Metabolic Biomarkers Predicting Response to Neoadjuvant Immunotherapy in Non-Small Cell Lung Cancer

Introduction: Metabolic reprogramming in cancer cells is an important feature that may impact response to immunotherapy. This study focuses on assessing glycolytic biomarkers through radiological (18F-FDG PET/CT), immunohistochemical (GLUT-1, Ki-67, PD-L1), and molecular analyses to better predict treatment outcomes in early-stage non-small cell lung cancer (NSCLC). Study Design: This is a prospective, single-arm, single-center clinical trial including 30 patients diagnosed with early-stage NSCLC (stages IB to IIIA) who are negative for EGFR and ALK mutations. All patients will receive two cycles of neoadjuvant nivolumab at 3 mg/kg combined with platinum-based chemotherapy (doublet regimen). Procedures: Before treatment, patients will undergo PET/CT scans to measure metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax). Tumor biopsies will be collected for immunohistochemistry and molecular profiling to evaluate markers such as GLUT-1, Ki-67, PD-L1, and oncogenic signaling pathways related to metabolism. Endpoints: Primary endpoints are major pathological response defined as ≤10% viable tumor cells in surgical specimens post-treatment, and immune microenvironment characterization through IHC markers (CD8, CD4, FOXP3, PD-1, CD68, CD163). Secondary endpoints include event-free survival, overall survival, and assessment of treatment-related toxicities. Standard of Care: Neoadjuvant chemotherapy and PET/CT imaging are part of routine clinical management for NSCLC at the institution. Significance: The study aims to provide a clinically feasible diagnostic tool to optimize patient selection for neoadjuvant immunotherapy, potentially enhancing efficacy and cost-effectiveness of treatment protocols in early-stage NSCLC.