Adjuvant PD-L1 blockade in non-small-cell lung cancer

Lung cancer is the leading cause of cancer-related mortality worldwide. 1 Thai AA Solomon BJ Sequist LV Gainor JF Heist RS Lung cancer. Lancet. 2021; 398: 535-554 Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar Surgical resection is the mainstay of therapy for patients with stage I–II and select stage IIIA non-small-cell lung cancer (NSCLC). Despite complete surgical excision, patients with NSCLC have high rates of relapse. 2 Goldstraw P Chansky K Crowley J et al. The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol. 2016; 11: 39-51 Summary Full Text Full Text PDF PubMed Scopus (1908) Google Scholar Historically, strategies to mitigate risk of relapse have focused on adjuvant chemotherapy. In randomised studies, adjuvant chemotherapy improves overall survival, but the degree of benefit is modest, and treatment is associated with clinically significant toxicity. 3 Pignon JP Tribodet H Scagliotti GV et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol. 2008; 26: 3552-3559 Crossref PubMed Scopus (1631) Google Scholar Until recently, progress in developing adjuvant therapies for NSCLC had been largely stagnant, which is in stark contrast with advanced NSCLC, where new therapeutics have been driven by the emergence of two treatment strategies: immune checkpoint inhibitors and targeted therapy. 1 Thai AA Solomon BJ Sequist LV Gainor JF Heist RS Lung cancer. Lancet. 2021; 398: 535-554 Summary Full Text Full Text PDF PubMed Scopus (70) Google Scholar Immune checkpoint inhibitors, targeting PD-1 and its ligand (PD-L1), have since become the cornerstones of first-line therapy for patients with advanced NSCLC with no targetable alterations. With this success, efforts have focused on moving these agents into earlier stages of disease. Adjuvant atezolizumab after adjuvant chemotherapy in resected stage IB–IIIA non-small-cell lung cancer (IMpower010): a randomised, multicentre, open-label, phase 3 trialIMpower010 showed a disease-free survival benefit with atezolizumab versus best supportive care after adjuvant chemotherapy in patients with resected stage II–IIIA NSCLC, with pronounced benefit in the subgroup whose tumours expressed PD-L1 on 1% or more of tumour cells, and no new safety signals. Atezolizumab after adjuvant chemotherapy offers a promising treatment option for patients with resected early-stage NSCLC. Full-Text PDF