Chair and Presenter, Jonathan D. Spicer, MD, PhD, FRCSC, Sara Najmeh, MD, and Paula A. Ugalde Figueroa, MD, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC activity titled “Neoadjuvant, Adjuvant, or Both: How to Solve the Puzzle of Perioperative Immunotherapy, Individualize Treatment Plans, and Improve Cure Rates in Resectable NSCLC.” For the full presentation, downloadable Practice Aids, and complete CME/MOC information, and to apply for credit, please visit us at https://bit.ly/3K8tKH9. CME/MOC credit will be available until June 5, 2024.

1. NSCLC Treatment Algorithm1
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SQN40
Stage and workup based on stage
•
cT1abc, N0: PFT, bronch, mediastinal staging, PET
•
cT2a-4, N0-3, M0-1: PFT, bronch, mediastinal staging, PET, brain MRI, and biomarker/mutation testing
Surgical candidate?
Lobectomy
(preferred)
or
segmentectomy/
wedge resection
(in select cases)
SBRT
or
conventionally
fractionated RT
Surgical resection
Mutational testing
EGFR ex19del/ex21 L858R present?
Surgical resection
T1
N0
M0
Operable disease
Yes
Yes
Yes
No
No
No
Multidisciplinary discussion for
neoadjuvant candidacy
T1–2, N1–2, M0
T3–4, N0–1, M0
Neoadjuvant chemoimmunotherapy
Nivolumab + platinum-based chemotherapy x 3 cycles
CheckMate -816: Nivo + chemo vs chemo
mEFS: 31.6 vs 20.8 mo (HR, 0.63)
Adjuvant chemotherapy
Platinum-based chemotherapy
LACE Meta-analysis: 5-y OS improvement of 5.4% vs no chemo
Adjuvant immunotherapy (stage II-IIIA)
Atezolizumab x 16 cycles
StageII-IIIA,PD-L1≥1%(seeFDAapproval)
Atezolizumab x 16 cycles
IMpower010: Atezo vs BSC
mDFS: NR vs 35.3 mo (HR, 0.66)
Pembrolizumab x 1 y
Stage IB (T2a ≥4 cm), II, or IIIA, regardless
of PD-L1 expression (see FDA approval)
Pembrolizumab x 1 y
PEARLS/KEYNOTE-091: Pembro vs placebo
mDFS: 53.6 vs 42.0 mo (HR, 0.76)
Adjuvant targeted therapy
Osimertinib x 3 y
ADAURA: Osimertinib vs placebo
2-y DFS (stage II-IIIA): 90% vs 44% (HR, 0.17)
NSCLC treatment algorithm
Stage IB-IIIA
(resectable)
Stage IA

2. NSCLC Treatment Algorithm1
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SQN40
Stage IIIA (unresectable) or IIIB/C
Definitive chemoradiation → durvalumab
Concurrent platinum-based chemotherapy and radiation with
consolidation durvalumab
PACIFIC: Durvalumab vs placebo
mPFS: 16.8 vs 5.6 mo (HR, 0.52)
BRAF V600E
Dabrafenib + trametiniba
BRF113928: Dabrafenib + trametinib single arm
ORR: 64% (95% CI, 46-79)
2L: KRAS G12C
Sotorasib
CodeBreaK100: Sotorasib single arm
ORR: 37.1% (95% CI, 29-46); mPFS: 6.8 mo
ALK
Alectiniba
ALEX: Alectinib vs crizotinib
1-y PFS: 68.4% vs 48.7% (HR, 0.47)
Brigatiniba
ALTA-1L: Brigatinib vs crizotinib
mPFS: 24 vs 11.1 mo (HR, 0.48)
Lorlatiniba
CROWN: Lorlatinib vs crizotinib
mPFS: NR vs 9.3 mo, (HR, 0.28); 1-y PFS: 78% vs 39%
Ceritinib
ASCEND-4: Ceritinib vs chemo
mPFS: 16.6 vs 8.1 mo (HR, 0.55)
Crizotinib
PROFILE 1007: Crizotinib vs chemo
mPFS: 7.7 vs 3 mo (HR, 0.49)
NTRK
Larotrecteniba
Entrectiniba
ALKA/STARTRK: Entrectinib single arm
ORR: 70% (NSCLC)
RET
Selpercatiniba
LIBRETTO-001: Selpercatinib single arm
ORR: 64%; mDOR: 17.5 mo
Pralsetiniba
ARROW: Pralsetinib single arm
ORR: 61% (95% CI, 50–71)
2L: EGFR (ex20)
Amivantamab
CHRYSALIS: Amivantamab single arm
CBR: 74% (95%CI, 63-83); mPFS: 8.3 mo
Mobocertinib
AP32788-15-101: Mobocertinib single arm
DCR: 78% (95% CI, 69-85); mPFS: 7.3 mo
ROS1
Crizotiniba
PROFILE 1001: Crizotinib single arm
ORR: 72% (95% CI, 58-84)
Entrectiniba
ALKA STARTRK: Entrectinib single arm
ORR: 67.1%; mPFS: 19 mo
Ceritinib
YONSEI: Ceritinib single arm
ORR: 67% (95% CI, 48-81)
EGFR (ex19 del or L858R)
Osimertiniba
FLAURA: Osimertinib vs erlotinib/gefitinib
mPFS: 18.9 vs 10.2 mo (HR, 0.46)
Erlotinib
EURTAC: Erlotinib vs chemo
mPFS: 9.7 vs 5.2 mo (HR, 0.37)
Afatinib
LUX-Lung 3: Afatinib vs cis/pemetrexed
mPFS: 13.6 vs 6.9 mo (HR, 0.47)
Gefitinib
IFUM: Gefitinib single arm
mPFS: 9.7 mo
Dacomitinib
ARCHER 1050: Dacomitinib vs gefitinib
mOS: 34.1 vs 27 mo (HR, 0.75)
Erlotinib + ramucirumab
RELAY: Erlotinib + ramucirumab vs erlotinib
mPFS: 19.4 vs 12.4 mo (HR, 0.59)
Erlotinib + bevacizumab
ARTEMIS-CTONG1509: Erlotinib + bevacizumab vs erlotinib
mPFS: 17.9 vs 11.2 mo (HR, 0.55)
MET (exon 14)
Capmatiniba
GEOMETRY mono-1: Capmatinib single arm
mPFS: 12.4 mo
Tepotiniba
VISION: Tepotinib single arm
mPFS: 8.5–11 mo
2L: HER2
Trastuzumab deruxtecan
DESTINY-Lung01
T-DXd single arm
ORR: 55% (95% CI, 44-65); mPFS: 8.2 mo
T1-2, N2–3, M0
T3, N1–3, M0
T4, N0–3, M0
Tx
Nx
M1
Actionable mutation detected
• EGFR
(ex19, ex20ins)
• ALK
• ROS1
• BRAF V600E
• RET
• MET (ex14)
• HER2
• NTRK1/2/3
• KRAS G12C
Mutation (minimum EGFR; broad NGS if possible) and PD-L1 testing
NSCLC treatment algorithm
Stage and workup based on stage
• cT1abc, N0: PFT, bronch, mediastinal staging, PET
• cT2a-4, N0-3, M0-1: PFT, bronch, mediastinal staging, PET, brain MRI, and biomarker/mutation testing
Please see the next page for recommendations if no actionable mutation is detected
Stage IV
Adagrasib
KRYSTAL-1: Adagrasib single arm
ORR: 43% (95% CI, 34-53); mDOR: 8.5 mo

3. NSCLC Treatment Algorithm1
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SQN40
a
Denotes NCCN-preferred regimens.
1. Created by Aakash Desai, MBBS, MPH, and Matthew Ho, MD, PhD. Used with permission from the authors.
PD-L1 1%
IMMUNOTHERAPY + CHEMOTHERAPY
SQUAMOUS:
• Pembrolizumab + chemotherapya
(carboplatin + paclitaxel/nab-paclitaxel)
KEYNOTE-407: Pembro + chemo vs chemo
mPFS: 6.4 vs 4.8 mo (HR, 0.56); mOS: 15.9 vs 11.3 mo (HR, 0.64)
NONSQUAMOUS:
• Pembrolizumab + chemotherapy (carboplatin + pemetrexed)a
KEYNOTE-189: Pembro + chemo vs chemo
mPFS: 8.8 vs 4.9 mo (HR, 0.52); 12-mo OS: 69% vs 49% (HR, 0.49)
• Atezolizumab + chemotherapy (carboplatin + paclitaxel + bevacizumab)
IMpower150: Atezo + chemo vs chemo
mPFS: 8.3 vs 6.8 mo (HR, 0.62)
DUAL IMMUNOTHERAPY + CHEMOTHERAPY
Nivolumab + ipilimumab + chemo (2 cycles)
CheckMate -9LA: Nivo/ipi + chemo vs chemo
mOS: 14.1 vs 10.7 mo
Durvalumab + tremelimumab + chemo (4 cycles)
POSEIDON: Durva/treme + chemo vs chemo
mOS: 14 vs 11.7 mo (HR, 0.77)
DUAL IMMUNOTHERAPY
Nivolumab + ipilimumab
CheckMate -227: Nivo/ipi vs chemo
mOS: 17.1 vs 14.9 mo
DUAL IMMUNOTHERAPY + CHEMOTHERAPY
Nivolumab + ipilimumab + chemo (2 cycles)
CheckMate -9LA: Nivo/ipi + chemo vs chemo
mOS: 14.1 vs 10.7 mo
Durvalumab + tremelimumab + chemo (4 cycle)
POSEIDON: Durva/treme + chemo vs chemo
mOS: 14 vs 11.7 mo (HR, 0.77)
IMMUNOTHERAPY MONOTHERAPY
Pembrolizumab
KEYNOTE-042: Pembro vs plat-based chemo
mOS: 16.7 vs 12.1 mo (HR, 0.81)
Ramucirumab + docetaxela
REVEL: Ram/docetaxel vs docetaxel; mOS: 10.5 vs 9.1 mo (HR, 0.86)
Docetaxela
TAX320: Docetaxel vs vinorelbine/ifosfamide; 1-y OS: 32% vs 19%
Gemcitabine
DUAL IMMUNOTHERAPY
Nivolumab + ipilimumab
CheckMate -227: Nivo/ipi vs chemo
mOS: 17.1 vs 14.9 mo
DUAL IMMUNOTHERAPY + CHEMOTHERAPY
Nivolumab + ipilimumab + chemo (2 cycles)
CheckMate -9LA: Nivo/ipi + chemo vs chemo
OS: 14.1 vs 10.7 mo
Durvalumab + tremelimumab + chemo (4 cycles)
POSEIDON: Durva/treme + chemo vs chemo
mOS: 14 vs 11.7 mo (HR, 0.77)
PD-L1 1%-49%
IMMUNOTHERAPY + CHEMOTHERAPY
SQUAMOUS:
• Pembrolizumab+chemotherapya
(carboplatin+paclitaxel/nab-paclitaxel)
KEYNOTE-407: Pembro + chemo vs chemo
mPFS: 6.4 vs 4.8 mo (HR, 0.56); mOS: 15.9 vs 11.3 mo (HR, 0.64)
NONSQUAMOUS:
• Pembrolizumab + chemotherapy (carboplatin + pemetrexed)a
KEYNOTE-189: Pembro + chemo vs chemo
mPFS: 8.8 vs 4.9 mo (HR, 0.52); 12-mo OS: 69% vs 49% (HR, 0.49)
• Atezolizumab + chemotherapy (carboplatin + paclitaxel + bevacizumab)
IMpower150 : Atezo + chemo vs chemo
mPFS: 8.3 vs 6.8 mo (HR, 0.62)
• Cemiplimab + chemotherapy (carboplatin + pemetrexed)
EMPOWER-Lung 3: Cemi + chemo vs chemo
mOS: 21.9 vs 13 mo (HR, 0.7)
PD-L1 ≥50%
IMMUNOTHERAPY MONOTHERAPY
Pembrolizumaba
KEYNOTE-024: Pembro vs platinum-based chemo
mPFS: 10.3 vs 6 mo (HR, 0.50)
Atezolizumaba
IMpower110: Atezo vs platinum-based chemo
mOS: 20.1 vs 13.1 mo (HR, 0.59)
Cemiplimaba
EMPOWER-Lung1: Cemi vs platinum-based chemo
mPFS: 8.2 vs 5.7 mo; mOS: NR vs 14.2 mo (HR, 0.57)
IMMUNOTHERAPY + CHEMOTHERAPY
SQUAMOUS:
• Pembrolizumab + chemotherapya
(carboplatin + paclitaxel/nab-
paclitaxel)
KEYNOTE-407: Pembro + chemo vs chemo
mPFS: 6.4 vs 4.8 mo (HR, 0.56); mOS: 15.9 vs 11.3 mo (HR, 0.64)
NONSQUAMOUS:
• Pembrolizumab + chemotherapya
(carboplatin + pemetrexed)
KEYNOTE-189: Pembro + chemo vs chemo
mPFS: 8.8 vs 4.9 mo (HR, 0.52); 12-mo OS: 69% vs 49% (HR, 0.49)
• Atezolizumab + chemotherapy (carboplatin + paclitaxel + bevacizumab)
IMpower150: Atezo + chemo vs chemo
mPFS: 8.3 vs 6.8 mo (HR, 0.62)
No actionable mutation detected (stratify based on PD-L1 staining %)
Second-line therapy

4. Immune-Related Adverse Events of Cancer Immunotherapies
Become Aware and Stay Vigilant
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SQN40
What Are irAEs?1
• Immune checkpoint inhibitors are associated with important clinical benefits, but general immunologic enhancement
can also lead to a unique spectrum of immune-related adverse events
• Any organ system can be affected, but more commonly occurring are pulmonary (pneumonitis), dermatologic (rash, pruritus,
blisters, ulcers, vitiligo), gastrointestinal (diarrhea, enterocolitis, transaminitis, hepatitis, pancreatitis), and endocrine
(thyroiditis, hypophysitis, adrenal insufficiency) irAEs
Endocrine
Hyper- or hypothyroidism
Hypophysitis
Adrenal insufficiency
Diabetes
Hepatic
Hepatitis
Renal
Nephritis
Dermatologic
Rash
Pruritus
Psoriasis
Vitiligo
DRESS
Stevens-Johnson
Hematologic
Hemolytic anemia
Thrombocytopenia
Neutropenia
Hemophilia
Ocular
Uveitis
Conjunctivitis
Scleritis, episcleritis
Blepharitis
Retinitis
Respiratory
Pneumonitis
Pleuritis
Sarcoid-like granulomatosis
Cardiovascular
Myocarditis
Pericarditis
Vasculitis
Gastrointestinal
Colitis
Ileitis
Pancreatitis
Gastritis
Neurologic
Neuropathy
Guillain Barŕe
Myelopathy
Encephalitis
Myasthenia
Musculoskeletal
Arthritis
Dermatomyositis
01 Prevention
02 Anticipation
03 Detection
04 Treatment
05 Monitoring
01
02
03
04
05

5. Immune-Related Adverse Events of Cancer Immunotherapies
Become Aware and Stay Vigilant
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SQN40
Guidance for Surgeons: Suspect, Detect, and Refer for Treatment2,3
• irAEs frequently occur in the perioperative setting, either before or after surgical intervention
• irAEs occurring during neoadjuvant immunotherapy are generally manageable and in most cases should not exclude
patients from surgery
• The onus is on the surgeon to have a high degree of suspicion for potential toxicities in patients treated with immunotherapy
• Vague symptoms should not be dismissed, because nonspecific ailments can be indicative of severe toxicity
– Rheumatologic toxicities and endocrinopathies are some of the most difficult to recognize, given their relatively
nonspecific presentation
» For example, fatigue, poor energy, and low mood could represent hypophysitis or adrenal insufficiency
– Other toxicities can be essentially asymptomatic
» For example, renal and hepatic toxicity are generally only detected on routine labs
– Pneumonitis is another relevant irAE requiring awareness by surgeons, as severe pneumonitis could potentially
exclude patients from operative therapy, but significant pneumonitis has been rare in trials to date
• A comprehensive workup for irAEs, with a thorough history specifically targeted to potential irAEs, should be conducted
• Coordinate and collaborate with oncologists and other multidisciplinary experts to optimally diagnose and manage irAEs
in patients who have received/are receiving perioperative immunotherapy
• The National Comprehensive Cancer Network (NCCN) and American Society of Clinical Oncology (ASCO) have issued
guidelines for recognition and management of immune-related adverse events

6. Immune-Related Adverse Events of Cancer Immunotherapies
Become Aware and Stay Vigilant
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SQN40
General Recommendations for Treating irAEs4-7
Increasing
intensity
of
treatment
required
Grade 2
Grade 1 Grade 3 Grade 4
Moderate
Mild Severe Very severe
Symptomatic supportive therapy
Stop treatment
Oral steroids Intravenous steroids. ------------
• Referral to specialist
• Strong immune suppressive treatment
Increasing grade of irAE
intravenous steroids
Steroids (PO/IV): 1-2 mg/kg/d
prednisone or equivalent,
slowly taper over 4-6 weeks
For some AEs, treatment can be
restarted after resolution (eg, rash);
generally, ICI can be continued
with endocrinopathies once managed
Managed in outpatient/
community setting
Generally requires
hospital admission

7. Immune-Related Adverse Events of Cancer Immunotherapies
Become Aware and Stay Vigilant
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SQN40
 Hold immunotherapy and reassess in 1-2 weeks
 Pulse oximetry rest and ambulation
 Consider chest imaging with CT (with contrast preferred)
 Repeat in 3-4 weeks
Moderate (grade 2): 25%-50%
lung involved
Severe (grade 3-4)
Grade 3: all lobes of lung or
50% of lung parenchyma;
limited ADLs, oxygen requirement
Grade 4: life threatening
 Hold immunotherapy
 Infectious workup (nasal swab, sputum, blood)
 Consider bronchoscopy and BAL
 Chest imaging with CT contrast
 Repeat in 3-4 weeks
 Consider empiric antibiotics
 Refractory: methylprednisolone 1-2 mg/m2
/day; if no response in 3-4 days, treat as grade 3
 Permanently discontinue immunotherapy and move to inpatient care
 Infectious workup (nasal swab, sputum, blood)
 Pulmonary and infectious disease consultation
 Bronchoscopy with BAL
 Empiric antibiotics
 Methylprednisolone 1-2 mg/m2
/day; when grade 1, taper over 6 weeks
 Refractory: infliximab, mycophenolate, or IVIG
How Should Pulmonary irAEs Be Diagnosed and Managed?4,8
 Pneumonitis: focal or diffuse inflammation of the lung parenchyma (typically identified on CT imaging)
 Diagnostic work-up: CXR, CT, pulse oximetry; for grade ≥2, may include infectious work-up
Mild (grade 1): 25% lung
involved
Additional considerations
• GI and pneumocystis prophylaxis may be offered to patients on prolonged steroid use (12 weeks)
• Consider calcium and vitamin D supplementation with prolonged steroid use
• Bronchoscopy and biopsy; if clinical picture is consistent with pneumonitis, no need for biopsy
Supportive care: smoking cessation and vaccinations (influenza, pneumococcal)

8. Immune-Related Adverse Events of Cancer Immunotherapies
Become Aware and Stay Vigilant
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SQN40
1. Champiat S et al. Ann Oncol. 2016;27:559-574. 2. Helmink BA et al. Ann Surg Oncol. 2020;27:1533-1545. 3. Stiles BM et al. J Thorac Cardiovasc Surg. 2020;160:1376-1382. 4. Brahmer JR et al. J Clin Oncol. 2018;36:1714-1786. 5. https://www.esmo.org/content/
download/124130/2352601/1/ESMO-Patient-Guide-on-Immunotherapy-Side-Effects.pdf. 6. https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf. 7. Puzanov I et al. J Immunother Cancer. 2017;5:95. 8. Provided courtesy of Marianne Davies, DNP, ACNP,
AOCNP, FAAN, 2021; adapted from AIM with Immunotherapy, NCCN, and CTCAE. 9. https://ascopubs.org/doi/full/10.1200/JCO.21.01440. 10. https://www.esmo.org/content/download/124130/2352601/1/ESMO-Patient-Guide-on-Immunotherapy-Side-Effects.pdf.
11. https://www.nccn.org/professionals/physician_gls/pdf/immunotherapy.pdf. 12. https://www.sitcancer.org/research/cancer-immunotherapy-guidelines/irae/immune-checkpoint-inhibitor-related-adverse-events.
Additional Guideline Recommendations for Treating irAEs9-12

9. Simple Summaries of Significant Studies
CheckMate -816 Study of Nivolumab Plus Chemotherapy Before Surgery for NSCLC1,2
Full abbreviations, accreditation, and disclosure information available at PeerView.com/SQN40
Plain language summaries (also called layperson summaries, lay language summaries,
simple summaries, and trial results summaries) have been introduced to communicate research
and clinical trial results in an understandable way to a broader audience, and they are intended
to make the clinical results of these studies understandable and accessible to healthcare
providers, researchers, patients, caregivers, and the general public
What Are Plain Language Summaries of Research and Clinical Trial Results?
The following pages include a simple infographic summary of the CheckMate -816 trial
for use as a printable resource
The following additional resources explaining the CheckMate -816 trial are also available
• Brief video summary: www.nejm.org/do/10.1056/NEJMdo006524/full
• Plain-language summary: https://www.futuremedicine.com/doi/epdf/10.2217/fon-2023-0007

10. 1. Provided courtesy of Patrick M. Forde, MD. 2. Forde PM et al. N Engl J Med. 2022;386:1973-1985.
358 people from 14 different countries
The researchers
created 2 groups
Who took part in this study?
What treatments were used?
Why is this study important?
Some people with non–small cell lung cancer (NSCLC)
have tumors that can be removed surgically. However,
the cancer often comes back or spreads to other parts
of the body, which may subsequently lead to death
Taking chemotherapy (chemo) before or after surgery
can reduce the risk of cancer coming back and may
help people live longer. However, this only works for
some people
Nivolumab (nivo) is an immunotherapy; it works by
activating a person’s immune system to fight back
against cancer cells
The goal of the CheckMate -816 study was to find out if
nivo plus chemo works better than chemo alone when
given before surgery for NSCLC
179 people in the
nivo plus chemo
group
179 people
in the chemo
alone group
Average age
64 years
All had tumors (4 centimeters or larger) in the lungs (and in some
cases, the nearby lymph nodes) that could be removed with surgery
IIIA
IIB
IIA
IB
As the number and letter goes
up, this represents a bigger
tumor and/or more spread
Staging is part of the lung cancer diagnosis.
This study included people with stages IB,
IIA, IIB, and IIIA NSCLC
7 in 10 were men 6 in 10 had stage IIIA NSCLC
Each treatment was taken
once every 3 weeks for a
total of 3 times
Surgery planned to
happen within 6 weeks
of the last dose
CheckMate -816 Study: Nivolumab Plus Chemotherapy Given Before Surgery for Non–Small Cell Lung Cancer1,2

11. 1. Provided courtesy of Patrick M. Forde, MD. 2. Forde PM et al. N Engl J Med. 2022;386:1973-1985.
What did the researchers look at?
What were the main results?
Nivo plus
chemo
Nivo plus
chemo
Nivo plus
chemo
Median EFS (number of months
half of the people lived without the
cancer getting worse or spreading)
People who took nivo plus chemo and had a pCR after surgery
lived longer without the cancer getting worse or spreading than
those who did not have a pCR
People alive at 2 years without
the cancer getting worse or
spreading
Chemo
Chemo
Chemo
8 in 10 7-8 in 10
0-1 in 10
2-3 in 10
4-5 in 10
Event-free survival (EFS)
How long did each person
live without the cancer
getting worse or spreading?
PRIMARY
ASSESSMENTS
ADDITIONAL
ASSESSMENTS
Pathological complete response (pCR)
Were there any cancer cells remaining in
the tissue samples obtained from the
lungs and lymph nodes after surgery?
Overall survival
How long did each person
live after starting
treatment?
What adverse events
did people have?
Most people went on to have surgery in both the nivo plus
chemo and chemo groups
People who took nivo plus chemo lived longer without the
cancer getting worse or spreading (EFS)
There was a trend for people who took nivo plus chemo to live
longer overall than those who took chemo alone. This remains to
be confirmed over time in the study
More people who took nivo plus chemo than who took chemo
alone had no remaining cancer cells in tissue samples obtained
from the lungs and lymph nodes after surgery (pCR)
32
months
21
months
CheckMate -816 Study: Nivolumab Plus Chemotherapy Given Before Surgery for Non–Small Cell Lung Cancer1,2

12. 1. Provided courtesy of Patrick M. Forde, MD. 2. Forde PM et al. N Engl J Med. 2022;386:1973-1985.
What were the adverse events?
What do these findings mean?
A serious adverse event is one that is life-threatening, requires going to
the hospital, or results in death
In CheckMate -816, people who took nivo plus chemo instead of
chemo alone before their surgery:
Lived longer without
the cancer getting worse
or spreading
Were more likely to have
lungs and lymph nodes
clear of cancer cells
after surgery
Had a trend to live longer
in general, which needs
more time to be confirmed
Did not have more
adverse events
About 1 in 10 people
in each group had a
serious adverse events
from treatment
Most adverse events from surgery were mild or moderate
Most adverse events
from treatment
were mild or
moderate
No people in the nivo plus chemo group died because of serious adverse events or serious surgery-related adverse events due to the treatment
Chemo
Nivo plus
chemo
1–2 in 10
1 in 10
Few people had severe or life threatening adverse events from surgery
Nivo plus chemo is now an
approved treatment in the
United States for adults
with NSCLC whose tumors
are 4 centimeters or larger
or have spread to nearby
lymph nodes
CheckMate -816 Study: Nivolumab Plus Chemotherapy Given Before Surgery for Non–Small Cell Lung Cancer1,2