Surgical outcomes for early-stage NSCLC are still very poor due to the high rate of recurrence through distant metastases. It is likely that these distant metastases are present at initial resection as undetectable micrometastases. In order to target these potential sites of recurrence in early-stage patients, trials using immunotherapy (IO) and tyrosine kinase inhibitors (TKI) approved for recurrent and late-stage lung cancers are being conducted in pre- and postoperative settings.
Phase II studies of adjuvant IO in patients with early-stage NSCLC have shown great promise and many have moved into phase III trials. The results of these trials are eagerly awaited. The CTONG1104: ADJUVANT trial showed that disease-free survival (DFS) for patients with EGFR-mutant (EGFRm) NSCLC was significantly improved. However, these results did not translate to a significant improvement in overall survival (OS). Further studies into adjuvant treatment with targeted therapies still need to be conducted.
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