IASLC Neoadjuvant Therapy in Lung Cancers Initiatives

The IASLC and FDA held a joint international multidisciplinary conference on neoadjuvant therapies in lung cancers in March 2018 to review available data on neoadjuvant therapies in lung cancers, catalog the benefits of neoadjuvant therapies, and identified three next steps to establish neoadjuvant therapy as a standard of care. 

Goals:

• Review the prior neoadjuvant experience in lung cancer
• Discuss the advantages and challenges of neoadjuvant strategies, lessons learned from neoadjuvant efforts in other cancers, and new modalities to assess therapeutic response
• Outline standards for the pathologic evaluation of resection specimens, to discuss if pathologic response can predict long-term outcomes

Next steps defined during the workshop:

• Standardize the definition of MPR and pCR to use in all ongoing and planned neoadjuvant trials of immunotherapy, targeted therapy, and combination therapy. 
• Use meta-analyses of neoadjuvant trials in lung cancer to determine if MPR or pCR can be used as efficacy endpoints to determine overall survival. 
• Use residual tumor in surgical resection specimens to understand determinants of persistent cell survival which may inform trials investigating post-operative approaches (FDA Paper). 

This IASLC-FDA joint workshop laid the groundwork for the IASLC Neoadjuvant Therapies in Lung Cancer Initiatives that are outlined below.