Comparing Neoadjuvant vs Adjuvant Therapy for Early-Stage NSCLC

Christine Ciuncie, MD, MSCE, Penn Presbyterian Medical Center, spoke about the use of neoadjuvant versus adjuvant treatment in patients with early-stage NSCLC.

Transcript:

Christine Ciunci:  Hi, I'm Christine Ciunci. I'm a thoracic medical oncologist at Penn Presbyterian Medical Center in the University of Pennsylvania. I'm here today giving a talk on early-stage non-small-cell lung cancer and neoadjuvant versus adjuvant treatment for that disease.

The significant things that we talked about today are that early-stage non-small-cell lung cancer is a curable disease and we want to take every opportunity to maximize that cure rate. Currently, adjuvant chemotherapy provides a five percent absolute survival benefit at five years, and we want to improve those numbers.

We didn't really see much in terms of a benefit looking at neoadjuvant chemotherapy versus adjuvant chemotherapy over the clinical trials that looked at both of those. The current standard of care is to still use adjuvant chemotherapy. More exciting, there's some new upcoming research looking at both adjuvant and neoadjuvant immunotherapy in this space.

In terms of adjuvant immunotherapy, we know that there's an ongoing NCTN trial, the alchemist trial that is going to look at adjuvant nivolumab after surgery, and we are anxiously awaiting data from that. Unfortunately, it is going to take several years for data from that study and other studies of adjuvant immunotherapy to come to light.

Neoadjuvant immunotherapy, though, we are able to get data quicker through the use of surrogate endpoints, mainly through major pathologic response. There have been several studies, starting out with a pilot study of nivolumab, a neoadjuvant study of atezolizumab as a single agent, that are providing data showing major pathologic responses in that disease.

The next obvious step is to look at chemotherapy and immunotherapy together in the neoadjuvant space, and there are several ongoing prospective clinical trials to look into that.

We have some information from neoadjuvant immunotherapy and chemotherapy trials that have shown impressive pathologic response rates and that these drugs are safe and able to be tolerated, and they do not delay or inhibit surgery.

My bottom line from today was that we are very excited about neoadjuvant treatments for lung cancer including chemoimmunotherapy and immunotherapy. We're hoping that over the next few years, we're going to get exciting data that will change the current management of early-stage non-small-cell lung cancer to improve cure rates for these patients.