ctDNA + genomics finally refining perioperative IO in resectable NSCLC 👀

#AACR26

CheckMate 77T – exploratory biomarker analysis

🧬 Population
Resectable stage IIA–IIIB (N2) NSCLC
NIVO + chemo → surgery → adjuvant NIVO vs placebo

🧪 Key genomic group
KEAP1 / STK11 / CDKN2A / SMARCA4 alterations

⚡ Key findings

✅ Genomically “high-risk” tumors benefit MORE
• EFS HR 0.48 (95% CI 0.28–0.83)
• 30-mo EFS 60% vs 30%

❗ No alterations → limited differential benefit
• HR 0.90

🧬 ctDNA matters
• Detectable baseline ctDNA → NIVO benefit (HR 0.58)
• MRD-negative post-surgery → trend favoring NIVO

🎯 Key predictors of better EFS
• pCR
• ctDNA clearance before surgery
• Receipt of NIVO
• Definitive surgery

🧠 Big insight
Genomic alterations linked to IO resistance in advanced disease
➡️ may NOT predict resistance in early-stage
➡️ may identify patients deriving greater perioperative benefit

🔥 Clinical takeaway
Perioperative NIVO works across genomics,
but ctDNA dynamics + high-risk mutations may enrich responders

📖 Full data from CheckMate 77T biomarker analysis

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