Will neo-adjuvant immunotherapy become a new paradigm in the treatment of lung cancer patients

Abstract

Nowadays neoadjuvant immunotherapy is one of the main research areas in oncology. This interest is supported by the success of check-point inhibitors in treatment of advanced and metastatic lung cancer. The postulate that neoadjuvant immunotherapy achieves tumor devitalization before surgery is confirmed by a morphological assessment of surgical material with a gradation of the antitumor effect. In addition to affecting directly to the tumor, it also affects at potential micrometastases. A morphological assessment with a gradation of the antitumor effect (MPR – a major pathomorphological response, CPR – a complete pathomorphological response) provides a unique opportunity to identify predictors of effectiveness and adjust the treatment tactic. A major morphological response (MPR – less than 10% of viable tumor cells in the tumor tissue) is associated with better overall survival. Currently, there is evidence that the appointment of neoadjuvant immunotherapy in mono mode allows you to achieve MPR in 18–45%, and the use of a combination of immunotherapy with chemotherapy increases it to 32–92%. Neoadjuvant immunotherapy or combination with chemotherapy does not postpone surgical treatment but allows us to achieve the better result.

Keywords

• neoadjuvant immunotherapy
• non-small cell lung cancer
• checkpoint inhibitors