ctDNA clues anchor nivolumab’s benefit in perioperative NSCLC
In the phase III CheckMate 77T trial, perioperative nivolumab plus platinum-doublet chemotherapy improved event-free survival versus placebo in resectable NSCLC (HR ~0.58). Biomarker analyses show ctDNA clearance before surgery and subsequent pathologic complete response (pCR) are associated with longer EFS, and fewer patients became MRD-positive after surgery in the nivolumab arm. Exploratory genomic analyses suggested benefits across several common tumour alterations (e.g., KRAS, KEAP1/STK11, TP53, CDKN2A/SMARCA4) but no validated predictive genomic biomarker emerged. Quality of life remained stable and safety was consistent with prior findings; overall survival data are immature. The results support combining ctDNA dynamics and pCR for risk stratification in perioperative immunotherapy and point to the need for larger pooled biomarker studies to refine predictive markers.