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Would you consider omission of PORT for node+ NSCLC with a positive margin in the setting of a high tumor PD-L1 score and plans for immunotherapy?

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Would you consider omission of PORT for node+ NSCLC with a positive margin in the setting of a high tumor PD-L1 score and plans for immunotherapy?

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2 Answers
Mednet Member
Mednet Member
Radiation Oncology · Tennessee Oncology
Answered on

For gross positive margins (R2), no, adjuvant chemoRT followed by consolidation immunotherapy.

For R1, SOC would still say PORT and adjuvant systemic therapy. But let's try to tease it out in a more nuanced way from available data. First PD-L1 high is certainly a check in the plus column for a clini...

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Mednet Member
Mednet MemberInvited Expert
Medical Oncology · Mary Lanning Healthcare Morrison Cancer Center/University of Nebraska Medical Center Adjunct Faculty
Answered on · Updated on

For T1abc–T2aN1, T2bN1, and T3, N0 disease, patients with negative surgical margins (R0) and appropriate biomarkers adjuvant chemotherapy (category 1) followed by atezolizumab, pembrolizumab, or osimertinib is recommended. (Pignon et al., PMID 18506026), (NSCLC Meta-analyses Collaborative Group, PMI...

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