Study discussant Bruna Pellini, MD, of the Department of Thoracic Oncology, Moffitt Cancer Center, Florida, noted that, regardless of PD-L1 or tumor mutation burden status, the NADIM trial demonstrated improved progression-free and overall survival for patients with resectable, stage IIIA non–small cell lung

Bruna Pellini, MD

cancer who received neoadjuvant nivolumab in addition to platinum-based chemotherapy. Findings from the study also showed that circulating tumor DNA (ctDNA) levels appear to be prognostic for progression-free and overall survival when analyzed in the pretreatment setting. Additionally, said Dr. Pellini, ctDNA may be a predictor of response, given that patients who are clear of ctDNA have superior overall survival.

Due to the study’s “modest sample size” and lack of a comparison control group, however, Dr. Pellini said these results are not yet practice changing. “In my opinion, we need larger phase III studies to show that these data can be replicated, and then we can change our practice,” she added.

Several Unanswered Questions

Dr. Pellini also noted several unanswered questions in the field, including the use of different surrogates for ctDNA measurement and detection. “It is not yet clear what the ideal cutoff for high vs low levels of ctDNA is, and better harmonization of surrogates for ctDNA measurement is needed,” she said. “I’d also like to know whether ctDNA analysis after surgery correlates with outcomes.”

Finally, said Dr. Pellini, it will be important to study whether patients with negative ctDNA levels after neoadjuvant treatment who maintain negative ctDNA levels after surgery need to undergo a full year of adjuvant immunotherapy. 

DISCLOSURE: Dr. Pellini reported financial relationships with AstraZeneca, BioAscend, Bristol Myers Squibb, Guardant Health, Guidepoint, MJH Life Sciences, OncLive, and Roche.