A Canadian Perspective on Perioperative Systemic Therapy in Resectable Non-Small Cell Lung Cancer
by
, ,
Saqib Raza Khan
1,2
,
Enxhi Kotrri
2,3,
Daniel Breadner
1,2,
Vijayananda Kundapur
4 and
Mita Manna
5,*
1
Division of Medical Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
2
Verspeeten Family Cancer Centre, London Health Sciences Centre, London, ON N6A 5W9, Canada
3
Division of Radiation Oncology, Department of Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
4
Department of Radiation Oncology, Saskatchewan Cancer Agency, University of Saskatchewan, 20 Campus Drive, Saskatoon, SK S7N 5A2, Canada
5
Department of Medical Oncology, Saskatchewan Cancer Agency, University of Saskatchewan, 20 Campus Drive, Saskatoon, SK S7N 5A2, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2026, 33(1), 20; https://doi.org/10.3390/curroncol33010020
Submission received: 6 November 2025
/
Revised: 22 December 2025
/
Accepted: 29 December 2025
/
Published: 30 December 2025
(This article belongs to the Special Issue Surgery in Locally Advanced Non-Small Cell Lung Cancer)
Simple Summary
Lung cancer is the leading cause of cancer death across the globe. The vast majority of cases are a type called non-small cell lung cancer, which includes common subtypes like adenocarcinoma and squamous cell carcinoma. Many patients remain at risk of cancer coming back even after being caught early and surgically removed. Previous studies have shown that adding chemotherapy after surgery helps patients live longer. Recently, major clinical trials have reported that treatments such as immunotherapy and targeted therapy before and/or after surgery (called perioperative therapy) can further improve patients’ chances of living longer without cancer coming back. This review summarizes recent clinical trial data and how they can be integrated into Canadian clinical practice.
Abstract
The management strategies in resectable non-small cell lung cancer (NSCLC) have changed over the last few years. Despite advancements in surgical techniques and conventional chemotherapy, patients with resectable NSCLC remained at high risk of future recurrence. Clinical trials have demonstrated improvements in response rates, pathological outcomes, and survival with the perioperative approach. Considering the findings of these landmark trials, there is a pressing need to contextualize and incorporate these global developments into the national practice framework. This review outlines key developments from recent clinical trials, with a focus on perioperative strategies in early-stage operable NSCLC from a Canadian perspective. We discuss the integration of checkpoint inhibitors in the perioperative setting for patients without actionable genomic alterations, adjuvant targeted therapies for EGFR and ALK mutant disease, and emerging tools such as ctDNA based minimal residual disease monitoring. The article also addresses the practical challenges of implementing these advances within the Canadian healthcare system, including systemic therapy approvals, barriers, and importance of multidisciplinary care to guide clinicians in optimizing patient outcomes.
