在局部非小细胞肺癌（NSCLC）中，手术后全身复发很常见。因此，使用辅助或新辅助化疗。随着免疫检查点抑制剂 (ICIs) 在转移性疾病中的出现，问题是 ICI 是否可以进一步改善预后。在多项 I/II 期试验中，多种 ICI 的主要病理缓解 (MPR) 率在 7% 至 50% 之间。没有发生重大的额外副作用。与化疗相结合，CheckMate-816 随机添加新辅助纳武单抗，并实现了较高的病理完全缓解 (pCR) 率和更好的无事件生存 (EFS)，且不会对手术产生负面影响。更多的随机试验涉及新辅助免疫化疗和术后辅助治疗。在 Keynote-671 中，派姆单抗在术前和术后使用，2 年时的 EFS 率显着较高（62.4% 对比 40.6%）。 AEGEAN（durvalumab）和 Neotorch（特瑞普利单抗）试验也报告了类似的初步结果。较高的肿瘤分期和 MPR、部分程序性细胞死亡 1 配体 1 (PD-L1) 表达、肿瘤突变负荷 (TMB) 和循环肿瘤 DNA (ctDNA) 与疗效相关。新辅助免疫化疗可提高 MPR 和 EFS 率，尤其是在晚期患者中肿瘤和表达 PD-L1 的肿瘤 - 不会相应增加毒性。但还需要进一步、更长时间的评估。版权所有 © 2023 Wolters Kluwer Health, Inc. 保留所有权利。

In localized nonsmall cell lung cancer (NSCLC) systemic recurrences after surgery are common. Therefore, adjuvant or neoadjuvant chemotherapy is used. With the advent of immune checkpoint inhibitors (ICIs) in metastatic disease the question is whether ICIs can further improve the outcome.In several phase I/II trials, major pathological response (MPR) rates with several ICIs between 7% and 50% were seen. No major additional side effects occurred. In combination with chemotherapy CheckMate-816 randomized additional neoadjuvant nivolumab and achieved a high pathological complete response (pCR) rate and a better event-free survival (EFS) - without negatively influencing surgery. More randomized trials are performed with neoadjuvant immunochemotherapy and adjuvant treatment after surgery. In Keynote-671, pembrolizumab is used pre and postoperatively with a significantly higher EFS rate at 2 years (62.4% vs. 40.6%). Similar preliminary results are reported in the AEGEAN (durvalumab) and Neotorch (toripalimab) trials. Higher tumour stage and MPR, partly programmed cell death 1 ligand 1 (PD-L1) expression, tumour mutational burden (TMB) and circulating tumour DNA (ctDNA) are correlated with efficacy.Neoadjuvant immunochemotherapy improves MPR and EFS rates, especially in more advanced tumours and tumours expressing PD-L1 - without relevantly increasing toxicities. But further and longer evaluation is needed.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.