Integrating Durvalumab and Atezolizumab Into Neoadjuvant and Adjuvant Sequencing Strategies for Resectable NSCLC

This episode, titled Integrating Durvalumab and Atezolizumab Into Neoadjuvant and Adjuvant Sequencing Strategies for Resectable NSCLC, features panelist discussing the following critical questions:

Durvalumab and atezolizumab are also approved in resectable NSCLC with slightly different indications. What did the safety and efficacy agents reveal with each of these?

As highlighted, there are several FDA-approved therapies for resectable NSCLC. How are you sequencing the approved immunotherapies in the neoadjuvant and adjuvant settings?

Led by the moderator Dr. Dietrich, Dr. Niu and Dr. Nadler examined both durvalumab and atezolizumab, which have demonstrated efficacy in resectable NSCLC but in distinct clinical contexts. Atezolizumab is approved in the adjuvant setting for patients with resected stage II–IIIA disease and PD-L1–positive tumors following platinum-based chemotherapy, based on improved disease-free survival and a manageable safety profile without new immune-related signals. Durvalumab has shown benefit in the perioperative setting when combined with neoadjuvant chemotherapy and continued as adjuvant therapy, improving event-free survival and pathologic response rates while maintaining surgical feasibility and tolerability consistent with prior experience. These data highlight differences in patient selection, particularly the PD-L1 requirement for adjuvant atezolizumab versus the broader perioperative population eligible for durvalumab-based strategies.

In practice, sequencing decisions are driven by stage, biomarker status, resectability, and whether a perioperative or adjuvant-only approach is planned. For patients who are candidates for neoadjuvant therapy, chemoimmunotherapy followed by surgery and completion of adjuvant immunotherapy is increasingly favored to maximize pathologic response and reduce recurrence risk. In contrast, patients who proceed directly to surgery—often due to low disease burden or logistical considerations—may receive adjuvant immunotherapy if they meet biomarker and staging criteria. Molecular testing remains essential to avoid immunotherapy in patients with targetable driver mutations who are better served by adjuvant targeted therapy. Multidisciplinary coordination among surgery, medical oncology, and pathology is critical to optimize timing and selection of these agents across the perioperative continuum.

Throughout the conversation, the experts provide a comprehensive reflection on the field and the factors that may shape how clinicians approach care moving forward.

In the next episode, Patient Selection and Immune-Related Toxicity Monitoring for Adjuvant Immunotherapy in Resectable NSCLC, panelists will continue their discussion on adjuvant therapy and adverse events.