Multiple Options, One Objective: Clearer Decisions in Resectable Non-Small Cell Lung Cancer

Abstract

Simple Summary Treatment options for resectable non-small cell lung cancer have expanded substantially with the introduction of targeted therapies and immune checkpoint inhibitors. This review summarizes current evidence for adjuvant, neoadjuvant, and perioperative systemic treatment and proposes a practical approach to treatment selection. Surgery remains central to curative treatment, particularly for early-stage disease, while perioperative chemoimmunotherapy is increasingly relevant for stage II–III disease, especially in patients with N2 involvement. Molecular alterations such as EGFR mutations and ALK rearrangements guide the use of adjuvant targeted therapy, whereas PD-L1 expression can inform adjuvant immunotherapy decisions. Emerging biomarkers, including pathological response, residual viable tumor, and circulating tumor DNA, may further help individualize treatment but their utility for guiding decisions requires prospective validation.