Douglas B. Johnson, Amin H. Nassar, Ayesha Aijaz,et al. Nat Rev Clin Oncol 2026 Feb 18.
Anti-PD-L1 antibodies have transformed cancer treatment and are increasingly being used in patients with early-stage malignancies including in the adjuvant and neoadjuvant settings. In this Review, we explore the optimal use of anti-PD-L1 antibodies in the adjuvant and perioperative settings, using examples from melanoma, renal cell carcinoma and non-small-cell lung cancer. We examine de-escalation strategies, including shortening treatment duration or deferring therapy to time of recurrence, at which point anti-PD-L1 antibodies might be more likely to be administered in combination; the expansion of certain specific indications, potentially leading to more effective combinations and/or use in biomarker-defined patients with high-risk early-stage disease; and selecting the most appropriate indication, with emerging data suggesting that neoadjuvant or perioperative use of anti-PD-L1 antibodies might be more effective than adjuvant use in certain cancers, as well as the possibility of personalization of therapy guided by biomarkers such as circulating tumor DNA or other emerging assays. Three key points: 1) Adjuvant therapy with an immune-checkpoint inhibitor (ICI) has become a standard option for patients with many high-risk, resected solid tumours. 2) Neoadjuvant or perioperative ICIs improve outcomes compared with adjuvant therapy in patients with melanoma and probably also in those with other cancers and are increasingly being used. 3) Both circulating tumour DNA and pathological complete responses are promising biomarkers that are likely to help attempts to personalize the use of adjuvant ICIs.
24 Mar, 2026