Bridging evidence and practice: international multidisciplinary consensus on non-metastatic NSCLC

Area of Science:

• Oncology
• Thoracic Surgery
• Medical Oncology

Background:

• Management of non-metastatic non-small-cell lung cancer (NSCLC) is complex, involving multimodality and biomarker-driven strategies.
• Current evidence and guidelines leave several clinically relevant areas insufficiently defined.
• An international multidisciplinary consensus was convened to address these uncertainties in real-world practice.

Purpose of the Study:

• To establish expert consensus on key areas of uncertainty in the management of non-metastatic NSCLC.
• To provide structured guidance for clinicians facing complex treatment decisions.
• To identify priorities for future research in NSCLC.

Main Methods:

• A modified Delphi process involving 89 thoracic oncology experts.
• Independent rating of predefined clinical statements using a 9-point Likert scale.
• Consensus defined as ≥75% agreement in the 7-9 range; rejection as ≥75% in the 1-3 range.

Main Results:

• Consensus was reached on 62 of 96 statements (64%).
• Supported routine FDG PET-CT staging, PD-L1 testing, DNA-based NGS, and specific surgical approaches for early-stage NSCLC.
• Consolidation durvalumab supported for unresectable stage II-III NSCLC regardless of PD-L1 status.

Conclusions:

• The consensus offers expert guidance for managing non-metastatic NSCLC in areas of clinical uncertainty.
• Highlights persistent controversies, including the role of brain MRI in stage I disease and the use of ctDNA for guiding treatment.
• Identifies critical areas for future prospective research in NSCLC.