Lung cancer is still the leading cause of cancer related-deaths worldwide, with an overall
all-stage 5-year survival of approximately 17%. The primary treatment of early stage (I-IIIA)
NSCLC is curative surgery. Although patients treated with curative surgery have a better
prognosis, the 5-year survival for patients treated with surgery alone remains low, ranging
from 67% (stage IA) to 23% (stage IIIA). Several randomized trials comparing postoperative
chemotherapy versus no chemotherapy have shown a significant overall survival benefit from
postoperative chemotherapy in completely resected patients with NSCLC stage II and IIIA.
Likewise other randomized trials have demonstrated preoperative chemotherapy improves
survival and recently the analyses also based on individual patients data of 15 randomized
trials showed a significant benefit of preoperative chemotherapy on survival with the same
survival improvement of 5% at 5 years. Then, neoadjuvant chemotherapy has also become
accepted in many countries.
Targeting of PD-1 receptors and its ligand PD-L1, and inhibiting their engagement is an
attractive therapeutic option in the early stage NSCLC, which may reactivate host immune
responses and enable longterm tumor control.