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The rapidly evolving paradigm of neoadjuvant immunotherapy across cancer types

Nature Cancer volume 6, pages 967–987 (2025)Cite this article

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Abstract

Neoadjuvant immunotherapy is rapidly changing the treatment landscape for many tumor types. The superiority of neoadjuvant compared to adjuvant immunotherapy has now been established in both preclinical studies and clinical trials. Neoadjuvant immunotherapy, either as monotherapy or in combination with other immune checkpoint inhibitors or other agents, has become a standard of care for several cancer types, while many new indications are expected. Future research should focus on determining the benefit of treatment combinations versus monotherapy and the contribution of adjuvant after neoadjuvant (or perioperative) treatment versus neoadjuvant treatment alone as well as on identifying predictive biomarkers of response.

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Fig. 1: Rationale for neoadjuvant versus adjuvant immunotherapy.

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Authors and Affiliations

  1. Department of Medical Oncology, Vrije Universiteit Brussel/Universitair Ziekenhuis Brussel, Brussels, Belgium

    Gil Awada

  2. Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Tina Cascone

  3. Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands

    Michiel S. van der Heijden, Christian U. Blank, Marleen Kok & Myriam Chalabi

  4. Department of Gastrointestinal Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands

    Myriam Chalabi

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Correspondence to Myriam Chalabi.

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Competing interests

G.A. declares honoraria from Novartis, consulting fees paid to the institute by Novartis, research funding to the institute from Novartis, Stichting tegen Kanker, Kom op tegen Kanker, research funding from ESMO and FWO; and travel, accommodations and expenses from Gilead Sciences and Pierre Fabre. T.C. reports speaker fees and/or honoraria (including travel and/or meeting expenses) from ASCO Post, AstraZeneca, Bio Ascend, Bristol Myers Squibb, Clinical Care Options, IDEOlogy Health, the Medical Educator Consortium, Medscape, OncLive, PEAK Medicals, PeerView, Physicians’ Education Resource and Targeted Oncology; advisory role and/or consulting fees (including travel and/or meeting expenses) from AstraZeneca, Bristol Myers Squibb, Daiichi Sankyo, Genentech, Merck, oNKo-innate, Pfizer, RAPT Therapeutics and Regeneron; and institutional research funding from AstraZeneca and Bristol Myers Squibb. M.S.v.d.H. declares research support from Bristol Meyers Squibb, AstraZeneca, Roche, 4SC and Merch Sharp & Dohme; and consultancy fees from Bristol Meyers Squibb, Merch Sharp & Dohme, Roche, AstraZeneca, Seagen, Pfizer, Janssen and Daiichi Sankyo. All grants were paid to the institute. C.U.B. has received research grants from Novartis, BMS and NanoString, is a paid advisory board member for BMS, MSD, Roche, Novartis, GlaxoSmithKline, AstraZeneca, Pfizer, Lilly, Genmab and Pierre Fabre and holds ownership interest in Uniti Card, Neon Therapeutics and Forty Seven, all outside this submitted work. M.K. reports research grants from AZ–Daiichi, BMS and Roche, speaker fees from AZ–Daiichi and Gilead, compensation for advisory work from Alderaan Biotechnology, AZ–Daiichi, BioNTech, BMS, Domain Therapeutics, Gilead, MSD, Novartis and Roche and nonfinancial support from Natera. All grants were paid to the institute. M.C. is advisor to Bristol Myers Squibb, Merck Sharp & Dohme, Agenus and Roche–Genentech and has received research grants unrelated to this study from Agenus, Merck Sharp & Dohme and Roche–Genentech. All grants were paid to the institute.

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Awada, G., Cascone, T., van der Heijden, M.S. et al. The rapidly evolving paradigm of neoadjuvant immunotherapy across cancer types. Nat Cancer 6, 967–987 (2025). https://doi.org/10.1038/s43018-025-00990-7

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