Recent Advances in Combined Medical and Surgical Therapy for Resectable NSCLC.

Abstract

Non-small cell lung cancer (NSCLC) remains the leading cause of cancer related mortality. Historically, even among patients with resectable disease, most would not survive 5 years after curative intent surgery. However, outcomes continue to improve through parallel advances in surgery and systemic therapy, the latter aiming to eradicate micrometastatic disease that underpins NSCLC relapse. The advent of precision oncology has transformed the management of oncogene-addicted NSCLC, with tyrosine kinase inhibitors (TKIs) demonstrating significant survival improvements in advanced disease. These agents are now demonstrating their efficacy in molecularly defined subsets of resectable NSCLC-specifically EGFR and ALK mutant tumours-whereby adjuvant TKI therapy significantly reduces recurrence compared with historical platinum-based chemotherapy. In parallel, the immunotherapeutic era has ushered in a new paradigm of curative intent therapy, with immune checkpoint inhibitors (ICIs) improving pathological responses and survival in the perioperative setting. Together, these developments continue to redefine personalised, optimal treatment algorithms for resectable NSCLC. This review outlines the biological rationale and clinical evidence for utilising systemic therapy in the perioperative management of NSCLC. We discuss emerging strategies- such as biomarker-driven, risk-adapted and multimodal approaches- designed to further mitigate the risk of potentially fatal relapse whilst avoiding overtreatment for patients with resectable disease.Copyright © 2026 Asian Pacific Society of Respirology.