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NSCLC — SCE Medical Oncology MCQ

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HardLung CancerNSCLCSCE Medical Oncology

A lung MDT judges a cT3N2M0 non-small-cell lung cancer resectable. The tumour has no EGFR mutation or ALK rearrangement, and the patient is fit for platinum chemotherapy. Which current NICE option includes treatment on both sides of surgery?

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Correct answer: C — Nivolumab with platinum chemotherapy before surgery, then nivolumab after resection

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as D · D = shown as E

B is correct. NICE TA1127 allows neoadjuvant nivolumab with platinum-based chemotherapy followed by adjuvant nivolumab for resectable NSCLC at high recurrence risk, defined as tumour at least 4 cm or node positive, when EGFR mutation and ALK rearrangement are absent. Neoadjuvant chemotherapy alone omits the adjuvant and immunotherapy components of this option. Nivolumab monotherapy before surgery is not the regimen, chemoradiotherapy is not automatically inserted into the perioperative schedule, and adjuvant-only nivolumab-chemotherapy reverses the tested sequence. Resectability of N2 disease still requires a specialist thoracic MDT rather than stage label alone.

Reference: NICE TA1127 perioperative nivolumab recommendations: https://www.nice.org.uk/guidance/ta1127/chapter/1-Recommendations