What is the ideal endpoint in early-stage immunotherapy neoadjuvant trials in lung cancer?

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Type
Article
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Authors
Cameron, Robert B 
Hines, Jacobi B 
Torri, Valter 
Porcu, Luca 
Donington, Jessica 
Abstract

Numerous clinical trials investigating neoadjuvant immune checkpoint inhibitors (ICI) have been performed over the last 5 years. As the number of neoadjuvant trials increases, attention must be paid to identifying informative trial endpoints. Complete pathologic response has been shown to be an appropriate surrogate endpoint for clinical outcomes, such as event-free survival or overall survival, in breast cancer and bladder cancer, but it is less established for non-small-cell lung cancer (NSCLC). The simultaneous advances reported with adjuvant ICI make the optimal strategy for early-stage disease debatable. Considering the long time required to conduct trials, it is important to identify optimal endpoints and discover surrogate endpoints for survival that can help guide ongoing clinical research. Endpoints can be grouped into two categories: medical and surgical. Medical endpoints are measures of survival and drug activity; surgical endpoints describe the feasibility of neoadjuvant approaches at a surgical level as well as perioperative attrition and complications. There are also several exploratory endpoints, including circulating tumor DNA clearance and radiomics. In this review, we outline the advantages and disadvantages of commonly reported endpoints for clinical trials of neoadjuvant regimens in NSCLC.

Description
Keywords
chemoimmunotherapy, endpoints, immunotherapy, neoadjuvant, pathologic response
Journal Title
Ther Adv Med Oncol
Conference Name
Journal ISSN
1758-8340
1758-8359
Volume Title
15
Publisher
SAGE Publications