Neoadjuvant/Perioperative Immunotherapy in NSCLC

Opinion
Video

Medical professionals discuss the role of neoadjuvant/perioperative immunotherapy in subgroups of patients with NSCLC with actionable genomic aberrations, including a brief look at the ALINA and ADUARA trials.

This is a video synopsis/summary of a Precision Medicine featuring Patrick Forde, MBBCh, and Tina Cascone, MD, PhD.

Forde and Cascone discuss the role of neoadjuvant and perioperative immunotherapy in subgroups of patients with actionable genomic alterations in resectable non–small cell lung cancer (NSCLC). In advanced disease, certain genomic alterations, such as EGFR, ALK, ROS1, and RET, derive much less benefit from immunotherapy. However, there are some alterations, like BRAF V600E and KRAS G12C, where there is equipoise between targeted therapy and immunotherapy.

In early-stage disease, there is limited data on the benefit of immunotherapy in patients with actionable genomic alterations, as they were largely excluded from neoadjuvant or perioperative trials. However, phase 3 data supports the use of adjuvant targeted therapy in patients with EGFR (ADAURA trial) or ALK (ALINA trial) alterations. Therefore, patients should be tested for EGFR and ALK alterations in the preoperative setting and, if positive, be excluded from preoperative immunotherapy and instead receive adjuvant chemotherapy followed by targeted therapy. This approach also avoids potential toxicity from the interplay between immunotherapy and targeted therapy.

Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.

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