Updates on the Perioperative Management of Resectable Non-Small Cell Lung Cancer

For patients with resectable non-small cell lung cancer (NSCLC), neoadjuvant or adjuvant chemotherapy was the only systemic treatment available for decades. The management has advanced in recent years, with large, randomized studies showing improvement in outcomes with the incorporation of targeted therapies or immunotherapy-based regimens. As in the metastatic setting, treatment is now personalized through biomarker selection. This narrative review details the current landscape of systemic treatment of resectable NSCLC. It covers patient selection, including the importance of appropriate staging workup and determination of resectability. The growing role of immunotherapy-based regimens in the neoadjuvant, adjuvant, and perioperative phases and the implications of PD-L1 status on clinical outcomes are discussed. Outcomes with targeted therapy, primarily in the adjuvant setting, for NSCLC harboring EGFR mutations or ALK rearrangements are summarized, and the importance of identifying these patients upfront is emphasized. Throughout, pending results and active areas of investigation are highlighted.