The Adjuvant-Phase Dilemma After Neoadjuvant Chemoimmunotherapy in Resectable NSCLC: Evidence and Response-Guided Strategies

Abstract

Simple Summary Perioperative immunotherapy, which includes treatment before and after surgery, has improved outcomes for some patients with resectable non-small cell lung cancer. However, current clinical trials usually test the entire treatment plan rather than the separate value of continuing immunotherapy after surgery. This raises an important question: does every patient need postoperative immunotherapy, or can treatment be adjusted according to their response and remaining risk? This review discusses how pathological response in the surgically removed tumor and lymph nodes, baseline clinical features of the tumor and its immune environment, postoperative monitoring of molecular residual disease, surgical recovery, and treatment feasibility may together inform future postoperative treatment strategies. However, none of these factors has yet been prospectively validated to independently determine postoperative treatment. We propose that future studies should evaluate whether patients with deep responses can safely receive less postoperative treatment, while patients with residual disease or high relapse risk may benefit from continued or intensified therapy.