周教授：这是一个尚未解答的重要问题。根据临床试验，辅助化疗通常持续约一年，但免疫治疗的时长尚无明确标准，尤其是对达到pCR的患者而言。一年的辅助免疫治疗可能过长，部分研究已探索对pCR患者进行6个月的辅助免疫治疗。无论如何，我们需要更多数据和临床试验来确定免疫治疗的理想时长。

 

Ruffini教授：我完全同意。因为免疫治疗的疗效毋容置疑，下一步应筛选出真正能从辅助免疫治疗中获益的患者，使患者得到最大程度获益。例如，若患者术后达到pCR，理论上已治愈，没有可检测到的肿瘤，是否还需要辅助治疗？为此，我们需要寻找和评估生物标志物（如循环肿瘤DNA），以判断是否有肿瘤细胞存在于血液中的间接证据，若有证据，全身疗法用于辅助治疗是有效的。我认为下一步研究重点是对接受新辅助化疗免疫治疗和手术的患者进行筛选，以判断其应当还是不应当进行辅助治疗。

周教授：我们需要生物标志物筛选适合围手术期化疗免疫治疗的患者，但目前尚无确凿的生物标志物。现有证据显示PD-L1表达可能与疗效相关，近期研究应重视循环肿瘤DNA和循环肿瘤细胞（CTC），但其检测方法仍需标准化验证。我们需要开展研究对生物标志物的预测效果进行验证，联合胸外科、肿瘤内科和转化医学等领域的科学家，共同寻找最佳生物标志物。

 

Dr.Zhou:That is an important question we haven’t answered so far.According to clinical trials，the duration of adjuvant chemo is about one year.But we are not sure of the proper standard duration of immunotherapy，especially for those pCR patients.One year of immunotherapy may be too long.Some studies have investigated six months of adjuvant immunotherapy for pCR patients.Anyway，we need data.We need clinical trials to determine optimal duration of IO in these populations.What is your idea?

 

Dr.Ruffini:I completely agree.I think the next step would be to select the patients who would benefit or not from adjuvant therapy.For the focus of our research in the coming years，we all know that immunotherapy is effective–there is no doubt about that–but we have to select the best patients in order to get the greatest benefit.For example，if after surgery，you have a pathologic complete response，should these patients receive adjuvant chemotherapy or not?In theory，they are cured.There is no detectable disease.Of course，we need some biomarkers，like circulating DNA，for example，to see if there is indirect evidence of tumor cells in the blood，and in that case，systemic therapy in an adjuvant setting might be effective.But I think the focus of the next research will be just to select the population to whom to offer or not to offer adjuvant chemotherapy after chemo-IO and surgery.This is my thought.

 

Dr.Zhou:I totally agree.We need a biomarker to select the right patients for perioperative chemo-IO.As for a biomarker，so far，we don’t have solid biomarkers.We know that PD-1 expression may be associated with better efficacy for perioperative chemo-IO.In the near future，we should look at circulating DNA and circulating tumor cells，but so far，we have not established a testing platform for what the standard method of testing for ctDNA and circulating tumor cells should be.We need studies to confirm the predictive effect of these biomarkers.We need a study.We need surgeons，medical oncologists and translational scientists to work together to find the best biomarkers for our daily practice.