Clinical Impact of Incorporation of Immunotherapy and Targeted Therapy in Early-Stage NSCLC

Patients with early-stage lung cancer have experienced dramatic improvements in treatment options through the integration of immunotherapy and targeted therapies into neoadjuvant, perioperative, and adjuvant treatment settings. Health care providers report that treatment paradigms require frequent updates following major cancer conferences, as the rapid pace of therapeutic advances continues to expand patient treatment options. The incorporation of checkpoint inhibitor immunotherapy with chemotherapy in the neoadjuvant setting has become standard practice, though questions remain about optimal treatment duration and patient selection for adjuvant immunotherapy.

Treatment decisions for patients with targetable genetic mutations continue to evolve, with emerging data supporting neoadjuvant targeted therapy approaches that may offer superior treatment completion rates compared with adjuvant-only strategies. Patients with EGFR mutations now have multiple treatment options, including single-agent targeted therapy, combination approaches with chemotherapy, and various sequencing strategies that can be tailored to individual patient characteristics and preferences. Health care providers must stay current with evolving overall survival data that increasingly support the integration of chemotherapy with targeted therapies in appropriate patient populations.

The decision-making process for treatment duration, particularly regarding the number of neoadjuvant cycles (3 vs 4), requires individualized assessment based on patient tolerance, tumor response, and surgical timing considerations. Patients benefit from treatment approaches that prioritize completing systemic therapy before surgery, given that a significant percentage of patients do not receive planned adjuvant therapy when treatment is delayed until after surgical recovery. Health care providers increasingly use interim imaging and clinical response assessments to optimize treatment sequencing and ensure patients receive maximum benefit from multimodal approaches while minimizing unnecessary treatment-related toxicity.