Real-World Adoption of Adjuvant Therapies for Resected Stage IB–III Non-Small-Cell Lung Cancer

Background: Recent clinical trials support adjuvant treatment with novel immunotherapy and targeted therapy agents for selected non-small-cell lung cancer (NSCLC) after resection. The “real-world” implementation of these treatments, however, remains unknown. This study evaluated trends in the uptake of adjuvant chemotherapy, immunotherapy, and targeted therapy for patients with resected NSCLC. Methods: Patients with resected stage IB-III NSCLC within the Veterans Health Administration (2017−2023) were included. Use of adjuvant chemotherapy, immunotherapy, and/or targeted therapy was evaluated over the study period. Factors associated with adjuvant therapy use were identified using multivariable-adjusted logistic regression. Results: Of the 1980 patients included, 846 (42.7%) underwent adjuvant therapy. There was a modest but not statistically significant increase in adjuvant therapy use from 37.1% in 2017 to 45.9% in 2023. Use of adjuvant chemotherapy alone declined from 36.6% to 23.5%, while use of adjuvant immunotherapy (0.5% to 21.2%) and targeted therapy (0% to 1.2%) increased. Factors associated with adjuvant therapy use included younger age, fewer comorbidities, and higher tumor stage. Conclusions: Despite the increased use of adjuvant immunotherapy and targeted therapy for resected stage IB-III NSCLC, overall adjuvant therapy uptake remains low. Further efforts will be necessary to better incorporate these novel treatments into routine clinical practice.