Bridging evidence and practice: international multidisciplinary consensus on non-metastatic NSCLC
- Author(s)
- Meyer, ML; Peters, S; Borghaei, H; Cascone, T; Dacic, S; Faivre-Finn, C; Leighl, N; Paz-Ares, L; Aerts, J; Aggarwal, C; Ahn, MJ; Arcila, ME; Ardizzoni, A; Arrieta, O; Awad, MM; Bar, J; Barlesi, F; Bazhenova, L; Besse, B; Chaft, J; Cho, BC; Curioni Fontecedro, A; DERuysscher D; Dingemans, AM; Dziadziuszko, R; Felip, E; Forde, P; Gandara, DR; Garassino, MC; Garcia Campelo, R; Garrido Lopez, P; Gautschi, O; Girard, N; Goto, Y; Gray, J; Hendriks, L; Hirsch, F; Hui, R; Janne, PA; Kerr, K; Khorshid, O; Pechoux, CLE; Leal, T; Lin, JJ; Linardou, H; Liu, S; Mahrous, M; Malapelle, U; Mercadante, E; Mitsudomi, T; Mok, T; Mountzios, G; Naidoo, J; Normanno, N; Novello, S; Oliveira, J; Pappagallo, G; Perrone, G; Pérol, M; Raez, LE; Ramella, S; Rami-Porta, R; Reckamp, K; Reguart Aransay, N; Remon Masip, J; Ricardi, U; Ricciuti, B; Rodriguez-Abreu, D; Rotow, JK; Santos, ES; Schalper, K; Senan, S; Seto, T; Skoulidis, F; Smit, EF; Soares, M; Solli, P; Solomon, B; Soo, RA; Stahel, R; Stiles, BM; VANSchil P; Veronesi, G; Wistuba,, II; Wolf, J; Wu, YL; Zer, A; Rolfo, C; Landi, L; Cappuzzo, F;
- Journal Title
- Journal of Thoracic Oncology
- Publication Type
- Online publication before print
- Abstract
- BACKGROUND: The management of non-metastatic non-small-cell lung cancer (NSCLC) has become increasingly complex with the integration of multimodality strategies and biomarker-driven approaches. Several clinically relevant areas remain insufficiently defined by current evidence and international guidelines. We conducted an international multidisciplinary consensus to address major areas of uncertainty in real-world practice. METHODS: A modified Delphi process was conducted during a 3-day in-person meeting in Barcelona, Spain (3-5 September 2025). Eighty-nine thoracic oncology experts independently rated predefined clinical statements developed by working groups and refined by a steering committee. Agreement was assessed using a 9-point Likert scale. Consensus was predefined as ≥75% of ratings in the 7-9 range; rejection as ≥75% in the 1-3 range. RESULTS: Ninety-six statements were evaluated. Consensus was achieved for 62 statements (64%), 31 (32%) remained without consensus, and 3 (3%) were rejected. Consensus supported routine FDG PET-CT for staging, histologic confirmation of suspicious mediastinal nodes, reflex PD-L1 testing and DNA-based next-generation sequencing at diagnosis, standardized post-neoadjuvant pathologic assessment, and sublobar resection with systematic nodal evaluation for selected peripheral node-negative tumors ≤2 cm. Consolidation durvalumab after definitive chemoradiotherapy was supported irrespective of PD-L1 expression in unresectable stage II-III disease. Persistent areas of controversy included brain MRI in stage I disease, mediastinal restaging after induction therapy, routine RNA-based testing, and the use of circulating tumor DNA/minimal residual disease to guide perioperative decisions. CONCLUSIONS: This international consensus provides structured expert guidance in areas of uncertainty in non-metastatic NSCLC and highlights priorities for future prospective research.
- Keywords
- Delphi methodology; Non-small-cell lung cancer; early-stage NSCLC; multidisciplinary consensus; perioperative immunotherapy
- Department(s)
- Medical Oncology
- Publisher's Version
- https://doi.org/10.1016/j.jtho.2026.104111
- Open Access at Publisher's Site
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Creation Date: 2026-08-11 05:52:48
Last Modified: 2026-09-14 12:01:08