Major breakthroughs in lung cancer adjuvant treatment: Looking beyond the horizon

•The ADAURA study marked the advent of precision medicine and molecular biomarker testing to the early stages disease.•The IMPower-010 trial paved the way to the application of immune-checkpoint inhibition in the post-operative setting.•The ITACA trial definitively established no role for tailored adjuvant chemotherapy in surgically resected NSCLC.•The Lung Art data questioned the efficacy of post-operative radiotherapy for pN2 resected disease.•Growing evidence is supporting MRD as reliable prognostic biomarker in the adjuvant setting. We are witnessing a silent revolution in the treatment of early stage non-small cell lung cancer (NSCLC), with a series of practice-changing clinical trials enriching the therapeutic perspectives of lung cancer patients with potentially curable disease. The ADAURA study marked the advent of precision medicine and biomarker testing to the early stages setting. The IMPower-010 trial interrupted the negative trend of adjuvant lung cancer immunotherapy, paving the way to the application of immune-checkpoint inhibition in the resected disease. The ITACA trial definitively established no role for tailored adjuvant chemotherapy in NSCLC, while the Lung Art data questioned the efficacy of post-operative radiotherapy for pN2 resected disease. Growing evidence is supporting MRD as effective adjuvant prognostic biomarker to stratify disease’s recurrence risk after radical interventions and select best candidates to the adjuvant strategies. This work summarizes the recent major breakthroughs in lung cancer adjuvant treatment, and provides a snapshot of the current real-world scenario, discussing the upcoming challenges and opportunities featuring the clinical management of early stage NSCLC patients.