Discussing the Need of Adjuvant Treatment After Neoadjuvant in Early Stage Lung Cancer

At the Great Debates and Updates in Lung Cancer Meeting in New York, New York, Christian Rolfo, MD, PhD, Mount Sinai Medical Center, New York, New York, argued that perioperative immunotherapy should not be used to treat patients with lung cancer.

As Dr Rolfo cited, “having different opportunities for the patients is great and the opportunity to discuss this in future trials is very important.” 

Transcript: 

Hello, my name is Christian Rolfo, I'm a professor of medicine at the Icahn School of Medicine at Mount Sinai New York. I was here today in the Great Debate in New York discussing about immunotherapy, adjuvant immunotherapy after neoadjuvant immunotherapy, in early-stage lung cancer. It was a great debate; we have Dr Jamie Chaft discussing the yes and I took over the part of the no that is difficult at this moment because we don't have data completely from both sides. 

What we know is that the CheckMate 816 trial demonstrated that there is an overall survival benefit when we are adding nivolumab to chemotherapy in 3 cycles before surgery. Then we were discussing the part of the adjuvant need for these patients. Here, there are several points to consider, for example, pathological complete response is very important to distinguish in different populations and for sure there are patients that we need to increase the response. Some other questions could be do we really need to continue immunotherapy in the same regimes that we were using in the adjuvant in patients who doesn't have response–this is something that we need to clarify. Biomarkers is an important topic to include, for example, here liquid biopsy could be able to distinguish in patients that are still ctDNA positive after neoadjuvant, and several considerations on how we create the flow in patients who are respectable in our institutions, and obviously the importance to distinguish, from very beginning, the definitions of resectability for the patients. 

It was a great debate, we have different opinions, but I think we both conclude that having different opportunities for the patients is great and have the opportunity to discuss this in future trials is very important.

Source: 

Rolfo C. Debate: Is there a role for adjuvant after neoadjuvant immunotherapy? Presented at Great Debates & Updates in Lung Cancer; April 27-28, 2024; New York, NY.