Early-stage non-small-cell lung cancer: emerging treatments and evolving challenges

The treatment of early-stage non-small-cell lung cancer (NSCLC) has evolved substantially in recent years. For decades, curative-intent surgery followed by platinum-based chemotherapy remained the standard of care (SOC), despite delivering only modest gains in long-term survival. Current evidence from randomised trials incorporating immunotherapy as a neoadjuvant or perioperative approach, along with targeted therapies, have defined a new SOC treatment approach for patients with resectable early-stage NSCLC. However, these advances have introduced uncertainties regarding optimal sequencing, treatment duration, patient selection, and the role of treatment escalation or de-intensification with immunotherapy and targeted therapies. The advances and uncertainties are discussed in this Series paper, along with the role of radiotherapy in this setting.