Opportunities and challenges of neoadjuvant immunotherapy innon-small cell lung cancer
10.3969/j.issn.1005-6483.20250808
- VernacularTitle:非小细胞肺癌新辅助免疫治疗的机遇与挑战
- Author:
Haoyou WANG
1
;
Wei WAGN
1
;
Hongxu LIU
1
Author Information
1. 110042 辽宁沈阳,辽宁省肿瘤医院 中国医科大学肿瘤医院 大连理工大学附属肿瘤医院胸外科
- Publication Type:Journal Article
- Keywords:
non-small cell lung cancer;
neoadjuvant immunotherapy;
surgical treatment
- From:
Journal of Clinical Surgery
2025;33(9):943-947
- CountryChina
- Language:Chinese
-
Abstract:
Non-small cell lung cancer(NSCLC)is the leading cause of cancer-related mortality worldwide,with approximately 30％of patients initially presenting at stage Ⅱ-Ⅲ and thus potentially eligible for surgical resection.However,surgery alone is insufficient to control postoperative recurrence and distant metastasis effectively.Therefore,neoadjuvant treatment has gradually become a critical approach to improving patient prognosis.Conventional neoadjuvant chemotherapy has historically shown limited pathological complete response(pCR)rates,while neoadjuvant targeted therapy,despite enhancing objective response rates(ORR),still results in relatively low pCR.Recently,neoadjuvant immunotherapy combined with chemotherapy has demonstrated groundbreaking progress.Several large-scale international and domestic clinical trials have reported that this combination strategy significantly increases pCR rates to between 17％and 41％and notably prolongs event-free survival.However,neoadjuvant immunotherapy also introduces new surgical challenges,including increased intraoperative difficulty due to tissue fibrosis,expanded surgical resections resulting from inadequate preoperative prediction,and emerging concerns surrounding the perioperative management of immune-related adverse events(irAEs).Recent advancements in artificial intelligence(AI)-assisted imaging models,multi-omics integration,and dynamic ctDNA monitoring offer novel perspectives and tools for accurately predicting pathological responses preoperatively.Furthermore,intensive studies on mechanisms underlying immunotherapy resistance,such as exosomal PD-L1 regulatory pathways and oxidative stress pathways,alongside emerging strategies involving bispecific antibodies and metabolic interventions,provide theoretical foundations for further optimizing therapeutic approaches.Looking forward,the development of precise preoperative efficacy prediction systems,deep integration of AI technology,and the expansion of multi-modal combination strategies will represent primary directions in the evolution of neoadjuvant immunotherapy for NSCLC.
