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ESMO 2018: NSCLC – Checkpoint inhibitors for early-stage disease

Growing evidence raises hopes for neoadjuvant checkpoint inhibition in early NSCLC. At ESMO 2018, exciting new preliminary phase II data from the NEOSTAR trial have emerged supporting this concept.

Immunotherapy is now a definite constitutent of therapy for selected patients with advanced non small cell lung cancer (NSCLC). An open question remained so far whether peri-operative immunotherapy in early-stage disease can offer a survival benefit. This is a vital topic – given that 30-60% of patients with stage I-III NSCLC ultimately develop metastasis post-resection.

Patients with stage I-IIIA NSCLC received neoadjuvant therapy with nivolumab (N) or nivolumab with ipilimumab (NI), and achieved an overall major pathological response rate of 26%. This interim analysis involved 32 evaluable patients. The overall response rate was 22%, including one complete response and six partial responses.

These results indicate that distinct anti-tumour immune responses may be triggered by the neoadjuvant checkpoint inhibitor regimen. Patients treated with the combination showed significantly higher proliferation of distinct, tumor-fighting T-cell subsets than those receiving monotherapy. Both regimens were generally well tolerated. Currently, there are several trials for neoadjuvant checkpoint blockade in early NSCLC ongoing and their results are eagerly awaited to supplement these encouraging data.



ESMO Congress 2018

Cascone T et al., Neoadjuvant nivolumab (N) or nivolumab plus ipilimumab (NI) for resectable non-small cell lung cancer (NSCLC). Abstract #LBA49