Adjuvant Chemotherapy and Adjuvant Radiation Therapy for Stages I-IIIA Resectable Non-Small Cell Lung Cancer

Rapid Recommendation Update

Published Online January 10, 2022

Katherine Pisters, Mark G. Kris, Laurie E. Gaspar,  and Nofisat Ismaila

Panel members: Christopher G. Azzoli, Lifespan Cancer Institute, Brown University; Jamie E. Chaft, Memorial Sloan Kettering Cancer Center; Peter Michael Ellis, Juravinski Cancer Institute; Laurie E. Gaspar, Banner MD Anderson Cancer Center, University of Colorado School of Medicine; Mark G. Kris, Memorial Sloan Kettering Cancer Center; Steven H. Lin, MD Anderson Cancer Center; Harvey I. Pass, New York University School of Medicine; Katherine Pisters, MD Anderon Cancer Center; Rahul Seth, SUNY Upstate Medical University; Frances A. Shepherd, Princess Margaret--University Health Network; David R. Spigel, Sarah Cannon Research Institute; John R. Strawn, Yee Ung, Odette Cancer Centre, Sunnybrook Health Sciences Centre

Updated Recommendations: 

Recommendation 1.2. Stage IB (3<T≤ 4 cm, N0M0). Adjuvant osimertinib is recommended for patients with sensitizing EGFR (Ex19del or L858R) mutations. 

Recommendation 1.2.1. Adjuvant cisplatin-based chemotherapy and/or atezolizumab are not recommended for routine use in this patient group. A postoperative multimodality evaluation, including a consultation with a medical oncologist, is recommended to assess benefits and risks of adjuvant therapies for each patient. Factors to consider other than tumor stage when making a recommendation for adjuvant therapy are outlined after the adjuvant systemic therapy section of the 2017 guideline. 

Recommendation 1.3. Stages IIA, IIB, and IIIA. Adjuvant cisplatin-based chemotherapy is recommended for all patients. Adjuvant osimertinib is recommended after chemotherapy for patients with tumors with sensitizing EGFR mutations, regardless of PD-L1 status. Adjuvant atezolizumab is recommended for all patients with PD-L1 ≥1% after cisplatin-based chemotherapy except for patients with sensitizing EGFR mutations.

Note: the guideline recommendations are based on the 7^th edition staging system used in the studies as opposed to the current 8^th edition staging system for lung cancer.¹

¹AJCC 8th edition for lung cancer. (AJCC cancer staging manual.  8th ed. New York: Springer 2017)

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