Better Biomarkers Needed to Guide Neoadjuvant Chemoimmunotherapy in NSCLC

In an interview with CancerNetwork®, at the Big Ten Cancer Research Consortium (Big Ten CRC) Summit, Mingjia Li, MD, an assistant professor of internal medicine and medical oncologist specializing in lung cancers at The Ohio State University Wexner Medical Center in Columbus, discussed the need for better biomarkers to guide neoadjuvant chemoimmunotherapy in resectable non–small cell lung cancer (NSCLC).

Neoadjuvant chemoimmunotherapy is now preferred over chemotherapy alone for fit patients with resectable NSCLC. Li noted, however, that only a minority of patients achieve a pathologic complete response (pCR). Those who do not may have suboptimal outcomes while still facing the risk of immune-related adverse events. His research has also examined other factors associated with outcomes in this setting. These include a retrospective analysis presented at the National Comprehensive Cancer Network (NCCN) 2026 Annual Conference, which found that a preoperative hemoglobin level below 10 g/dL was associated with significantly worse overall survival.

Li explained that PD-L1 expression and alterations such as STK11 and KEAP1 remain imperfect predictors. He expressed hope that biomarkers now in development could help better identify which patients will benefit from treatment and which are at risk of toxicity.

Transcript:

Currently, in thoracic oncology in the neoadjuvant setting, we do not have great biomarkers to help us select the right patients, and this area definitely deserves more attention. When we give chemoimmunotherapy, we know that 20% to 30% of patients can achieve a pathologic complete response, and they do very well. But for the rest of the patients, outcomes are still suboptimal, and these patients are still at risk for toxicities such as severe immune-related adverse events.

Unfortunately, the biomarkers we have right now, including PD-L1, are not great at helping us select the right patients. There are biomarkers such as STK11 and KEAP1 alterations that are typically associated with poor outcomes on immunotherapy-based treatment; however, they are not absolute. I have a strong feeling that the novel biomarkers we are developing today can potentially help solve this problem in the future.

Reference

Hwang J, Su P-L, Zhao S, et al. CLO26-114: Association between neoadjuvant chemoimmunotherapy-induced anemia and survival in patients with resectable non-small cell lung cancer. J Natl Compr Canc Netw. 2026;24(3.5). doi:10.6004/jnccn.2025.7321