Neoadjuvant PD-1 blockade in non-small cell lung cancer: what else do we need to do?

For decades, systemic therapy for non-small cell lung cancer (NSCLC) was subjected to cytotoxic agents. For patients with locally advanced NSCLC (stages IIIA–B) not suitable to surgical resection, the current standard of regimen is concurrent chemoradiotherapy, which induces median survival time in excess of 2- and 5-year survival of 15–20% (1). For advanced NSCLC patients, the application of third-generation of chemotherapy drugs such as docetaxel, paclitaxel and gemcitabine, had improved the overall survival to 8 months (2). For resectable NSCLC patients, neoadjuvant chemotherapy would significantly improve the overall survival (HR =0.84; 95% CI, 0.77–0.92; P=0.0001). With regard to stage III NSCLC, the result was similar (HR =0.84; 95% CI, 0.75–0.95; P=0.005) (3). However, in 2002, Carney concluded that we had reached a plateau of efficacy in NSCLC, which cannot be improved further with conventional chemotherapeutic drugs (4)