A Canadian Perspective on Perioperative Systemic Therapy in Resectable Non-Small Cell Lung Cancer

The management strategies in resectable non-small cell lung cancer (NSCLC) have changed over the last few years. Despite advancements in surgical techniques and conventional chemotherapy, patients with resectable NSCLC remained at high risk of future recurrence. Clinical trials have demonstrated improvements in response rates, pathological outcomes, and survival with the perioperative approach. Considering the findings of these landmark trials, there is a pressing need to contextualize and incorporate these global developments into the national practice framework. This review outlines key developments from recent clinical trials, with a focus on perioperative strategies in early-stage operable NSCLC from a Canadian perspective. We discuss the integration of checkpoint inhibitors in the perioperative setting for patients without actionable genomic alterations, adjuvant targeted therapies for EGFR and ALK mutant disease, and emerging tools such as ctDNA based minimal residual disease monitoring. The article also addresses the practical challenges of implementing these advances within the Canadian healthcare system, including systemic therapy approvals, barriers, and importance of multidisciplinary care to guide clinicians in optimizing patient outcomes.