Immune checkpoint inhibitors in resectable non-small cell lung cancer: recent successes and ongoing challenges

Systemic treatment for resectable early-stage non-small cell lung cancer (NSCLC) has historically consisted of chemotherapy, with limited efficacy and substantial toxicity. Immune checkpoint inhibitors (ICI) have found increasing use in neoadjuvant, adjuvant, and perioperative settings. In this review, we summarize major clinical trials using ICI in the adjuvant, neoadjuvant, and perioperative settings. We further discuss novel biomarkers, including pathologic response, ctDNA, genomic and protein expression patterns, and machine learning approaches such as radiomics and digital pathology. Finally, we discuss recent and ongoing trials of different escalation approaches.