Various regimens consisting of anti-PD-(L)1 antibodies with or without chemotherapy have been approved for the first-line treatment of patients with advanced NSCLC that does not harbor genomic alterations. The analysis reported at ASCO 2022 by Akinboro et al. used pooled data from 12 pivotal studies to compare overall survival (OS) obtained with chemoimmunotherapy (n = 455) vs. immunotherapy (n = 1,298) in patients with ALK- and EGFR-negative tumors that showed ≥ 50 % PD-L1 expression.

KRASG12C mutations are found in approximately 14 % of patients with adenocarcinoma of the lung. Adagrasib, a covalent inhibitor of KRASG12C, has been developed to show a long half-life of 23 hours, dose-dependent pharmacokinetics, and CNS penetration. At ASCO 2020, Spira et al. reported data from a registrational phase II cohort of 116 patients with unresectable or metastatic, KRASG12C-mutated NSCLC included in the multi-cohort, phase I/II KRYSTAL-1 study.

Many immunotherapies are being studied in the neoadjuvant or perioperative setting, but the only one that has been reported in a phase III trial as neoadjuvant treatment to date is nivolumab. There are three prospective trials that assessed nivolumab in the resectable setting. The NADIM I trial was a groundbreaking phase II study that looked at nivolumab plus chemotherapy followed by resection and demonstrated impressive results regarding pathologic endpoints and two-year survival.

Neoadjuvant chemotherapy has been shown to significantly prolong overall survival (OS) in resectable non–small-cell lung cancer (NSCLC), although the absolute 5-year survival is improved by as little as 5 %. Similarly, pathological complete responses (pCR) are infrequently achieved; 15 trials investigating preoperative chemotherapy revealed an overall median rate of 4 %.