Non-small-cell lung cancer, resectable stage II-IIIA

Non-small-cell lung cancer →

Molecular testing splits the road: without a driver mutation, chemo-immunotherapy comes before surgery and immunotherapy after; with an EGFR or ALK alteration, surgery is followed by a targeted tablet for two to three years.

Download

Typical sequence for stage II-IIIA (resectable) disease; durations are protocol values (cycle counts and lengths, fraction schedules, guideline follow-up intervals), not averages of real patients. Your team's plan will differ in detail.

Phase by phase

1. Diagnosis, staging and molecular testing
weeks 0-5
CT and PET-CT, brain MRI, biopsy with PD-L1 and a molecular panel (EGFR, ALK, ROS1, KRAS and others), mediastinal staging, lung function tests.
PET/CT MRI Comprehensive genomic profiling Histopathology & immunohistochemistry
Source
Decision: Is there an EGFR mutation or ALK fusion?
- No driver: neoadjuvant chemo-immunotherapy, surgery, adjuvant immunotherapy
- EGFR-mutant: surgery first, chemotherapy, then osimertinib for 3 years
- ALK-positive: surgery first, then alectinib for 2 years
2. Neoadjuvant nivolumab + platinum chemotherapy (no driver)
weeks 3-12
Three 3-week cycles before surgery (CheckMate 816); the KEYNOTE-671 alternative gives four cycles with pembrolizumab.
NivolumabCisplatinPembrolizumabImmune checkpoint inhibitors Platinum agents
Source
3. Surgery (lobectomy)
weeks 12-18
Lobectomy with lymph node dissection 4-6 weeks after the last cycle; often minimally invasive or robotic.
Robotic & minimally invasive surgery
Source
4. Adjuvant therapy
weeks 16-172
No driver: adjuvant pembrolizumab for 13 cycles (39 weeks, KEYNOTE-671). EGFR-mutant: platinum chemotherapy (12 weeks) then osimertinib for 3 years (ADAURA). ALK-positive: alectinib for 2 years (ALINA).
PembrolizumabOsimertinibAlectinibSmall-molecule kinase inhibitors Immune checkpoint inhibitors
Source
5. Surveillance
from week 28, continues for years
CT every 6 months for 2-3 years, then a low-dose CT yearly; smoking cessation support.
CT (computed tomography)
Source

Non-small-cell lung cancer, resectable stage II-IIIA

Phase by phase

Sources

Non-small-cell lung cancer, resectable stage II-IIIA

Phase by phase

Sources