Adjuvant Systemic Therapy After Surgery for Operable Early-Stage NSCLC (Stage I–IIIA)
For patients with operable, resectable early-stage non-small cell lung cancer — clinical stage I, II, or selected resectable stage IIIA — surgical resection is the primary treatment. Once surgery has been performed, structured adjuvant systemic therapy defines the next step in management.
Clinical Scenario
Operable, resectable early-stage NSCLC (clinical stage I, II, or selected resectable stage IIIA). Surgery provides the best chance for cure in patients with stage I or II disease, and surgical resection is considered the first option for operable patients with negative nodes.
Previous Treatment Line
Surgical resection
The intended surgical outcome is complete resection with negative margins (R0). Following surgery, adjuvant systemic therapy is the structured next phase of treatment for appropriate patients — addressing residual disease risk according to stage, histology, and tumour biomarker profile.
Post-Surgical Treatment — Partial Overview
Adjuvant systemic therapy after resection involves platinum-based chemotherapy combinations selected by tumour histology, followed by additional agents determined by specific biomarker findings. The full algorithm — including which combinations apply to which stage and histology, and which biomarker-driven options follow — is set out in the complete protocol.
References
- In general, surgery provides the best chance for cure in patients with stage I or II disease.
- Surgical resection is considered the first option for operable patients with cancer with negative nodes.
- For stage IIB (T1, N2a; T2, N1; T3, N0), stage IIIA (T1, N2b; T2–T3, N2a; T3, N1; T4, N0–1), stage IIIB (T2–T3, N2b; T4, N2), adjuvant chemotherapy is recommended.
- Alectinib (for patients with ≥4 cm or node-positive NSCLC stages IB–IIIA, IIIB [T2–T3, N2b; T4, N2], and positive for ALK gene fusions) (category 1).
- Osimertinib (for patients with NSCLC positive for EGFR exon 19 deletion or L858R mutation).
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