OnCo
pairingsPairing

Neoadjuvant immunotherapy → response-adapted adjuvant

Treat before surgery, look at the removed tumour, and only continue treatment if the response was incomplete.

NADINA's design: two neoadjuvant cycles, surgery, then adjuvant therapy only for partial or non-responders. Sixty percent of patients avoided a year of adjuvant treatment. SWOG S1801 showed the same drug works better given partly before surgery.

Rationale
The intact tumour and nodes provide antigen and T-cell priming; pathological response is a reliable early readout that lets therapy be de-escalated.
Evidence
Phase 3 NADINA, phase 2 SWOG S1801.

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