How are you approaching patients with early-stage NSCLC who progress on neoadjuvant chemo-immunotherapy and are no longer surgical candidates?  

This is a good question, and we are seeing it too often these days. This question cites progression as the reason for not proceeding to surgery after neoadjuvant chemo-IO. We are also seeing patient refusal and ineligibility (i.e. N3 disease that didn't respond) as reasons. I think it's very importa...

When surgery is not an issue due to progression on neoadjuvant chemo-immunotherapy, then definitive chemoradiation would be my preference as it could offer the prospect of long-term survival and response. In this case, the neoadjuvant treatment serves as induction therapy. It is not optimal, though,...

It depends a bit on why they are no longer a surgical candidate (locoregional progression making unresectable vs worsening of medical comorbidities/PS vs distant progression of disease) but assuming we are talking about the former, I would proceed with concurrent chemoradiation followed by consolida...

The approach depends on the pattern of tumor progression, assuming that the reason behind the unresectability is the progressive disease itself. If the tumor progressed with distant metastases, systemic therapy with palliative intent would constitute the next treatment step. The choice of systemic t...

One of the biggest issues we see is a lack of appreciation for what defines progression. To address this reality, either thoracic surgery or radiation oncology sees the patient periodically during the course of induction systemic therapy and with this re-assessment in place, there is a lower likelih...