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ES NSCLC Forum
Call To Action: Individualizing Treatment Plans in Resectable Early-Stage NSCLC

Released: June 04, 2026

Patrick Forde
Patrick Forde, MD, PhD
Karen Reckamp
Karen Reckamp, MD, FASCO
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Key Takeaways
  • Delays in molecular testing and inconsistent multidisciplinary care pathways remain major barriers to guideline-concordant care in resectable early-stage NSCLC.
  • Healthcare professionals continue to face uncertainty regarding optimal perioperative immunotherapy strategies, particularly in patients with pCR after neoadjuvant therapy, PD-L1–negative disease, and/or non-EGFR/ALK driver alterations.
  • Patient-centered care requires consistent and ongoing shared decision-making and proactive management of immune-related adverse events alongside personalized treatment selection.

A Call to Action in Resectable Early-Stage NSCLC
The treatment landscape for resectable early-stage non-small-cell lung cancer (NSCLC) has evolved rapidly, creating new opportunities to improve outcomes through highly individualized perioperative treatment strategies. However, important gaps remain in optimizing the workflows needed to deliver this care consistently in practice. Healthcare professionals (HCPs) continue to face challenges related to delays in molecular testing, limited tissue availability in the neoadjuvant setting, and the complexity of coordinating care and communication across multiple specialties. Advancing patient-centered care in early-stage NSCLC will require ongoing multidisciplinary coordination, earlier and more efficient biomarker testing, clearer communication, and more intentional collaboration with patients and caregivers throughout the treatment journey. The gaps highlighted in this commentary reflect ongoing difficulties reported by HCPs across academic and community practice settings, as well as input from the SMART Patients advocacy group, in adapting practice to the rapidly evolving clinical landscape. These insights will help inform the discussion points for an upcoming educational meeting series focused on integrating immunotherapy into the management of resectable early-stage NSCLC.

Setbacks for Timely, Guideline-Concordant Molecular Testing
Incorporating molecular testing and biomarker results into (neo)adjuvant treatment decision-making for resectable early-stage NSCLC remains challenging across practice settings, particularly when working with limited tissue availability and narrow treatment windows. Obtaining sufficient tissue for diagnosis, next-generation sequencing, and PD-L1 testing can be especially difficult when minimally invasive procedures such as endobronchial ultrasound are used, often forcing HCPs to balance the urgency of treatment initiation with the need for complete molecular information. In the neoadjuvant setting specifically, turnaround times for biomarker testing may take weeks, delaying treatment decisions and creating uncertainty regarding optimal sequencing strategies. Liquid biopsy, although promising, is not yet sensitive enough in many early-stage cases to reliably overcome these limitations. Additional logistical barriers also emerge when biomarker testing has not been ordered reflexively by outside providers or when pathology specimens are difficult to track across institutions. Strategies that may help mitigate these challenges include stronger coordination with pulmonology, thoracic surgery, and pathology teams to secure additional tissue at the time of biopsy; reflex molecular testing protocols with preliminary next-generation sequencing results available within days; and automatic biomarker ordering by pathologists to reduce delays and variability in care. Collectively, these experiences underscore that improving biomarker-driven care in early-stage NSCLC will require not only advances in testing technologies, but also more coordinated multidisciplinary workflows designed to ensure timely molecular evaluation before treatment decisions are finalized.

Navigating the Gray Areas: Selecting the Right Perioperative Immunotherapy Approach
The optimal use of perioperative immunotherapy-based strategies in early-stage NSCLC continues to vary across practice settings, underscoring several important clinical “gray areas” that warrant greater clarity and alignment in treatment decision-making. Developing individualized treatment plans requires consideration of factors such as disease stage, comorbidities, molecular alterations, autoimmune disease, social support, and patient preferences. These uncertainties continue to complicate clinical management and highlight the need for practical guidance to support the evidence-based integration of immunotherapy into the management of resectable early-stage NSCLC.

Additional Unanswered Questions to be Explored:

  • Should adjuvant therapy still be pursued in patients who achieve a pathologic complete response following neoadjuvant chemoimmunotherapy?
  • How should perioperative treatment strategies be adapted for patients with non-EGFR/ALK actionable driver alterations?
  • Should surgery-first approaches still be considered in the current treatment landscape?
  • What is the optimal management approach for patients with PD-L1–negative tumors?
  • When is it appropriate to omit adjuvant therapy following neoadjuvant treatment?
  • What is the best approach to neoadjuvant or perioperative immunotherapy in patients with underlying autoimmune disease?
  • How should HCPs approach “borderline resectable” disease?
  • What is the optimal number of preoperative treatment cycles, and when is the adjuvant component still necessary?

Preparing Practice for SC Immunotherapy: New Workflows, New Opportunities
The emergence of subcutaneous (SC) immunotherapy presents both an important opportunity and a new operational challenge for oncology care teams. As practices begin integrating this route of administration into routine care, logistical hurdles continue to emerge and may vary significantly across practice settings. Ongoing discussions around implementation, including access, reimbursement, scheduling, staffing, and coordination of care, will be essential both within institutions and across the broader oncology community. Sharing real-world experiences and practical implementation strategies may help support a smoother transition into practice.

Input from SMART Patients highlights the potentially meaningful impact of SC immunotherapy on patient quality of life, particularly through reduced time in clinic and greater convenience. As these treatment options become more widely available, HCPs and healthcare systems will need to develop new workflows that balance operational efficiency with patient-centered care and individual treatment preferences.

Patient Perspectives as a Call to Action: Educational Gaps Identified Through SMART Patients
Finally, findings from SMART Patients focus groups revealed that many patients feel underinformed about treatment decisions, recovery expectations, and immune-related adverse events. Some patients described learning more from peer communities than from the healthcare system itself, while others experienced persistent toxicities without fully understanding the risks beforehand. These findings underscore the urgent need for clearer, more proactive patient education and stronger communication strategies to support shared decision-making throughout the treatment journey. They also highlight an important opportunity for future educational initiatives to better equip HCPs with practical tools and communication strategies for discussing treatment expectations, toxicity management, and survivorship concerns with patients and caregivers.

Your Thoughts
What strategies have been most effective in your practice for improving timely biomarker testing in resectable early-stage NSCLC? Are there additional “gray areas” regarding the use of immunotherapy in early-stage NSCLC that you would like faculty to discuss?

Be sure to return and visit our page for this educational program often. In the coming months, we will be posting downloadable resources, certified podcasts, and certified text modules to provide you with practical insights from the experts on how to address some of the challenges and barriers noted in this commentary!

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Which topic(s) related to the management of patients with early-stage NSCLC would you most appreciate additional guidance or education on to help enhance your practice?

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