ASCO Expert Perspective
“This study demonstrates a potential new paradigm of perioperative immunotherapy, building upon the current standard of care of neoadjuvant immunotherapy with chemotherapy prior to surgical resection in patients with surgically resectable stage III non-small cell lung cancer.”
– Charu Aggarwal, MD, MPH, ASCO Expert in Lung Cancer

Adding toripalimab to perioperative chemotherapy led to an improvement in event-free survival for patients with stage III resectable non-small cell lung cancer (NSCLC), according to research that will be presented during the April 2023 session of the American Society of Clinical Oncology (ASCO) Plenary Series.  

In this analysis of the phase III Neotorch study, 404 patients with stage III NSCLC in China were randomized 1:1 to receive either the anti-PD-1 monoclonal antibody toripalimab or a placebo in combination with chemotherapy every three weeks for three cycles before surgery and one cycle after surgery, followed by toripalimab or placebo monotherapy every three week for 13 cycles. After a median follow-up of 18.3 months, event-free survival had significantly improved in patients receiving toripalimab. The median EFS was not reached in the toripalimab arm – meaning less than half of patients had their cancer return or progress – and was 15.1 months in the placebo arm. Major pathological response rates – when there is ≤10% of a tumor remaining – and pathologic complete response rates – or a lack of active cancer cells – were higher in the toripalimab arm compared to the placebo arm (48.5% vs 8.4%, and 24.8% vs 1.0%, respectively). The researchers also observed a trend in overall survival results favoring toripalimab plus chemotherapy compared to placebo plus chemotherapy. Patients will continue to be followed for overall survival results.

According to the authors, while the event-free survival benefit was more prominent among patients with positive PD-L1 expression, all patients with NSCLC can benefit from toripalimab treatment, regardless of PD-L1 expression status.

“The Neotorch study is the first study to present the efficacy and safety data of anti-PD-1 antibody in early-stage NSCLC as perioperative treatment and provided the evidence for the selection of dosage and treatment duration of anti-PD-1 antibody treatment,” said Shun Lu, PhD, from Shanghai Jiao Tong University and lead author of the study. “These findings can support establishing anti-PD-1 antibody treatment in combination with chemotherapy as the backbone regimen for patients with resectable NSCLC, which will change clinical practice in the near future.”

Abstract and presentation will be available on April 20, 2023, at 3:00 pm ET.

View the author disclosures: https://coi.asco.org/Report/ViewAbstractCOI?id=425126

View the disclosures for Dr. Aggarwal: https://coi.asco.org/share/JJW-AX4H/Aggarwal%2c%20Charu

ATTRIBUTION TO THE ASCO PLENARY SERIES IS REQUESTED IN ALL COVERAGE.

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