Asian Expert Consensus on Early and Locally Advanced NSCLC Management

An expert consensus statement by 13 lung cancer specialists across 11 Asian countries outlines regional management strategies for early resectable and locally advanced non-small cell lung cancer (NSCLC). Lung cancer remains the most common malignancy in Asia, where a substantial proportion of cases occur in never-smokers and only 20% to 25% of newly diagnosed patients present with resectable disease.

The consensus panel supports annual low-dose computed tomography (LDCT) screening for high-risk individuals, with adjusted criteria to account for Asia's burden among never-smokers and persons with a family history of lung cancer. Diagnostic recommendations emphasize rapid tissue acquisition and early biomarker testing—specifically for EGFR, ALK, and PD-L1—at initial diagnosis across both resectable and unresectable settings.

For resectable stage II–III NSCLC, evidence from multiple Phase III trials demonstrates that combining immunotherapy with neoadjuvant or perioperative chemotherapy enhances pathological response and event-free survival while preserving surgical feasibility. For unresectable stage III NSCLC, concurrent chemoradiotherapy followed by consolidation durvalumab persists as standard care, with recent LAURA trial data supporting consolidation osimertinib for EGFR-mutated disease following chemoradiotherapy based on a reported progression-free survival benefit (HR 0.16). Key regional implementation hurdles identified include low screening uptake, disparities in molecular testing and targeted therapy reimbursement, and variable multidisciplinary team access.