Would you consider adjuvant immune checkpoint inhibitor therapy for non-small cell lung cancer patients with residual disease after neoadjuvant chemoradiation and surgical resection?

Prior radiation was an exclusion criteria for adjuvant atezolizumab in IMpower010. Also, neoadjuvant chemotherapy was not permitted and patients only received 4 cycles of adjuvant cisplatin based chemotherapy prior to atezolizumab. So this would be outside the scope of the trial. That being said, I could potentially see this being considered for high risk, PDL1 high patients, though given the data from CheckMate 816, I think the role of neoadjuvant chemoradiation is going to be fairly limited moving forward, especially since the addition of radiation can increase surgical risk. There is another question with great insights regarding the decision making about the use of neoadjuvant chemo-immunotherapy and the question that has arisen as a result of CheckMate 816.