How to Treat Localized Non-Small Cell Lung cancer – Treatment Algorithm with Dr. Sanjay Popat

Early-stage non-small cell lung cancer treatment requires comprehensive staging and upfront next-generation sequencing to guide curative-intent strategies. For resectable disease, neoadjuvant chemoimmunotherapy, such as the nivolumab-based regimen in CheckMate 816, significantly improves overall survival, though the necessity of post-operative immunotherapy remains a subject of clinical debate and shared decision-making. Patients with actionable mutations like EGFR or ALK benefit from targeted therapies like osimertinib or alectinib, often following platinum-based chemotherapy. While data supports these targeted approaches, extrapolating them to rarer mutations like RET or ROS1 requires caution, pending further trial results. In the unresectable setting, concurrent chemoradiation followed by durvalumab serves as the standard of care, with emerging evidence for targeted maintenance therapy. Dr. Sanjay Popat emphasizes that clinical decisions must balance survival data, potential toxicities, and individual patient circumstances to optimize outcomes.