Consensus recommendations on surveillance and survivorship for patients with unresectable/stage IV non-small cell lung cancer after completing Immunotherapy: a Delphi study by Canadian experts.

BACKGROUND

With the advent of immunotherapy, a subset of patients with unresectable or stage IV non-small cell lung cancer (NSCLC) achieve durable responses after completing standard treatment durations (typically 2 years). However, guidelines for post-treatment surveillance and survivorship care in this population remain limited, particularly in the Canadian context.

METHODS

A panel of 10 Canadian lung cancer experts, including medical oncologists, radiation oncologists, and primary care providers, participated in a modified Delphi process to develop consensus recommendations. The process involved initial discussion of key questions, anonymous voting, and iterative refinement until ≥ 70% agreement was reached.

RESULTS

Consensus was achieved on four key areas: (1) natural history post-immunotherapy, with experts noting durable responses in 20-25% of patients but risks of late progression; (2) surveillance, recommending contrast-enhanced CT chest/abdomen (± pelvis if clinically indicated) every 3-6 months for 2 years, then every 6-12 months for 3 years, then as clinically needed, with additional considerations for brain MRI in patients with prior brain metastases; (3) discharge considerations, emphasizing patient readiness, fear of progression, and multidisciplinary support; (4) survivorship, focusing on monitoring immune-related adverse events (irAEs), lifestyle interventions, and psychosocial support.

CONCLUSIONS

These recommendations provide a framework for managing long-term survivors of advanced NSCLC post-immunotherapy, bridging gaps in existing guidelines.