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Do you still offer adjuvant chemotherapy and chemoradiation for NSCLC after neoadjuvant chemoimmunotherapy?
NCCN states that all operable NSCLC patients should be evaluated for pre-op therapy with strong consideration of nivolumab + chemotherapy for those with tumors 4 cm or larger or that are lymph node positive, and that tumors should be tested for PDL-1 status, EGFR, and ALK (EGFR and ALK mutated NSCLC ineligible).
If a patient undergoes neoadjuvant chemoimmunotherapy followed by lobectomy and mediastinal nodal sampling with positive margins, would you still offer adjuvant chemoradiation? Or does the preceding neoadjuvant chemoimmunotherapy change this recommendation for positive margins in the modern era?
Answer from: Medical Oncologist at Academic Institution
In the pre-neoadjuvant era, the options for patients who had R1 (positive margin) or R2 (gross residual disease) were: re-resection followed by adjuvant chemo; sequential adjuvant chemo followed by radiation; or concurrent chemoradiation. There is retrospective data suggesting a survival benefit fro...
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Answer from: Radiation Oncologist at Community Practice
PORT (with or without concurrent chemo) is appropriate for positive margins after chemoICI->surgery.