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This algorithm covers perioperative systemic therapy for resectable and early-stage non-small cell lung cancer, organized by stage and driver status. For resectable stage IB to IIIA disease treated before surgery, options are neoadjuvant chemotherapy plus nivolumab (CheckMate 816) or perioperative chemotherapy plus pembrolizumab (KEYNOTE-671). For resected tumors without a driver alteration, adjuvant atezolizumab is shown for PD-L1 of 1% or higher (IMpower010), with adjuvant pembrolizumab as an alternative (KEYNOTE-091).
Resected non-squamous tumors should be tested for EGFR and ALK, because adjuvant targeted therapy outperforms immunotherapy in driver-positive disease. Resected EGFR-mutant tumors receive adjuvant osimertinib (ADAURA), and resected ALK-positive tumors receive adjuvant alectinib (ALINA), which produced a large disease-free survival improvement over platinum chemotherapy with notable CNS protection. For unresectable stage III disease, the chart shows consolidation durvalumab after chemoradiation (PACIFIC). Osimertinib and alectinib are flagged for CNS activity.
Background reading: NSCLC (Part 1): Biology, Screening, Staging, Early-Stage and Stage III board review notes.
By stage and driver status → neoadjuvant, adjuvant, and unresectable-stage III pathways. Starting point: Resectable / early-stage NSCLC by stage & driver. Full background: NSCLC (Part 1): Biology, Screening, Staging, Early-Stage and Stage III notes.
Simplified board-prep scaffold; verify against current guidelines and primary literature. Test resected non-squamous tumors for EGFR/ALK: adjuvant targeted therapy outperforms IO in driver-positive disease.