L'immunothérapie péri-opératoire des cancers bronchiques non à petites cellules (CBNPC) : standards actuels et perspectives

Abstract

Surgical resection is the cornerstone of the management of resectable stage I to III nonsmall cell lung cancer (NSCLC). Platinum-based chemotherapy, whether neoadjuvant or adjuvant, has long been combined with surgery for patients with resectable stage II-III disease, although the benefits are modest, with an overall survival gain of approximately 5 %. Recently, immunotherapy has been incorporated into neoadjuvant, adjuvant, and perioperative treatment regimens based on data showing improvements in event-free survival (EFS), disease-free survival (DFS), and overall survival in patients with localized or locally advanced, resectable NSCLC without oncogenic driver mutations. Two phase 3 trials demonstrated a benefit of adjuvant immunotherapy, leading to European approval, although these are not currently reimbursed in France. Six phase 3 trials CheckMate-816, AEGEAN, CheckMate-77T, NeoTORCH, KEYNOTE-671, and RATIONALE-315 have shown a benefit from adding an immune checkpoint inhibitor to chemotherapy in the neoadjuvant or perioperative setting. Based on the results of CheckMate-816, neoadjuvant nivolumab has been approved in combination with platinum-based chemotherapy for adult patients with resectable NSCLC at high risk of recurrence, whose tumors express PD-L1 > 1 % and are negative for EGFR mutations and ALK rearrangements.