NSCLC Case Study 1: PD-L1 30% and No Mutations

Experts discuss treatment options for stage III non-small cell lung cancer (NSCLC) without actionable driver mutations and with a PD-L1 expression of 30%. The experts emphasize a multidisciplinary evaluation to decide between a surgical or non-surgical approach.

For a young, healthy patient with resectable disease, the preferred strategy is a surgical one involving neoadjuvant chemoimmunotherapy (inspired by trials like CheckMate 816 and KEYNOTE-671), followed by surgery. A key dilemma discussed is the role of adjuvant immunotherapy (continued treatment after surgery). Recent data suggests that just a few cycles of neoadjuvant immunotherapy may be as effective as a full year of perioperative treatment, raising questions about potentially de-escalating therapy to reduce patient burden. The alternative, non-surgical path for unresectable tumors would be concurrent chemoradiation followed by consolidation immunotherapy based on the PACIFIC trial regimen.