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Giving immunotherapy both before and after lung cancer surgery cut the risk of recurrence by about a third, and left 17.2 percent of tumours with no viable cancer at all in the specimen.
The AEGEAN investigators, reported by Heymach, Harpole, Mitsudomi and colleagues, randomised 802 patients with resectable stage II to IIIB (N2) non-small-cell lung cancer to platinum chemotherapy with durvalumab or placebo for four cycles before surgery, followed by durvalumab or placebo every four weeks for twelve cycles afterwards. Patients with EGFR or ALK alterations were excluded from the efficacy analyses.
AEGEAN, KEYNOTE-671 and CheckMate 77T all give immunotherapy on both sides of the operation, and CheckMate 816 gives it only before. None of them has been compared against the others, so which of the four schedules is best remains the largest unanswered question in early-stage lung cancer.
Perioperative immunotherapy is now standard for resectable lung cancer without a targetable driver. The updated overall survival hazard ratio of 0.89, with a confidence interval crossing one, is the honest state of the evidence on whether it cures more people.
The strongest signal that neoadjuvant immunotherapy makes stage III lung cancer operable as well as more often curable. Twenty-four percentage points more patients reaching surgery is a result that only a neoadjuvant design can produce.
This is the paper Europe PMC returns for registry id NCT03425643 with the most citations, so it is the natural first reading for anyone following the KEYNOTE-671 trial. Read the abstract above alongside the trial page and the registry entry; the record was linked automatically and its figures have not been checked by hand.
Patients with operable stage II-III lung cancer without EGFR or ALK alterations should have chemo-immunotherapy discussed before surgery rather than only afterwards. Three pre-operative cycles do not compromise the operation and improve cure rates. Whether to continue immunotherapy after surgery, as the perioperative trials do, and whether patients with pCR need any further treatment, remain open questions.
Adjuvant immunotherapy entered lung cancer here, and with it the question that still divides practice: whether it is better given before the operation, after it, or on both sides.
Shares Martin Reck, Immune checkpoint, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, No one can predict who responds to immunotherapy and the tag lung-evidence.
Shares Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB-IIIA non-small-cell lung cancer (IMpower010), Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Dormant cells and minimal residual disease, Neoadjuvant / adjuvant / perioperative and the tag lung-evidence.
Shares Immune checkpoint, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, No one can predict who responds to immunotherapy, PD-L1 and the tag lung-evidence.
Shares Immune checkpoint, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, No one can predict who responds to immunotherapy, Durvalumab and the tag lung-evidence.
Shares Immune checkpoint, Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, No one can predict who responds to immunotherapy, Durvalumab and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Dormant cells and minimal residual disease, Neoadjuvant / adjuvant / perioperative, Resectable stage I to III non-small-cell lung cancer and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Trial design, endpoints and cost, New England Journal of Medicine, Cisplatin and the tag lung-evidence.
Shares Lung cancer roadmap: from Doll and Hill and the naming of tobacco, through the cytotoxic plateau, computed tomography screening, EGFR and ALK, immunotherapy by PD-L1, the perioperative trials and PACIFIC, to DLL3 in small-cell disease and a 2032 registry watch, Neoadjuvant / adjuvant / perioperative, Trial design, endpoints and cost, Cisplatin and the tag lung-evidence.