Advances in cancer immunotherapy have led to clinical trials of immunotherapy-based neoadjuvant treatments for early stage non-small-cell lung cancer (NSCLC). Use of radiotherapy to enhance the effects of immune checkpoint inhibitors has been explored extensively in preclinical models.  Evidence for priming of the immune system using both preoperative short-course radiotherapy and immunotherapy in this setting has now emerged from a randomized phase II study incorporating pathological and immunological end points. In a recent publication, Altorki et al. report on a single- centre phase II study in which 60 patients with resectable stage I–IIIA NSCLC were randomly assigned (1:1) to receive two neoadjuvant cycles of durvalumab either with or without stereotactic body radiotherapy (SABR) to the primary tumour.

Dr. Famke Schneiders and Prof. Suresh Senan published a ‘News and Views’ article in Nature Reviews Clinical Oncology about radioimmunotherapy in non-small-cell lung cancer (NSCLC), referring to Altorki, N. K. et al. Neoadjuvant durvalumab with or without stereotactic body radiotherapy in patients with early- stage non- small- cell lung cancer: a single- centre, randomised phase 2 trial. Lancet Oncol. 22, 824–835 (2021).

Immunotherapy in patients with a primary operable NSCLC is a field of active research. The authors conclude that future neoadjuvant trials require immunology- driven designs, and immunological outcomes should be included as co-primary end points, in addition to pathological outcomes. Post- surgical assessment of such parameters could potentially guide the development of tailored adjuvant strategies, including the choice of agents and the optimal duration of treatment.

Read the article online in Nature Reviews Clinical Oncology