Concurrent versus sequential chemoradiotherapy for unresectable locally advanced stage III non-small cell lung cancer: Retrospective analysis in a single United Kingdom cancer centre

Spencer, Alice; Williams, J.; Samuel, Robert; Boon, Ian S; Clarke, K.; Jain, Pooja

doi:10.1016/j.ctarc.2021.100460

Cited by 3 publications

(2 citation statements)

References 27 publications

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“…Although many studies have shown that patients receiving CCRT have a high survival rate with SCRT 26 – 28 , this survival benefit is usually at the expense of greater therapeutic toxicity. Many studies have confirmed that SCRT is less toxic to patients’ organs and hematologic system than CCRT 29 , 30 . Even in some studies, the survival rate of patients receiving SCRT was significantly better than that of patients receiving CCRT 31 , 32 .…”

Section: Discussionmentioning

confidence: 99%

Establishment of a prognostic nomogram for elderly patients with limited-stage small cell lung cancer receiving radiotherapy

Zhang,

et al. 2024

Sci Rep

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The present study explored the risk factors associated with radiotherapy in seniors diagnosed with limited-stage small cell lung cancer (LS-SCLC) to construct and validate a prognostic nomogram. The study retrospectively included 137 elderly patients with LS-SCLC who previously received radiotherapy. Univariate and multivariate COX analyses were conducted to identify independent risk factors and determine optimal cut-off values. Kaplan–Meier survival curves and nomograms were constructed to predict survival. Calibration and receiver operating characteristic (ROC) curves were used to evaluate the accuracy and consistency of the nomogram. Illness rating scale-geriatric (CIRS-G) score, treatment strategy, lymphocyte-to-monocyte ratio (LMR), white blood cell-to-monocyte ratio (WMR), and prognostic nutritional index (PNI) were discovered to be independent prognostic factors. Based on the findings of our multivariate analysis, a risk nomogram was developed to assess patient prognosis. Internal bootstrap resampling was utilized to validate the model, and while the accuracy of the AUC curve at 1 year was modest at 0.657 (95% CI 0.458–0.856), good results were achieved in predicting 3- and 5 year survival with AUCs of 0.757 (95% CI 0.670–0.843) and 0.768 (95% CI 0.643–0.893), respectively. Calibration curves for 1-, 3-, and 5 year overall survival probabilities demonstrated good cocsistency between expected and actual outcomes. Patients with concurrent chemoradiotherapy, CIRS-G score > 5 points and low PNI, WMR and LMR correlated with poor prognosis. The nomogram model developed based on these factors demonstrated good predictive performance and provides a simple, accessible, and practical tool for clinicians to guide clinical decision-making and study design.

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Section: Discussionmentioning

confidence: 99%

Establishment of a prognostic nomogram for elderly patients with limited-stage small cell lung cancer receiving radiotherapy

Zhang,

et al. 2024

Sci Rep

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“…54,55 Likewise, patients with PS ⩾2 were excluded from the PACIFIC trial, and in real world, this population represent up to 14% of patients with stage III NSCLC. 56,57 Although in the PACIFIC-6 patients with PS 2 were allowed, only 2.6% of enrolled patients actually had PS 2. Several ongoing phase II clinical trials are aiming to determine whether consolidation ICI improves outcomes in patients with ECOG PS2, such as the S1933 trial (NCT04310020), is testing hypofractionated radiation alone, 60 Gy in 15 fractions, followed by atezolizumab (1200 mg Q3W for 17 cycles), and finally the DUART trial (NCT04249362) is testing durvalumab (1500 mg Q4W for 12 cycles) after RT (60 Gy).…”

Section: Elderly Population and Patients With Poor Psmentioning

confidence: 99%

Current challenges of unresectable stage III NSCLC: are we ready to break the glass ceiling of the PACIFIC trial?

et al. 2022

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Consolidation anti-programmed death-ligand 1 has become a new standard of care in unresectable stage III non-small cell lung cancer (NSCLC) following chemo-radiotherapy (CTRT), based on the results of two phase III trials. Advances remain however needed, in particular to reduce the risk of distant relapse and for treatment personalization. Newer strategies are currently being tested, including consolidation with dual immune checkpoint inhibitors (ICIs), concurrent chemo-radioimmunotherapy and (chemo)-immunotherapy induction before CTRT. One randomized phase II reported better outcomes with a double ICI consolidation as compared with durvalumab alone. Three nonrandomized phase II trials also suggested that concurrent ICI-CTRT was feasible. Within this review, we summarize the current evidence, highlight ongoing trials and discuss challenges that will ideally lead to a cure for more patients with unresectable stage III NSCLC.

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Pneumonitis With Combined Immune Checkpoint Inhibitors and Chemoradiotherapy in Locally Advanced Non-Small-Cell Lung Cancer: a Systematic Review and Meta-Analysis

Yang

et al. 2023

Future Oncol.

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Aims: This study systematically evaluated cases of pneumonitis following combined immune checkpoint inhibitors (ICI) and chemoradiotherapy (CRT) for locally advanced non-small-cell lung cancer (LA-NSCLC). Methods: Studies from Embase, PubMed and the Cochrane Library on patients with LA-NSCLC who received CRT and ICIs were reviewed. The primary outcomes were rates of all-grade, grade 3–5 and grade 5 pneumonitis. Results: Overall, 35 studies involving 5000 patients were enrolled. The pooled rates of all-grade, grade 3–5 and grade 5 pneumonitis were 33.0% (95% CI: 23.5–42.6), 6.1% (95% CI: 4.7–7.4) and 0.8% (95% CI: 0.3–1.2), respectively, with 7.6% of patients discontinuing ICIs because of pneumonitis. Conclusion: The incidence rates of pneumonitis following combined CRT and ICIs for LA-NSCLC were acceptable. However, the pulmonary toxicity of concurrent CRT and nivolumab plus ipilimumab should be noted.

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Concurrent versus sequential chemoradiotherapy for unresectable locally advanced stage III non-small cell lung cancer: Retrospective analysis in a single United Kingdom cancer centre

Cited by 3 publications

References 27 publications

Establishment of a prognostic nomogram for elderly patients with limited-stage small cell lung cancer receiving radiotherapy

Establishment of a prognostic nomogram for elderly patients with limited-stage small cell lung cancer receiving radiotherapy

Current challenges of unresectable stage III NSCLC: are we ready to break the glass ceiling of the PACIFIC trial?

Pneumonitis With Combined Immune Checkpoint Inhibitors and Chemoradiotherapy in Locally Advanced Non-Small-Cell Lung Cancer: a Systematic Review and Meta-Analysis

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