OBJECTIVES: The continually evolving neoadjuvant/adjuvant treatment landscape for early-stage/resectable NSCLC currently includes PD-1/PDL-1-targeting immunotherapy (pembrolizumab, nivolumab, atezolizumab), the tyrosine kinase inhibitor osmeritinib, and chemotherapy. Recently, neoadjuvant pembrolizumab + chemotherapy and adjuvant pembrolizumab was approved by the FDA for resectable NSCLC. Approval was based on findings from the KEYNOTE-671 trial which demonstrated improved efficacy of this regimen versus neoadjuvant chemotherapy alone and surgery. This study aimed to examine US oncologists' utilization and perceptions of treatment options in this setting.

METHODS: Questions related to neoadjuvant and adjuvant therapy for early-stage/resectable NSCLC were presented to US-based oncologists/hematologists during a live meeting held in July 2023. Up to 108 participants responded to questions, though not all participants answered each question. Responses were summarized using descriptive statistics.

RESULTS: For a hypothetical 62-year-old male with immunotherapy and cisplatin-eligible resectable stage IIIA N2 non-squamous NSCLC, most (69.8%) respondents initially reported a treatment preference for neoadjuvant nivolumab +cisplatin + pemetrexed treatment. Forty-one percent would consider immunotherapy for resectable NSCLC, regardless of PD-L1 expression. After reviewing KEYNOTE-671, 74.5% respondents indicated being very likely to consider neoadjuvant pembrolizumab + chemotherapy, and adjuvant pembrolizumab treatment for resectable NSCLC and providers were more likely to prescribe chemoimmunotherapy (47.4%) versus targeted therapy (40.2%) as neoadjuvant therapy for epidermal growth factor receptor-mutated NSCLC. The most frequently cited challenges to prescribing neoadjuvant chemoimmunotherapy and adjuvant immunotherapy for patients with resectable NSCLC included understanding if patients require both neoadjuvant and adjuvant treatment (51%), identifying patients benefitting most (47%), and the impact of actionable mutations on outcomes (33%).

CONCLUSIONS: Overall, with enhanced interest in immunotherapy use in both neoadjuvant and adjuvant settings, understanding treatment optimization, differentiating between competing targeted and immunotherapy treatment options, adverse event management, and impact of mutations on patient outcomes will become critical treatment considerations.