The Benefit of Perioperative Immunotherapy in Lung Cancer Treatment

At the Great Debates and Updates in Lung Cancer Meeting in New York, New York, Jamie Chaft, MD, Memorial Sloan-Kettering Cancer Center, New York, New York, argued in favor of perioperative immunotherapy in the treatment of lung cancer.

As Dr Chaft cited, “The overwhelming data supports the combination of pre-operative immunotherapy in a patient with resectable lung cancer without EGFR or ALK alterations and without a contraindication to immunotherapy. We believe, based on the study designs, that perhaps there's some advantage to that adjuvant component."

Transcript:

I'm Jamie Chaft from Memorial Sloan Kettering Cancer Center and I had the privilege of debating Dr Christian Rolfo [MD, PhD, Mount Sinai Hospital, New York] today on the topic of perioperative immunotherapy versus pre-operative immunotherapy. My argument was for the combination of both pre- and post-operative immunotherapy.

All of our studies show event-free survival advantage, we have studies of pre-operative chemoimmunotherapy only or perioperative chemoimmunotherapy and the studies are all a bit unfair, as the post-operative arms are uneven as are the pre-operatives, so we don't have a good component analysis yet to know how much of each we need, therefore we speculate based on side-by-side trial comparisons.

My argument focused on the subset of patients without a pathologic complete response after pre-operative chemoimmunotherapy and the data showing a subtle but real improvement in event-free survival when patients were assigned to the immunotherapy intervention. That doesn't necessitate they need a year or a completion of a year of adjuvant immunotherapy, however in these study designs that's what they got. The majority of patients do start adjuvant immunotherapy when assigned to that intervention arm, about half of them in the data we've seen today complete it, but we still don’t know how much they need.

Right now, the overwhelming data supports the combination of pre-operative immunotherapy in a patient with resectable lung cancer without EGFR or ALK alterations and without a contraindication to immunotherapy. We believe, based on the study designs, that perhaps there's some advantage to that adjuvant component, but how much of that adjuvant year they need, we really don't know.

Source:

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