Dr Garon on Considerations for Perioperative Immunotherapy Use in Lung Cancer

Edward B. Garon, MD, MS, professor of medicine, Department of Medicine, Division of Hematology/Oncology, David Geffen School of Medicine, the University of California, Los Angeles (UCLA), UCLA Health, discusses key considerations when selecting an optimal perioperative treatment approach for patients with lung cancer.

As the field of lung cancer continues to rapidly develop, data from numerous studies tend to be concurrently read out and compared with the same standard of care, Garon begins. This deluge of information can complicate data interpretation. However, the current body of evidence is increasingly supporting the integration of immunotherapy into the perioperative space, he says. The primary challenge now is determining the optimal amount of chemoimmunotherapy to administer to patients, and whether adjuvant immunotherapy is necessary for those who have already received chemoimmunotherapy before surgery, Garon explains.

Cross-trial comparisons suggest that continuing treatment with adjuvant therapy might be advantageous even for patients who received neoadjuvant therapy, Garon continues. However, this hypothesis needs validation through randomized trials, which are currently lacking, he notes, adding that this gap in data creates uncertainty about the best course of action in these treatment sequences.

Moreover, there is a noticeable disparity in the adoption of neoadjuvant chemoimmunotherapy between academic centers and community practice settings, Garon says. Academic centers are more inclined to incorporate chemoimmunotherapy before surgery, specifically for patients with lymph node–positive disease who will likely require adjuvant therapy, he explains. This approach is based on strong data and theoretical benefits, suggesting that neoadjuvant therapy might be more effective than adjuvant therapy alone, Garon states.

The enthusiasm for neoadjuvant chemoimmunotherapy in academic settings is driven by the belief that it can provide better outcomes for patients needing systemic therapy, Garon details. However, it is necessary to assess whether this enthusiasm for neoadjuvant chemoimmunotherapy is resonating with broader clinical practice, he notes. Understanding if healthcare providers outside of academic centers are recognizing and adopting these strategies is crucial, Garon emphasizes. This insight could help bridge the gap between research findings and real-world application, ensuring that patients across different treatment settings receive the most effective care, he concludes.