Approximately one third of patients with non–small cell lung cancer (NSCLC) initially present with stage III disease. Major treatment advances in unresectable stage III NSCLC have emerged in recent years, but finding the optimal treatment approach can be complex. In this Roundtable, Dr Jyoti Patel is joined by Drs Greg Durm and Mohamed Abazeed for a discussion on optimal treatment approaches to improve outcomes in stage III unresectable NSCLC.
The panelists open by discussing the factors contributing to the treatment strategy for unresectable stage III NSCLC, including appropriate evaluation to determine fitness level and thorough staging. They underscore that accurate mediastinal staging not only establishes extent of disease but also guides radiation treatment fields.
The physicians then reflect that gains resulting from standard chemoradiation of stage III disease have been improved with the addition of consolidation immunotherapy. They discuss the practice-changing results of the PACIFIC trial, which showed that consolidation immunotherapy improves overall survival in patients who have been treated with chemoradiation, regardless of histology. They also debate ways in which toxicity from radiation can be minimized.
Next, the experts share insights on optimal approaches to genetic testing and the importance of obtaining PD-L1 status.
Dr Patel concludes by discussing the importance of multidisciplinary teams in the management of locally advanced NSCLC and who should be involved.
Jyoti D. Patel, MD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: AbbVie; Astra Zeneca; Bristol Myers Squibb
Mohamed Abazeed, MD, PhD, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant, or trustee for: Advisor: Mirati Therapeutics, Inc
Serve(d) as a speaker or a member of a speakers bureau for: American Society for Clinical Pathology (educational material)
Received research grant from: National Institutes of Health
Received income in an amount equal to or greater than $250 from: American Society for Clinical Pathology; Mirati Therapeutics, Inc
Invention: Decision support system for personalizing radiotherapy
Greg Durm, MD, has disclosed the following relevant financial relationships:
Serve(d) as a speaker or a member of a speakers bureau for: AstraZeneca; Curio Science
Received research grant from: Merck; AstraZeneca; Bristol Myers Squibb