Management of Patients With Resectable and Metastatic Non–Small Cell Lung Cancer

For patients with resectable non–small cell lung cancer (NSCLC) as well as those with metastatic disease, there have been significant recent advances in therapies. In patients with resectable disease, new evidence supports use of neoadjuvant nivolumab + chemotherapy for eligible patients with resectable stage II–IIIA NSCLC. Separate data lead to the recommendation for adjuvant atezolizumab (after adjuvant chemotherapy) for eligible patients with completely resected stage II–IIIA NSCLC and PD-L1 expression ≥1%. Adjuvant osimertinib (± adjuvant chemotherapy) is an alternative for eligible patients with completely resected stage IB–IIIA NSCLC and EGFR mutations (exon 19 del or L858R). For patients with metastatic NSCLC, molecular testing is recommended for EGFR and BRAF mutations; MET exon skipping 14 alterations; ALK, ROS1, RET, and NTRK1/2/3 gene arrangements; and KRAS G12C mutations. First-line targeted therapies are available for many of these targets and, in the second-line setting, there are new targeted agents for KRAS G12C mutations and EGFR exon 20 insertions.

Disclosures: Dr. Yanagawa has disclosed receiving honoraria from Great Debates & Updates in Electrophysiology; serving as an officer, director, or any other fiduciary role for and having ownership/partnership/principal in ICONA; and receiving consulting fees from a legal firm. Dr. Riely has disclosed receiving grant/research support from Merck & Co., Inc., Mirati Therapeutics Inc., Novartis Pharmaceuticals Corporation, Pfizer Inc., Roche Laboratories, Inc., and Takeda Pharmaceuticals North America, Inc.

Correspondence: Jane Yanagawa, MD, University of California Los Angeles, 10833 LeConte Avenue, Box 957313, Room 64-124 CHS, Los Angeles, CA 90095. Email: jyanagawa@mednet.ucla.edu; and Gregory J. Riely, MD, PhD, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065. Email: rielyg@mskcc.org
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