Clinical recommendations for perioperative immunotherapy‐induced adverse events in patients with non‐small cell lung cancer

• Main Authors: Jun Ni, Miao Huang, Li Zhang, Nan Wu, Chun‐Xue Bai, Liang‐An Chen, Jun Liang, Qian Liu, Jie Wang, Yi‐Long Wu, Feng‐Chun Zhang, Shu‐Yang Zhang, Chun Chen, Jun Chen, Wen‐Tao Fang, Shu‐Geng Gao, Jian Hu, Tao Jiang, Shan‐Qing Li, He‐Cheng Li, Yong‐De Liao, Yang Liu, De‐Ruo Liu, Hong‐Xu Liu, Jian‐Yang Liu, Lun‐Xu Liu, Meng‐Zhao Wang, Chang‐Li Wang, Fan Yang, Yue Yang, Lan‐Jun Zhang, Xiu‐Yi Zhi, Wen‐Zhao Zhong, Yu‐Zhou Guan, Xiao‐Xiao Guo, Chun‐Xia He, Shao‐Lei Li, Yue Li, Nai‐Xin Liang, Fang‐Liang Lu, Chao Lv, Wei Lv, Xiao‐Yan Si, Feng‐Wei Tan, Han‐Ping Wang, Jiang‐Shan Wang, Shi Yan, Hua‐Xia Yang, Hui‐Juan Zhu, Jun‐Ling Zhuang, Ming‐Lei Zhuo
• Format: Article
• Language: English
• Published: Wiley 2021-05-01
• Series: Thoracic Cancer
• Subjects: clinical recommendation; irAE; non‐small cell lung cancer; perioperative immunotherapy
• Online Access: https://doi.org/10.1111/1759-7714.13942

Abstract Perioperative adjuvant treatment has become an increasingly important aspect of the management of patients with non‐small cell lung cancer (NSCLC). In particular, the success of immune checkpoint inhibitors, such as antibodies against PD‐1 and PD‐L1, in patients with lung cancer has increased our expectations for the success of these therapeutics as neoadjuvant immunotherapy. Neoadjuvant therapy is widely used in patients with resectable stage IIIA NSCLC and can reduce primary tumor and lymph node stage, improve the complete resection rate, and eliminate microsatellite foci; however, complete pathological response is rare. Moreover, because the clinical benefit of neoadjuvant therapy is not obvious and may complicate surgery, it has not yet entered the mainstream of clinical treatment. Small‐scale clinical studies performed in recent years have shown improvements in the major pathological remission rate after neoadjuvant therapy, suggesting that it will soon become an important part of NSCLC treatment. Nevertheless, neoadjuvant immunotherapy may be accompanied by serious adverse reactions that lead to delay or cancellation of surgery, additional illness, and even death, and have therefore attracted much attention. In this article, we draw on several sources of information, including (i) guidelines on adverse reactions related to immune checkpoint inhibitors, (ii) published data from large‐scale clinical studies in thoracic surgery, and (iii) practical experience and published cases, to provide clinical recommendations on adverse events in NSCLC patients induced by perioperative immunotherapy.