Figures
- FIGURE 1
Proposal for further strategies in clinical trials and registries about the management of locally advanced nonsmall cell lung cancer (NSCLC). FDG: fluorodeoxyglucose; PET: positron emission tomography; CT: computed tomography; PS: performance status; PFS: progression-free survival.
Tables
- TABLE 1
5-year survival rates in stage III depending on sub-stage and specific staging methods
TNM 8 Clinical stage % Pathological stage % IIIA 36 41 IIIB 26 24 IIIC 13 12 Data from [1].
- TABLE 2
Considerations in the multidisciplinary decision about locally definitive treatment
Surgery Radiotherapy Combined Adequate functional status Multilevel or bulky N2 Local tumour control is very important Bulky, necrotic tumours with possible complications (Small) tumours with multiple mediastinal lymph node involvement Locally invasive tumours with slim possible resection margins (e.g. superior sulcus tumours) Multiple nodules in the same lobe Reasonable dose affections of lung and heart No pneumonectomy necessary PD-L1 inhibition possible PD-L1: programmed death ligand 1.
- TABLE 3
Current clinical trials on immunotherapy in the setting of surgery in early and locally advanced nonsmall cell lung cancer (NSCLC)
ClinicalTrials.gov ID Phase NSCLC stage IO-drug Protocol Primary
end-pointInduction therapy NCT03694236 I/II II/IIIA Durvalumab Chemoradiotherapy+durvalumab induction→surgery pCR NCT03237377 II III Durvalumab/
tremelimumabRadiotherapy+durvalumab ± tremelimumab→surgery pCR NCT03197467 II II/IIIA Pembrolizumab Pembrolizumab induction→surgery Safety NCT02994576 II IB–IIIA Atezolizumab Atezolizumab induction→surgery Safety NCT03732664 I IA–IIIA Nivolumab Nivolumab induction→surgery Safety NCT04205552 II IB–IIIA Nivolumab/
relatlimabNivolumab ± relatlimab induction→surgery Feasibility NCT02259621 II IB–IIIA Nivolumab/
ipilimumabNivolumab ± ipilimumab induction→surgery Safety NCT04348292 I I–IIIA Durvalumab/
sirolimusDurvalumab+sirolimus induction→surgery Safety Combined induction and adjuvant therapy NCT03871153 II Resectable III Durvalumab Chemoradiotherapy+durvalumab induction→surgery→durvalumab consolidation pCR NCT04062708 II III Durvalumab Chemotherapy+durvalumab induction→surgery→radiotherapy→durvalumab consolidation pCR NCT03871153 II Resectable III Durvalumab Chemotherapy+durvalumab induction→radiotherapy+durvalumab→surgery→
durvalumab consolidationpCR NCT04202809 II IIIA–B Durvalumab Chemotherapy induction→chemoradiotherapy ± durvalumab→surgery if resectable PFS NCT02818920 II IB–IIIA Pembrolizumab Pembrolizumab induction→surgery→pembrolizumab consolidation Surgical feasibility rate NCT03838159 II IIIA Nivolumab Arm 1: chemotherapy+nivolumab induction→surgery→nivolumab consolidation
Arm 2: chemotherapy induction→surgerypCR NCT02572843 II IIIA Durvalumab Chemotherapy+durvalumab induction→surgery→durvalumab consolidation DFS NCT04025879# III II–IIIB Nivolumab Chemotherapy ± nivolumab→surgery→nivolumab consolidation or observation DFS Adjuvant therapy NCT02595944# III IB–IIIA Nivolumab Surgery→chemotherapy→nivolumab consolidation or observation DFS, OS Data obtained from www.clinicaltrials.gov on 7 August 2020. IO: immune-oncology; pCR: pathological complete response; PFS: progression-free survival; DFS: disease-free survival; OS: overall survival. #: phase III trials.
- TABLE 4
Current clinical trials on immunotherapy and chemoradiotherapy in mostly stage II and III nonsmall stage lung cancer (NSCLC)
ClinicalTrials.gov ID Phase NSCLC stage IO-drug Protocol Primary end-point Concurrent (+consolidation) regimen NCT04202809 II IIIA–B Durvalumab Chemotherapy induction→chemoradiotherapy ± durvalumab→surgery if resectable PFS NCT03694236 I/II II/IIIA Durvalumab Chemoradiotherapy+durvalumab→surgery pCR NCT02343952 II IIIA–B Pembrolizumab Chemoradiotherapy→pembrolizumab consolidation PFS NCT02987998 I III Pembrolizumab Chemoradiotherapy+pembrolizumab Safety NCT03519971# III Unresectable Durvalumab Chemoradiotherapy ± durvalumab PFS NCT04013542 I II–III Nivolumab/
ipilimumabRadiotherapy+nivolumab/ipilimumab Safety NCT03523702 II II–III Pembrolizumab Arm 1 (PD-L1 >50%): radiotherapy+pembrolizumab
Arm 2 (PD-L1 1–49%): chemoradiotherapyPFS NCT03631784 II III unresectable Pembrolizumab Chemoradiotherapy+pembrolizumab→
pembrolizumab consolidationSafety, ORR NCT03644823 II III–IV Atezolizumab Radiotherapy+atezolizumab Safety Combination regimen NCT04085250 II III Nivolumab Chemotherapy ± nivolumab induction→ chemoradiotherapy→nivolumab consolidation or observation PFS NCT03589547 II III Durvalumab Durvalumab→chemoradiotherapy→durvalumab Safety, PFS NCT04380636# III III Pembrolizumab Arm 1: chemoradiotherapy+pembrolizumab→
pembrolizumab+placebo
Arm 2: chemoradiotherapy+pembrolizumab→
pembrolizumab+olaparib
Arm 3: chemoradiotherapy→durvalumabPFS, OS NCT03871153 II Resectable III Durvalumab Chemoradiotherapy+durvalumab induction→surgery→durvalumab consolidation pCR NCT03693300 II III Durvalumab Chemoradiotherapy→durvalumab (fixed dose) Safety NCT03285321 II IIIA–B Nivolumab/
ipilimumabChemoradiotherapy→nivolumab ± ipilimumab consolidation PFS NCT04026412# III IIIA–C Nivolumab/
ipilimumabArm 1: chemoradiotherapy+nivolumab→
nivolumab/ipilimumab consolidation
Arm 2: chemoradiotherapy+nivolumab→
nivolumab consolidation
Arm 3: chemoradiotherapy→durvalumab consolidationPFS, OS NCT04062708 II III resectable Durvalumab Chemotherapy+durvalumab induction→ surgery→radiotherapy→durvalumab consolidation pCR NCT03237377 II III resectable Durvalumab/
tremelimumabRadiotherapy+durvalumab ± tremelimumab→surgery pCR NCT03871153 II III resectable Durvalumab Chemotherapy+durvalumab induction→radiotherapy+durvalumab→surgery→durvalumab consolidation pCR NCT03663166 I/II III Nivolumab/
ipilimumabChemoradiotherapy+ipilimumab→nivolumab consolidation Safety, PFS Induction regimen NCT04287894 Ib III Durvalumab/
tremelimumabDurvalumab+tremelimumab induction→chemoradiotherapy Safety NCT03102242 II IIIA–B Atezolizumab Atezolizumab induction→chemoradiotherapy DCR Data obtained from www.clinicaltrials.gov on 7 August 2020. IO: immune-oncology; pCR: pathological complete response; PFS: progression-free survival; OS: overall survival: PD-L1: programmed death ligand 1; ORR: overall response rate; DCR: disease control rate. #: phase III trials.
Vol 30 Issue 160
Table of Contents
New developments in locally advanced nonsmall cell lung cancer
Jump To
- Article
- Abstract
- Abstract
- Introduction
- Evaluation by imaging, function and metabolism in locally advanced NSCLC
- Targeted therapy in locally advanced NSCLC
- Addition of immunotherapy in the setting of surgery
- Adjuvant radiotherapy
- Integration of immunotherapy in radiochemotherapy in locally advanced NSCLC
- Footnotes
- References
- Figures & Data
- Info & Metrics