ESMO 2022 | Unanswered questions on immunotherapy for lung cancer

So the unanswered questions are not the role. Apart from the fact that we will love in the future to see overall survival data and we’ll all wait for overall survival data, mature data. But the most important questions today is to understand what strategy to use. Because what I’d like to answer to your question is a daily question we have while practicing. So basically you have this CheckMate 816, which is shot. They give three cycles of chemo and they give nivolumab shot, they operate, surgery, and it’s over. And you have these two adjuvant trials, where you give do surgery, chemo, and you give one year of IO.

Of course you cannot compare, you don’t look at the same patient population. They’re all completely different. But what should you do in the clinic? Go for neoadjuvant IO shot, go for the normal process and then the adjuvant. And do you have the freedom to do that? Some countries are dominated by surgeon, so anyway, the surgeon will come first. So you don’t just have the follow-up options.

So the main scientific question we have is is there any reason to think that neoadjuvant is better than adjuvant or that any strategy would be more feasible. So we really need to wait a bit more time, probably because lots of trial we read in the next two years, probably five of them, with all of these designs.

The most, I would say interesting design in term of how much benefit it will bring is all design, meaning neoadjuvant plus adjuvant. And most of the trial, which we read now, do that. They give neoadjuvant chemo IO plus one year of adjuvant IO. But it’s a lot, of course. It’s a lot of, I would say, demand put on the shoulder of patients, is it useful?

So that’s the main question, neoadjuvant, adjuvant or preoperative. And we need somehow to compare trials and try to understand what to choose. Today it’s left to the investigator.