Dr. Donington on Neoadjuvant Immunotherapy in Lung Cancer

Jessica Donington, MD, MSCR, professor of surgery and chief of the Section of Thoracic Surgery at the University of Chicago Medicine, discusses the effectiveness of neoadjuvant immunotherapy and how it compares with neoadjuvant chemotherapy in patients with lung cancer.

Initial safety data pulled from trials evaluating neoadjuvant immunotherapy in lung cancer show that induction immunotherapy seems to be similar to that of induction chemotherapy, says Donington. There is some surgical attrition with induction immunotherapy, meaning some patients start their induction therapy with a plan of moving on to surgery but do not make it to surgery, explains Donington. About 10% of patients start immunotherapy and do not make it to surgery, which is similar to the number of patients who receive induction chemotherapy for locally advanced disease.

Similarly, about 10% or less of patients appear unresectable post-immunotherapy and -chemotherapy. The complications are a little higher than expected for patients with stage I disease but not dramatic, ranging from 20% to 30%. Most of these patients have adverse events (AEs) in the grade 3 range, which is ideal when evaluating surgical complications, says Donington. The need to replace potassium in a patient is not concerning, but grade 4 or 5 AEs are major issues that require immediate attention. Induction immunotherapy appears to be as safe as induction chemotherapy; the former does not appear to derail surgery any more than the latter, concludes Donington.