How are you approaching patients who receive neoadjuvant chemo immunotherapy for resectable NSCLC who after completion of neoadjuvant treatment are no longer surgical candidates due to factors such as toxicity, decline in PS, or patient preference?

This scenario seems to happen in 17-20% of patients. It’s very important to appropriately stage patients at diagnosis with PET CT, EBUS, etc to ensure accurate staging without which a good discussion regarding resectability is not possible. If a patient does, in spite of our due diligence, end up not being a surgical candidate then the next steps depend on the scenario. If a patient for example can receive definitive XRT, would consider that. If PS is poor, would observe and assess options when it improves. If a patient is progressing on chemotherapy and immunotherapy, unfortunately, this might suggest aggressive disease and poor prognosis. I would make sure the patient has had genomic testing at diagnosis so all treatment options are discu...