Managing Recurrent NSCLC After Immunotherapy & Surgery

Experts address managing recurrent non-small cell lung cancer (NSCLC) after definitive treatment with surgery and immunotherapy (IO). The experts outline a strategy based on the timing of recurrence.

For patients who relapse a significant time (suggested as one to two-plus years) after finishing adjuvant immunotherapy, they can be treated as a new (de novo) stage IV case. This often means reconsidering first-line options, including a potential IO rechallenge.

The more challenging scenario is an early recurrence during or shortly after adjuvant IO. Here, standard second-line therapy like docetaxel is an option but is not ideal. The experts strongly recommend prioritizing clinical trial enrollment to access novel, targeted agents. If a KRAS mutation or other biomarker is present, this can guide trial selection. Re-introducing platinum-based chemotherapy is also a reasonable consideration if a sufficient time has elapsed since initial treatment. The key takeaway is the critical need for better data and innovative approaches for this patient population.