(Neo)adjuvant approaches in lung cancer—paving the road to a cure

Immune checkpoint inhibitors (ICI) have revolutionized the treatment landscape of metastatic non-small-cell lung cancer (NSCLC). During the past few years the focus of research has shifted toward examining these therapies in patients with early-stage NSCLC to improve long-term overall survival and cure rates. As recurrence rates are high and the relapse pattern in patients with completely resected early-stage NSCLC is predominantly systemic, high expectations rest on the integration of ICI therapy in their treatment approach. A large number of studies with adjuvant or neo-adjuvant ICI are ongoing. The first data from phase III studies have demonstrated improvements in disease-free survival and pathologic remissions, but overall survival data are mostly immature. Additionally, targeted therapies have also been explored in early-stage NSCLC. The first very promising results are available from EGFR-mutant and ALK-translocated NSCLC and have already changed our clinical practice for some patient subgroups. This review discusses the most recent results of phase III trials in the neoadjuvant, perioperative, and adjuvant setting for ICI and targeted therapies in early-stage resectable NSCLC.