Best Practices for Use of Neoadjuvant Immunotherapy in Resectable Early-Stage NSCLC

Patients receiving neoadjuvant immunotherapy and chemotherapy require systematic restaging procedures to assess treatment response and confirm surgical candidacy, though the optimal imaging strategy continues to evolve based on institutional experience and patient risk factors. Health care providers typically utilize CT imaging for routine restaging, with some institutions performing interim scanning after 2 cycles to identify early progression or exceptional responses that might influence treatment decisions. The role of PET scanning and brain MRI in routine restaging remains controversial, as these studies may identify inflammatory changes that complicate treatment decisions without providing clear clinical benefit.

The need for repeat invasive mediastinal staging after neoadjuvant therapy depends on clinical circumstances and imaging findings, with most institutions avoiding routine repeat procedures unless specific concerns arise about treatment response or nodal status. Patients benefit from individualized approaches that consider their initial staging results, treatment response, and planned surgical procedure when determining the need for additional invasive staging. Health care providers report low rates of immune-related inflammatory changes that require additional tissue confirmation, suggesting that routine repeat biopsies may be unnecessary in most patients.

Patient care optimization includes careful consideration of treatment cycles and timing, with emerging evidence suggesting that maximal therapeutic benefit may be achieved within the first 2 to 3 treatment cycles. Health care providers increasingly focus on treatment completion rates and patient fitness for surgery when determining optimal neoadjuvant duration. The integration of circulating tumor DNA monitoring remains investigational, though early data suggest prognostic value that may eventually guide treatment decisions. Patients currently benefit most from standardized treatment approaches based on established clinical trial evidence while participating in research studies that will inform future practice evolution.