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NSCLC Adjuvant — SCE Medical Oncology MCQ

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ModerateLung CancerNSCLC AdjuvantSCE Medical Oncology

A 60-year-old man with stage IIB NSCLC (pT3 N0 M0, 6 cm tumour) undergoes lobectomy with complete resection. EGFR/ALK wild-type. PD-L1 TPS 30%. What adjuvant therapy is recommended?

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Correct answer: A — Cisplatin-based adjuvant chemotherapy (4 cycles)

For completely resected stage IB (≥4 cm) to IIIA NSCLC, adjuvant cisplatin-based chemotherapy for 4 cycles is the standard based on the LACE meta-analysis showing approximately 5% absolute OS benefit at 5 years. Adjuvant atezolizumab (IMpower010) is an option for PD-L1 TC ≥50% after chemotherapy. Adjuvant osimertinib is only for EGFR-mutant disease. PD-L1 30% does not meet the ≥50% threshold for adjuvant atezolizumab.

Reference: NICE NG122; LACE meta-analysis Pignon et al JCO 2008; ESMO 2024 Early NSCLC Guidelines