Perioperative Treatment Strategies for Lung Cancer in 2025: A Paradigm Shift

Authors

  • Ramy Samaha, MD Centre Hospitalier de l’Université de Montréal, Montreal, QC
  • Jonathan Spicer, MD Centre Hospitalier de l’Université de Montréal, Montreal, QC
  • Normand Blais, MD Co‐Founder, Groupe d’Études en Oncologie du Québec Chair, Thoracic Oncology Program, CHUM Cancer Center

DOI:

https://doi.org/10.58931/cot.2025.2236

Abstract

Perioperative management of resectable non-small cell lung cancer (NSCLC) has evolved significantly with the integration of immune checkpoint inhibitors and targeted therapies. This review synthesizes current evidence from key clinical trials, highlighting the improved survival outcomes achieved with neoadjuvant and perioperative chemoimmunotherapy in oncogene-wildtype NSCLC, as well as adjuvant tyrosine kinase inhibitors (TKIs) in epidermal growth factor receptor (EGFR)‑ and anaplastic lymphoma kinase (ALK)-altered tumours. While neoadjuvant immunotherapy has demonstrated high pathological response rates and long-term survival benefits, perioperative strategies may offer added value in selected subgroups. The ADAURA and ALINA trials have established adjuvant osimertinib and alectinib as new standards of care in oncogene-driven disease. Unresolved questions remain regarding optimal treatment sequencing, duration, and patient selection. Emerging tools such as circulating tumour DNA and artificial intelligence hold promise for refining risk stratification and guiding individualized treatment approaches.

Author Biographies

Ramy Samaha, MD, Centre Hospitalier de l’Université de Montréal, Montreal, QC

Dr. Ramy Samaha is a fellow in thoracic oncology at the Centre Hospitalier de l’Université de Montréal. He completed his medical degree in Beirut, Lebanon, where he began his training in hematology-oncology. He went on to complete his specialization with two years at Gustave Roussy in Villejuif, France. His clinical and research interests focus on thoracic malignancies, with a particular emphasis on optimizing treatment strategies in advanced non-small cell lung cancer.

Jonathan Spicer, MD, Centre Hospitalier de l’Université de Montréal, Montreal, QC

Dr. Spicer was born and raised in Montreal and completed his Bachelor degree in Science at McGill University. He continued his medical training at McGill where he earned his MD, after which he moved to Vancouver and completed his surgical internship at the University of British Columbia. He returned to McGill the following year and completed his general surgical training during which he participated in the Surgeon Scientist and Clinical Investigator programs as an FRSQ funded student and earned a PhD in Experimental Surgery. Dr. Spicer completed his training in Cardiothoracic Surgery at the world’s largest cancer center – University of Texas, MD Anderson Cancer Center in Houston. His clinical interests focus on minimally invasive approaches to lung cancer as well as complex resections for advanced thoracic malignancies. He has paired his clinical focus with a comprehensive research program in cancer metastasis. His laboratory studies the link between inflammation and metastasis with a particular focus on neutrophil and circulating tumor cell interactions.

Normand Blais, MD, Co‐Founder, Groupe d’Études en Oncologie du Québec Chair, Thoracic Oncology Program, CHUM Cancer Center

A medical graduate of the University of Sherbrooke, Dr. Blais completed his residency at the University of Sherbrooke and the University of Montreal in internal medicine, hematology and medical oncology, followed by a sabbatical year of study at McMaster University. Dr. Blais's primary interest is lung cancer, particularly clinical and correlative studies related to this type of cancer. He also has expertise in clinical research on lung and bladder cancer. His clinical and research work focuses on cancer‑associated thrombosis. 

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Published

2025-08-14

How to Cite

Samaha, R., Spicer, J., & Blais, N. (2025). Perioperative Treatment Strategies for Lung Cancer in 2025: A Paradigm Shift. Canadian Oncology Today, 2(2), 20–26. https://doi.org/10.58931/cot.2025.2236

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Volume 2, Issue 2, Summer 2025

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