Optimizing Early-Stage NSCLC Management Through Multidisciplinary Strategies: ASCO 2025 - Episode 7
MDT Management of Borderline Resectable Early-Stage NSCLC and Delayed Surgery After Neoadjuvant IO
Panelists discuss how borderline resectable patients can be made resectable through neoadjuvant chemoimmunotherapy when surgeons have clear, objective goals for what they aim to achieve rather than vague hopes to make surgery “less scary.”
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Borderline resectability remains a key challenge in early-stage non–small cell lung cancer, and surgeons Mara Antonoff, MD, FACS, and Brendon Stiles, MD, advocate for aggressive, personalized strategies. They highlight the potential of neoadjuvant chemoimmunotherapy to convert borderline or technically unresectable tumors into operable disease.
Dr Antonoff emphasizes the need for clearly documented surgical goals, such as avoiding pneumonectomy or achieving lobectomy, to guide treatment expectations and trial design. She warns against vague reasoning like “the tumor looks scary” and calls for objective criteria to define surgical conversion.
Dr Stiles agrees that evolving systemic therapies warrant reevaluating resectability. He describes institutional protocols where early immunotherapy is followed by reevaluation, especially for bulky or anatomically challenging tumors, and encourages broader implementation of such approaches to expand curative options.
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