Dr Florez on the Role of Chemoimmunotherapy in Borderline Resectable NSCLC

“If a patient with early-stage NSCLC achieves a pCR after neoadjuvant chemoimmunotherapy, is adjuvant immunotherapy is still necessary? This gap of knowledge is still very [large].”

Narjust Florez, MD, the associate medical director of the Cancer Care Access Program and a thoracic medical oncologist at the Dana-Farber Brigham Cancer Center, a member of faculty at Harvard Medical School, and co-chair of the 2025 Bridging the Gaps in Lung Cancer meeting, addressed key areas of uncertainty in the management of early-stage and borderline resectable non–small cell lung cancer (NSCLC), drawing on responses collected during real-time audience polling during the meeting.

In response to the question of whether chemoimmunotherapy is ready for routine clinical use to convert borderline resectable NSCLC into resectable disease, Florez emphasized that this remains an area of ongoing investigation, and this approach should only be utilized within the context of a clinical trial. During the session, 35% of respondents on LinkedIn and 29% on X indicated that this strategy should be limited to clinical trials. Florez concurred, stating that current phase 3 trials, including CheckMate 77T (NCT04025879), KEYNOTE-671 (NCT03425643), and AEGEAN (NCT03800134) were not specifically designed for patients with borderline resectable tumors.

She further emphasized that surgical resectability is a multidisciplinary determination and should involve thoracic surgeons early in the treatment planning process. In her view, routine clinical adoption of chemoimmunotherapy in the setting of borderline resectable disease is premature and should be restricted to protocol-defined trials.

Florez also discussed a second question related to the role of adjuvant immunotherapy in patients with early-stage NSCLC who achieve a pathologic complete response (pCR) following neoadjuvant chemoimmunotherapy. Survey responses showed that 61% of participants on X and 54% on LinkedIn supported stopping immunotherapy in the adjuvant setting in the context of a pCR. However, Florez cautioned that this represents a significant evidence gap. In the phase 3 CheckMate 816 trial (NCT02998528), patients who achieved pCR experienced improved overall survival, and at the time of data cutoff, none of these patients had died of lung cancer. However, there are no prospective data confirming that adjuvant immunotherapy can be safely omitted in this population.

She noted that ongoing studies, both cooperative group and industry-sponsored, are actively investigating whether pCR can serve as a surrogate end point for treatment de-escalation. Until those results are available, the decision to continue or discontinue adjuvant immunotherapy should be individualized based on residual risk factors, including pleural involvement, lymphovascular invasion, and nodal status, she concluded.