CheckMate 77T: Updated Survival and Biomarker Insights Shaping Early-Stage NSCLC Care

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The CheckMate 77T trial updates presented at the 2025 American Society of Clinical Oncology Annual Meeting provide crucial insights into perioperative chemoimmunotherapy strategies, demonstrating that patients benefit from nivolumab plus chemotherapy even when receiving fewer than the planned 4 neoadjuvant cycles. This finding addresses real-world clinical scenarios where treatment modifications become necessary due to toxicity or other complications, reassuring oncologists that partial treatment exposure still confers meaningful clinical benefit compared with chemotherapy alone.

Revolutionary biomarker analyses from CheckMate 77T have identified ctDNA clearance as a powerful independent predictor of treatment success, complementing traditional pathologic response assessments. Patients achieving ctDNA clearance during neoadjuvant therapy demonstrated improved event-free survival regardless of pathologic response status, providing clinicians with an additional tool for treatment personalization. This biomarker represents a paradigm shift toward liquid biopsy-guided treatment decisions in early-stage disease management.

Perhaps most importantly, the trial definitively addressed concerns about treating patients with historically poor-prognosis molecular features, demonstrating clear event-free survival benefits even in patients harboring KRAS/STK11 or KEAP1 comutations. These findings eliminate previous hesitations about withholding immunotherapy from patients with these negative prognostic markers, establishing that all eligible patients should receive chemoimmunotherapy regardless of molecular characteristics while simultaneously highlighting the need for intensified research into optimal treatment strategies for these higher-risk populations.