A narrative review of toxicity of chemoradiation and immunotherapy for unresectable, locally advanced non-small cell lung cancer

Prasad, Rahul N.; Williams, Terence M.

doi:10.21037/tlcr-20-638

Cited by 7 publications

(4 citation statements)

References 41 publications

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“…It is known that adverse events of ICI may quell the enthusiasm for using these therapies in settings where patients have already experienced toxicity from CRT [ 38 ]. One concern about initiating an anti-PD-1/PD-L1 monoclonal antibody shortly after a definitive dose of radiation is the theoretical combined risk of pneumonitis.…”

Section: Discussionmentioning

confidence: 99%

Real-World Journey of Unresectable Stage III NSCLC Patients: Current Dilemmas for Disease Staging and Treatment

Agbarya

Shalata

Addeo

et al. 2022

JCM

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Daily-practice challenges in oncology have been intensified by the approval of immune checkpoint inhibitors (ICI). We aimed to outline current therapy policies and management of locally advanced unresectable stage III non-small-cell lung cancer (NSCLC) in different countries. One thoracic oncologist from each of the following countries—Belgium, Croatia, Greece, Israel, the Netherlands, Norway, Poland, Portugal, Romania, Slovenia, and Switzerland—participated in an electronic survey. Descriptive statistics were conducted with categorical variables reported as frequencies and continuous variables as median and interquartile range (IQR) (StataSE-v15). EBUS (endobronchial ultrasound bronchoscopy) was used either upfront or for N2 confirmation. Resectability is still a source of disagreement; thus, decisions vary within each multidisciplinary team. Overall, 66% of stage III patients [IQR 60–75] undergo chemoradiation therapy (CRT); concurrent CRT (cCRT) accounts for most cases (~70%). Performance status is universally used for cCRT eligibility. Induction chemotherapy is fairly weighted based on radiotherapy (RT) availability. Mean time to evaluation after RT completion is less than a month; ICI consolidation is started within six weeks. Durvamulab expenditures are reimbursed in all countries, yet some limiting criteria exist (PD-L1 ≥ 1%, cCRT). No clear guidance on therapies at Durvamulab progression exist; experts agree that it depends on progression timing. Given the high heterogeneity in real-world practices, standardized evidence-based decisions and healthcare provision in NSCLC are needed.

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Section: Discussionmentioning

confidence: 99%

Real-World Journey of Unresectable Stage III NSCLC Patients: Current Dilemmas for Disease Staging and Treatment

Agbarya

Shalata

Addeo

et al. 2022

JCM

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“…Regarding the combination treatment strategies based on concurrent chemoradiotherapy, toxicity has been a main concern, especially in the real-world setting ( 17 ). As shown in this study, AE was the main reason for treatment discontinuation in the strategy of induction chemotherapy and concurrent chemoradiotherapy (10% of total patients, 33.9% of all patients who discontinued the treatment).…”

Section: Discussionmentioning

confidence: 99%

Characteristics of toxicity occurrence patterns in concurrent chemoradiotherapy after induction chemotherapy for patients with locally advanced non-small cell lung cancer: a pooled analysis based on individual patient data of CALGB/Alliance trials

Yang¹,

He²,

Zhang³

et al. 2022

Transl Cancer Res TCR

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Background: For patients with locally advanced non-small-cell lung cancer (NSCLC), concurrent chemoradiotherapy is the foundational treatment strategy. Adding induction chemotherapy did not achieve a superior efficacy but increased the burden from toxicity. Accordingly, we retrospectively investigated the toxicity patterns through pooling individual patient data of the Cancer and Leukemia Group B (CALGB)/ Alliance trials.Methods: We included a total of 637 patients with unresectable stage III NSCLC who received induction chemotherapy with a platinum doublet and concurrent chemoradiotherapy and experienced at least one adverse event (AE) in CALGB 9130, 9431, 9534, 30105, 30106 and 39801 trials. The following toxicity occurrence patterns were evaluated: top 10 most frequent AEs, AE distribution by grade, rate of treatment discontinuation due to AEs, associations of AE occurrence with patient characteristics and treatment phase, the time to the first grade ≥3 AE occurrence and its associations with patient characteristics and treatment phase.Results: The occurrence of AEs was the main reason accounting for treatment discontinuation (60 of 637 among all patients; 18 of 112 patients who experienced the induction phase only; 42 of 525 patients who experienced both phases). All patients experienced a total of 11,786 AEs (grade ≥3: 1,049 of 5,538 in induction phase, 1,382 of 6,248 in concurrent phase). Lymphocytes and white blood count were of top 3 grade ≥3 AEs that patients experienced the most in the either phase. Multivariable analysis found AE occurrence was associated with age ≥65 {any grade: odds ratio (OR) =1.

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“…Pneumonitis is a common AE associated with chemoradiotherapy. The rate of grade ≥ 3 pneumonitis ranges from 5 to 10% of patients depending on the radiotherapy technique and chemotherapy agents [80]. A meta-analysis of 836 patients who underwent cCRT with cisplatin and etoposide or carboplatin and paclitaxel found out that the rate of grade ≥ 2 pneumonitis was 29.8% [81].…”

Section: Pneumonitismentioning

confidence: 99%

The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer

Oliveira,

Fontes,

Montella

et al. 2023

Current Oncology

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Lung cancer is a major cause of cancer deaths worldwide. Non-small-cell lung cancer (NSCLC) represents most lung cancer cases, and approximately one-third of patients present with stage III disease at diagnosis. As multiple treatment plans can be adopted for these patients depending on tumor size and nodal staging, stage III NSCLC management is challenging. Over the past decades, multidisciplinary teams (MDTs) have been implemented in healthcare services to coordinate actions among the different health care professionals involved in cancer care. The aim of this review was to discuss real-world evidence of the impact of MDTs on stage III NSCLC management, survival, and quality of life. Here, we performed a literature review to investigate the role of nutrition and navigational nursing in NSCLC care and the influence of MDTs in the choice of treatment plans, including immunotherapy consolidation, and in the management of chemotherapy and radiotherapy-related adverse events. We also performed a mapping review to identify gaps in the implementation of cancer care MDTs in healthcare services around the world.

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A narrative review of toxicity of chemoradiation and immunotherapy for unresectable, locally advanced non-small cell lung cancer

Cited by 7 publications

References 41 publications

Real-World Journey of Unresectable Stage III NSCLC Patients: Current Dilemmas for Disease Staging and Treatment

Real-World Journey of Unresectable Stage III NSCLC Patients: Current Dilemmas for Disease Staging and Treatment

Characteristics of toxicity occurrence patterns in concurrent chemoradiotherapy after induction chemotherapy for patients with locally advanced non-small cell lung cancer: a pooled analysis based on individual patient data of CALGB/Alliance trials

The Best Supportive Care in Stage III Non-Small-Cell Lung Cancer

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