Session Item

In resectable non-small cell lung cancer (NSCLC), both neoadjuvant as well as adjuvant chemotherapy result in an 5% gain in overall survival (OS) at 5 years. However, especially for stage II and III NSCLC, 5 year OS is still poor, and the majority of patients with a disease relapse have a distant relapse. Therefore, systemic therapies (neoadjuvant and/or adjuvant) should be improved. Adjuvant MAGE-A3, gefitinib as well as bevacizumab did not improve outcomes. Neoadjuvant therapy has the advantage that patients are still fit, and that the efficacy of the neoadjuvant therapy can be evaluated in the resection specimen. Disadvantage is that some patients will not proceed to surgery, either due to disease progression or due to complications of the systemic therapy. Adjuvant therapy has the advantage that the patient underwent the curative intent resection, but the disadvantage is the higher risk of not receiving adjuvant therapy due to postoperative complications resulting in a delayed recovery. Preferably, new systemic therapies eradicate microscopic disease, without increasing the rate of complications or long-term toxicities. Furthermore, early endpoints associated with OS are preferred to early implement new strategies. In locally advanced as well as metastatic NSCLC, immunotherapy has become standard of care. Furthermore, for patients with an activating EGFR mutation, tyrosine kinase inhibitors (TKI) have become standard of care in the metastatic setting, as well as in the adjuvant setting. In this presentation I will give an overview of the completed phase III immunotherapy trials (CheckMate816, IMpower010, PEARLS) and ongoing trials, and I will discuss open questions regarding neoadjuvant and adjuvant immunotherapy. Furthermore, I will discuss the completed phase III EGFR-TKI trials including their differences and the implications and open questions.