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Surgery alone is no longer the default for resectable non-small cell lung cancer (NSCLC). New data show that adding immunotherapy before (and sometimes after) surgery significantly boosts 5-year survival rates, while targeted therapies are cementing their role for patients with specific gene mutations. The field is now focused on fine-tuning these combinations for the best outcomes.
Surgery alone is no longer the default for resectable non-small cell lung cancer (NSCLC). Mounting phase 3 trial data presented at the 44th Annual Chemotherapy Foundation Symposium show that neoadjuvant (pre-surgery) chemoimmunotherapy dramatically improves survival, with both nivolumab-based (CheckMate 816) and pembrolizumab-based (KEYNOTE-671) regimens delivering ~65% 5-year overall survival rates — roughly 10 percentage points better than chemotherapy alone.
One standout finding: patients who achieve a pathologic complete response (pCR) — meaning no detectable cancer after treatment — have exceptional long-term outcomes, with 93–100% alive at 5 years. Meanwhile, the value of continuing immunotherapy after surgery remains an open question, with conflicting results across trials and dedicated studies (ADOPT-lung, INSIGHT) not expected to report until 2032–2035.
Key Takeaways
Why it matters: For the roughly 30% of NSCLC patients diagnosed with resectable disease, these advances translate to real survival gains. Targeted therapies are now standard for oncogene-driven subtypes, and the field is actively working to personalize treatment — sparing some patients unnecessary therapy while escalating care for those at higher risk of relapse.
