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...

This question is a current dilemma in the management of locally advanced lung cancer. The rate of patients falling out of the surgical pathway in randomized trials, a highly selected population having seen the surgeon before any therapy was given, is in the range of 15-20%. In the real world, the nu...

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...

My management of an early-stage NSCLC patient who progresses on chemo-IO and is no longer a surgical candidate depends on the degree of progression, updated staging after induction, and performance status after induction. If the patient has progressed to develop nodal disease (but not distant metast...