The Current Treatment Landscape in the UK for Stage III NSCLC

Overview

Journal Br J Cancer

Specialty Oncology

Date 2020 Dec 9

PMID 33293670

Citations 46

Authors

Matthew Evison

Affiliations

Soon will be listed here.

Abstract

For stage III non-small cell lung cancer (NSCLC), approximately a third of patients survive up to 5 years, with decreasing 5-year survival rates for stage IIIB and stage IIIC disease. Although curable, stage III NSCLC encompasses a diverse range of disease presentation, with an equally complex range of multi-modal treatment options, including systemic and local therapies for distant and local disease control, respectively. This complexity results in a number of challenges for the multi-disciplinary team (MDT) in achieving optimal treatment outcomes for patients. As multi-modality treatment is the preferred treatment strategy for all stage III disease, the focus of this article is the key surgical, chemotherapy and radiotherapy clinical trials as well as guidelines that currently outline radical therapy options for patients with both potentially resectable and unresectable stage III NSCLC.

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References

Horinouchi H . Role of multimodality therapy in cIIIA-N2 non-small cell lung cancer: perspective. Jpn J Clin Oncol. 2016; 46(12):1174-1178. PMC: 5144660. DOI: 10.1093/jjco/hyw131. View

Navani N, Fisher D, Tierney J, Stephens R, Burdett S . The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer: An Analysis Based on Individual Participant Data. Chest. 2018; 155(3):502-509. PMC: 6435782. DOI: 10.1016/j.chest.2018.10.020. View

Vallieres E, Shepherd F, Crowley J, Van Houtte P, Postmus P, Carney D . The IASLC Lung Cancer Staging Project: proposals regarding the relevance of TNM in the pathologic staging of small cell lung cancer in the forthcoming (seventh) edition of the TNM classification for lung cancer. J Thorac Oncol. 2009; 4(9):1049-59. DOI: 10.1097/JTO.0b013e3181b27799. View

Rusch V, Crowley J, Giroux D, Goldstraw P, Im J, Tsuboi M . The IASLC Lung Cancer Staging Project: proposals for the revision of the N descriptors in the forthcoming seventh edition of the TNM classification for lung cancer. J Thorac Oncol. 2007; 2(7):603-12. DOI: 10.1097/JTO.0b013e31807ec803. View

Felip E, Rosell R, Maestre J, Rodriguez-Paniagua J, Moran T, Astudillo J . Preoperative chemotherapy plus surgery versus surgery plus adjuvant chemotherapy versus surgery alone in early-stage non-small-cell lung cancer. J Clin Oncol. 2010; 28(19):3138-45. DOI: 10.1200/JCO.2009.27.6204. View

Albain K, Swann R, Rusch V, Turrisi 3rd A, Shepherd F, Smith C . Radiotherapy plus chemotherapy with or without surgical resection for stage III non-small-cell lung cancer: a phase III randomised controlled trial. Lancet. 2009; 374(9687):379-86. PMC: 4407808. DOI: 10.1016/S0140-6736(09)60737-6. View

Movsas B, Scott C, Sause W, Byhardt R, Komaki R, Cox J . The benefit of treatment intensification is age and histology-dependent in patients with locally advanced non-small cell lung cancer (NSCLC): a quality-adjusted survival analysis of radiation therapy oncology group (RTOG) chemoradiation studies. Int J Radiat Oncol Biol Phys. 1999; 45(5):1143-9. DOI: 10.1016/s0360-3016(99)00325-9. View

Antonia S, Villegas A, Daniel D, Vicente D, Murakami S, Hui R . Overall Survival with Durvalumab after Chemoradiotherapy in Stage III NSCLC. N Engl J Med. 2018; 379(24):2342-2350. DOI: 10.1056/NEJMoa1809697. View

Eberhardt W, Mitchell A, Crowley J, Kondo H, Kim Y, Turrisi 3rd A . The IASLC Lung Cancer Staging Project: Proposals for the Revision of the M Descriptors in the Forthcoming Eighth Edition of the TNM Classification of Lung Cancer. J Thorac Oncol. 2015; 10(11):1515-22. DOI: 10.1097/JTO.0000000000000673. View

10.

Urvay S, Yucel B, Erdis E, Turan N . Prognostic Factors in Stage III Non-Small-Cell Lung Cancer Patients. Asian Pac J Cancer Prev. 2016; 17(10):4693-4697. PMC: 5454619. DOI: 10.22034/apjcp.2016.17.10.4693. View

11.

Ramnath N, Dilling T, Harris L, Kim A, Michaud G, Balekian A . Treatment of stage III non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013; 143(5 Suppl):e314S-e340S. DOI: 10.1378/chest.12-2360. View

12.

Eberhardt W, De Ruysscher D, Weder W, Le Pechoux C, De Leyn P, Hoffmann H . 2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer. Ann Oncol. 2015; 26(8):1573-88. DOI: 10.1093/annonc/mdv187. View

13.

Rami-Porta R, Bolejack V, Crowley J, Ball D, Kim J, Lyons G . The IASLC Lung Cancer Staging Project: Proposals for the Revisions of the T Descriptors in the Forthcoming Eighth Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2015; 10(7):990-1003. DOI: 10.1097/JTO.0000000000000559. View

14.

Asamura H, Chansky K, Crowley J, Goldstraw P, Rusch V, Vansteenkiste J . The International Association for the Study of Lung Cancer Lung Cancer Staging Project: Proposals for the Revision of the N Descriptors in the Forthcoming 8th Edition of the TNM Classification for Lung Cancer. J Thorac Oncol. 2015; 10(12):1675-84. DOI: 10.1097/JTO.0000000000000678. View

15.

Antonia S, Villegas A, Daniel D, Vicente D, Murakami S, Hui R . Durvalumab after Chemoradiotherapy in Stage III Non-Small-Cell Lung Cancer. N Engl J Med. 2017; 377(20):1919-1929. DOI: 10.1056/NEJMoa1709937. View

16.

Lim E, Baldwin D, Beckles M, Duffy J, Entwisle J, Faivre-Finn C . Guidelines on the radical management of patients with lung cancer. Thorax. 2010; 65 Suppl 3:iii1-27. DOI: 10.1136/thx.2010.145938. View

17.

Liang J, Bi N, Wu S, Chen M, Lv C, Zhao L . Etoposide and cisplatin versus paclitaxel and carboplatin with concurrent thoracic radiotherapy in unresectable stage III non-small cell lung cancer: a multicenter randomized phase III trial. Ann Oncol. 2017; 28(4):777-783. DOI: 10.1093/annonc/mdx009. View

18.

Pless M, Stupp R, Ris H, Stahel R, Weder W, Thierstein S . Induction chemoradiation in stage IIIA/N2 non-small-cell lung cancer: a phase 3 randomised trial. Lancet. 2015; 386(9998):1049-56. DOI: 10.1016/S0140-6736(15)60294-X. View

19.

Bryan D, Donington J . The Role of Surgery in Management of Locally Advanced Non-Small Cell Lung Cancer. Curr Treat Options Oncol. 2019; 20(4):27. DOI: 10.1007/s11864-019-0624-7. View

20.

Eberhardt W, Pottgen C, Gauler T, Friedel G, Veit S, Heinrich V . Phase III Study of Surgery Versus Definitive Concurrent Chemoradiotherapy Boost in Patients With Resectable Stage IIIA(N2) and Selected IIIB Non-Small-Cell Lung Cancer After Induction Chemotherapy and Concurrent Chemoradiotherapy (ESPATUE). J Clin Oncol. 2015; 33(35):4194-201. DOI: 10.1200/JCO.2015.62.6812. View