Adjuvant Systemic Therapy and Adjuvant Radiation Therapy for Stage I to IIIA Completely Resected Non–Small-Cell Lung Cancers

Stage IA: Adjuvant chemotherapy is NOT recommended. (EB/PC, H, M, S)

Stage IB (3< T ≤ 4 cm, N0M0). Adjuvant osimertinib is recommended for patients with sensitizing epidermal growth factor receptor (EGFR) (Ex19del or L858R) mutations. (EB, B, H, S)

Adjuvant cisplatin-based chemotherapy and/or atezolizumab are NOT recommended for routine use in this patient group. A postoperative multimodality evaluation, including a consultation with a medical oncologist, is recommended to assess benefits and risks of adjuvant therapies for each patient. Factors to consider other than tumor stage when making a recommendation for adjuvant therapy are outlined after the adjuvant systemic therapy section of the 2017 guideline. (EB/PC, B, I, M)

Stages IIA, IIB, and IIIA. Adjuvant cisplatin-based chemotherapy is recommended for all patients. Adjuvant osimertinib is recommended after chemotherapy for patients with tumors with sensitizing EGFR mutations, regardless of PD-L1 status. Adjuvant atezolizumab is recommended for all patients with PD-L1 ≥1% after cisplatin-based chemotherapy except for patients with sensitizing EGFR mutations. (EB/PC, B, H, S)