The Role of Immunotherapy in Resectable Non-Small Cell Lung Cancer

The advent of immune checkpoint inhibitors (ICIs) targeting PD-1, PD-L1, and CTLA-4 has transformed the therapeutic landscape of advanced non-small cell lung cancer (NSCLC), and recent clinical trials have extended their application to resectable disease. Multiple randomized phase III trials have demonstrated that neoadjuvant and adjuvant immunotherapy, particularly when combined with platinum-based chemotherapy, significantly improves pathological complete response (pCR), major pathological response (MPR), event-free survival (EFS), disease-free survival (DFS), and overall survival (OS) compared to chemotherapy alone. Several key questions remain unresolved—including whether preoperative or postoperative immunotherapy yields superior outcomes, whether adjuvant therapy provides additional benefit after neoadjuvant immune checkpoint inhibitors plus chemotherapy (ICI-CT), and how best to identify the patients most likely to benefit from each strategy. This review will critically examine the current evidence, clinical trial landscape, and future directions for immunotherapy in resectable NSCLC.