S18 Ep32: Non–Small Cell Lung Cancer 2026 UPDATE

Early-stage and locally advanced non-small cell lung cancer (NSCLC) management centers on the 9th edition TNM staging system, which introduces critical updates to N2 and M1C categories. Clinical practice requires mandatory biomarker testing for EGFR, ALK, RET, and PD-L1 to guide therapeutic selection. For resectable cases, perioperative chemo-immunotherapy regimens—such as those validated in the CheckMate 816 and Keynote 671 trials—have become standard, though immunotherapy is strictly contraindicated for patients with actionable driver mutations like EGFR or ALK. Instead, these patients benefit from targeted therapies like osimertinib or alectinib. Unresectable stage 3 disease continues to rely on definitive concurrent chemoradiation followed by consolidative durvalumab, as established by the PACIFIC trial. Surgical candidacy remains dependent on pulmonary function metrics, with lobectomy serving as the preferred standard for operable patients.