National Delphi consensus on perioperative and locally advanced NSCLC management in Colombia

OBJECTIVES: To develop Colombian, evidence-informed consensus recommendations for perioperative systemic therapy and unresectable stage III non-small cell lung cancer (NSCLC), considering local testing and access constraints. METHODS: Three Colombian professional societies conducted a modified Delphi process. A multidisciplinary panel completed two anonymous rating rounds in September 2024 and a structured debate. A systematic literature search (2010-2024) informed 34 draft statements spanning diagnostic workup, neoadjuvant and adjuvant therapy, and unresectable stage III management. RESULTS: Consensus was reached for 33/34 statements (97.1%). The panel endorsed multidisciplinary tumor board review and pretreatment molecular profiling. For resectable stage II-III disease without sensitizing EGFR/ALK alterations, neoadjuvant chemo-immunotherapy was preferred. For unresectable stage III, chemoradiotherapy followed by durvalumab consolidation was endorsed for PD-L1-positive tumors; use in PD-L1 tumor proportion score < 1% should be individualized. In EGFR-mutated unresectable stage III disease, durvalumab was not endorsed; osimertinib consolidation was favored. The only non-consensus item was adjuvant atezolizumab for PD-L1 ≥1% after platinum chemotherapy in EGFR/ALK-negative stage II-IIIA disease (AJCC 7th), lacking INVIMA approval at the time. CONCLUSION: This Delphi consensus provides a practical national framework for perioperative and unresectable stage III NSCLC management in Colombia.