Perioperative pembrolizumab in early-stage non-small-cell lung cancer

In the recently published KEYNOTE-671 trial, Wakelee et al. reported a significant improvement in event-free survival with the use of perioperative pembrolizumab for patients with Stage II-IIIB non-small-cell lung cancer (NSCLC).[1-3] It was concerning to note that immune-mediated adverse events occurred in 25.3% of patients on pembrolizumab, of which 5.8% were ≥Grade 3. A similar high proportion of adverse effects was also noted with the use of adjuvant pembrolizumab in early-stage NSCLC in the KEYNOTE-091 trial.[4] Certain immune-mediated adverse effects are likely to have permanent sequelae, and hence, they should be taken into consideration before adopting immune-checkpoint inhibitors in the (neo) adjuvant settings. Furthermore, the optimal duration of perioperative immunotherapy remains unknown. Hence, a shorter duration of immunotherapy is likely to limit adverse effects or the development of resistance.[5] We also note that EGFR and ALK status were unknown in 65.8% (526/797) and 67.6% (539/797) patients.[6,7] Tumors with driver mutations are less likely to benefit from immune checkpoint inhibitors.[8] Hence, a comprehensive genomic characterization should have been a part of the trial's eligibility criteria. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.