Multidisciplinary Perspectives In the Management of Borderline Resectable Early-Stage NSCLC: A Focus on the Role of Pulmonary Rehabilitation

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PD-L1 Status in Treatment Decisions for Unresectable Early-Stage NSCLC

Role of PD-L1 Status in Unresectable Early-Stage Disease

PD-L1 expression serves as a significant biomarker that guides immunotherapy decisions in unresectable early stage NSCLC. Higher PD-L1 expression levels (≥1%) are associated with improved response to immune checkpoint inhibitors, particularly when combined with standard chemoradiation approaches. The magnitude of benefit from immunotherapy appears to correlate with PD-L1 expression levels.

Treatment Approach for Unresectable Early-Stage NSCLC with PD-L1 <1%

For patients with unresectable early-stage NSCLC exhibiting low or negative PD-L1 expression (<1%), the recommended treatment approach includes:

• Definitive concurrent chemoradiation as the foundation of treatment
• Consideration of consolidation immunotherapy despite low PD-L1 expression, as some patients may still derive benefit
• Enrollment in clinical trials investigating novel combination approaches specifically for PD-L1–low populations when available
• Close monitoring for disease progression with early intervention strategies
• Careful assessment of patient-specific factors including performance status, comorbidities, and tumor characteristics to guide individualized treatment decisions

This approach recognizes that while PD-L1 status is important for predicting immunotherapy benefit, other factors including disease burden, patient characteristics, and alternative biomarkers should be considered when making treatment decisions for this challenging patient population.