Early-Stage NSCLC: Novel Surgical Techniques and Neoadjuvant, Adjuvant, and Perioperative Therapies

Neoadjuvant and perioperative chemoimmunotherapy has transformed the treatment of tumors >4 cm or node-positive disease (stage II to IIIA, AJCC 8th edition) in non-small cell lung cancer (NSCLC). Compared with neoadjuvant chemotherapy alone, the addition of neoadjuvant immunotherapy to chemotherapy before resection has demonstrated improved pathologic complete response rate, event-free survival, and overall survival in stage II to IIIA NSCLC. The benefit observed with pathologic response after neoadjuvant therapy expands to include patients with stage II to IIIB NSCLC with sensitizing EGFR mutations with neoadjuvant osimertinib and is being evaluated with targeted therapies in additional actionable genomic drivers. Predictive biomarkers for pathologic response after neoadjuvant or perioperative therapies and biomarkers for disease recurrence, including evaluation of minimal residual disease through liquid biopsies, are under investigation to identify NSCLC patients who may have long-term survival with neoadjuvant or perioperative treatment. This chapter summarizes the current clinical landscape of neoadjuvant, perioperative, and adjuvant therapies and updates on surgical techniques for early-stage NSCLC.