Chair and Presenter, Brendon M. Stiles, MD, and Balazs Halmos, MD, prepared useful Practice Aids pertaining to NSCLC for this CME/MOC activity titled “Building Multidisciplinary Partnerships to Facilitate Genomic Testing and Master the Integration of EGFR-Targeted Therapy in Resectable Stage I-III NSCLC.” For the full presentation, downloadable Practice Aids, and complete CME/MOC information, and to apply for credit, please visit us at https://bit.ly/3RkX3em. CME/MOC credit will be available until February 27, 2025.

1. Treatment Algorithm for Resectable NSCLC1
Full abbreviations, accreditation, and disclosure information available at PeerView.com/WFZ40
Stage and workup based on stage
•
cT1abc, N0: PFT, bronch, mediastinal staging, PET
•
cT2a-4, N0-3, M0-1: PFT, bronch, mediastinal staging, PET, brain MRI, and biomarker/mutation testing
Surgical candidate?
Lobectomy
(preferred)
or
segmentectomy/
wedge resection
(in select cases)
SBRT
or
conventionally
fractionated RT
Surgical resection
Mutational testing (if not conducted earlier)
EGFR ex19del/ex21 L858R present?
Surgical resection
T1
N0
M0
Operable disease
Yes
Yes
Yes
No
No
No
Multidisciplinary discussion for
neoadjuvant candidacy
T1–2, N1–2, M0
T3–4, N0–1, M0
Neoadjuvant
chemoimmunotherapy
Neoadjuvant portion of
perioperative immunotherapy
Adjuvant chemotherapy
Platinum-based chemotherapy
LACE Meta-analysis: 5-y OS improvement of
5.4% vs no chemo
Adjuvant immunotherapy (stage II-IIIA)
Atezolizumab x 16 cycles
StageII-IIIA,PD-L1≥1%(seeFDAapproval)
Atezolizumab x 16 cycles
IMpower010: Atezo vs BSC
mDFS: NR vs 35.3 mo (HR, 0.66)
Pembrolizumab x 1 y
Stage IB (T2a ≥4 cm), II, or IIIA, regardless of
PD-L1 expression (see FDA approval)
Pembrolizumab x 1 y
PEARLS/KEYNOTE-091: Pembro vs placebo
mDFS: 53.6 vs 42.0 mo (HR, 0.76)
Adjuvant targeted therapy
Osimertinib x 3 y
ADAURA: Osimertinib vs placebo
2-y DFS (stage II-IIIA): 90% vs 44% (HR, 0.17)
NSCLC treatment algorithm
Stage IB-IIIA (resectable)
Stage IA
Surgical resection
Adjuvant portion of perioperative immunotherapy
1. Adapted from an algorithm created by Aakash Desai, MBBS, MPH, and Matthew Ho, MD, PhD. Used with permission from the authors.
Nivolumab + platinum-based
chemotherapy x 3 cycles
CheckMate -816: Nivo + chemo vs chemo
(see FDA approval)
mEFS: 31.6 vs 20.8 mo (HR, 0.63)
Pembrolizumab + platinum-containing
chemotherapy x 4 cycles as neoadjuvant
KEYNOTE-671: Pembro + chemo vs placebo + chemo
(neoadjuvant) / pembro vs placebo (adjuvant )
(see FDA approval)
mOS: not reached vs 52.4 mo; mEFS: not reached vs 17 mo
Pembrolizumab, up to 13 cycles
KEYNOTE-671: Pembro + chemo vs placebo + chemo
(neoadjuvant) / pembro vs placebo (adjuvant )
(see FDA approval)
mOS: not reached vs 52.4 mo; mEFS: not reached vs 17 mo