Optimizing Early-Stage NSCLC Management Through Multidisciplinary Strategies: ASCO 2025 - Episode 9
Optimizing Adjuvant Therapy Decisions in Resectable NSCLC: Integrating Pathologic Response, PD-L1, and Nodal Status
Panelists discuss how treatment decisions should integrate multiple factors, including pathologic complete response (pCR), PD-L1 status, and nodal involvement, with particular emphasis on continuing adjuvant therapy for N2 disease and non-PCR patients despite the complexity of using residual viable tumor as a decision-making tool.
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The panelists explore how pathological response, PD-L1 status, and nodal involvement inform adjuvant therapy decisions following resection in non–small cell lung cancer. Aditya Juloori, MD, stresses that patients with N2 disease and incomplete response remain at high risk and warrant continued treatment and close surveillance.
Wade Iams, MD, MSCI, and Josh Reuss, MD, debate the clinical utility of pCR and percent viable tumor, acknowledging their value as continuous—not categorical—markers. Although pCR is a strong predictor of cure, residual disease and PD-L1 expression must be weighed together when determining further treatment.
The panelists concur that patients with residual disease, especially PD-L1–negative or N2-positive tumors, may benefit from continued immunotherapy. However, they emphasize that randomized trials are still needed to definitively guide adjuvant therapy de-escalation or escalation based on biomarker data.
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