Expert Consensus Recommendations on NSCLC Management: Evidence-Based Strategies for Early Resectable and Locally Advanced Disease from Asia

Abstract: Lung cancer remains the most common malignancy in Asia and is characterised by a substantial proportion of cases occurring in never-smokers, a feature that distinguishes the region from many Western populations. Only 20– 25% of patients with newly diagnosed non‑small cell lung cancer (NSCLC) present with resectable disease. As precision oncology expands into earlier stages, understanding how global standards can be adapted to Asian healthcare systems is increasingly important. This expert consensus report summarises evidence-informed opinions and voting outcomes from 13 lung cancer specialists across 11 countries to identify regional priorities, practical implementation needs, and management strategies for early and locally advanced NSCLC. Experts supported annual low‑dose CT (LDCT) screening for high‑risk individuals, with adaptation of criteria to better capture Asia’s substantial burden of never‑smokers and individuals with strong family history. Early diagnostic pathways emphasised rapid tissue acquisition and timely biomarker testing specifically EGFR, ALK, and PD‑L1 at initial diagnosis for both resectable and unresectable disease. Across resectable stage II–III disease, evidence from multiple Phase III trials consistently demonstrates that integrating immunotherapy with neoadjuvant or perioperative chemotherapy improves pathological response and event‑free survival, while maintaining surgical feasibility. Differences between regimens relate largely to timing, agent selection, and biomarker effects, and practical adoption in Asia varies according to diagnostic capacity and local resource availability. For unresectable stage III NSCLC, concurrent chemoradiotherapy followed by consolidation durvalumab remains standard, while recent data from the LAURA trial support consolidation osimertinib after CRT for EGFR-mutated disease, with a marked progression-free survival benefit (HR 0.16). Shared regional gaps include limited screening uptake, variable reimbursement for molecular testing and targeted therapies, and uneven access to multidisciplinary care. Collectively, the available evidence suggests that earlier biomarker testing, structured nodule management pathways, and broader access to perioperative and consolidation therapies can meaningfully improve outcomes in Asian populations. Strengthening MDT integration and harmonising diagnostic and therapeutic workflows across settings remain essential next steps. Keywords: resectable NSCLC, EGFRm, SBRT