lung cancer.
In patients with resectable non-small cell lung cancer, neoadjuvant Nivolumab plus chemotherapy resulted in significant longer event free survival and a higher percentage of patients with a pathological complete response than chemotherapy alone in patients with stage IB to IIIA non-small cell lung cancer.
Neoadjuvant nivolumab plus chemotherapy in Non small cell lung carcinoma resulted in a significantly longer event free survival.
KEYNOTE-671 trial: patients with stage II, IIIA, IIIB received four cycles of neoadjuvant, pembrolizumab or placebo in addition to chemotherapy, followed by surgical resection: event, free survival, and possible overall survival benefit are emerging, increased pathological complete response, and major pathological response as well.