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Justin Benet
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MA08 - Pawing the Way to Improve Outcomes in Stage III NSCLC (ID 127)
- Event: WCLC 2019
- Type: Mini Oral Session
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:Simon Ekman, Helena A Yu
- Coordinates: 9/08/2019, 15:15 - 16:45, Tokyo (1982)
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MA08.02 - Durvalumab Impact in the Treatment Strategy of Stage III Non-Small Cell Lung Cancer (NSCLC): An EORTC Young Investigator Lung Cancer Group Survey (Now Available) (ID 608)
15:15 - 16:45 | Author(s): Justin Benet
- Abstract
- Presentation
Background
Stage III NSCLC represents a very heterogeneous population with extremely different treatment modalities including surgery, chemotherapy (CT) and radiotherapy (RT), mostly in combination. The results of the PACIFIC trial have now been reported in full including an overall survival (OS) benefit with durvalumab in addition to concomitant CT-RT. An electronic European survey was circulated to evaluate the impact of durvalumab in the staging and treatment strategy of stage III disease.
Method
A Young Investigator EORTC Lung Cancer Group survey containing 31 questions, was distributed between 31/01/18 and 31/03/19 to EORTC LCG and several European thoracic oncology societies’ members
Result
206 responses were analyzed (radiation oncologist: 50% [n=103], pulmonologist: 26.7% [n=55], medical oncologist: 22.3% [n=46]; 81.5% with >5 years experience in treating NSCLC). Italy (27.7%, n=57), Netherlands (22.8%, n=47), France (13.6%, n=28), and Spain (11.6%, n=24) contributed most. 83.5% (n=172) confirmed that they had access to durvalumab at the time of the survey. 97.6% (n=201) report that treatment decision is made by a multidisciplinary board. Regarding staging, 76.7% (n=158) support the need of a mediastinal pathological staging in case of suspect lymph-nodes, with a preference for EBUS/EUS (61.2%, n=126). 81.6% (n=168) treated more than half of patients with a concomitant CT-RT with the 1st cycle of chemotherapy in 39.7% (n=81). 95.1% consider durvalumab as practice changing, especially given the OS results (77.9%, n=152/195). 30% (n=119/395) will give patients concomitant CT-RT if PD-L1 >1%, and in borderline resectable cases 17.7% (n=70/395) will propose concomitant CT-RT instead of surgery. Durvalumab administration will be given regardless of PDL1 status in 13.1% (n=27) and 28.6% (n=59) would consider the possibility of a rebiopsy after CT-RT in case of negative PD-L1. 38.8% (n=80) foresee some problems with PD-L1 testing in this population due to availability of cytologic or small histologic samples. About 53.8% (n=105/195) normally will start durvalumab within 6 weeks after CT-RT and 48.5% (n=100) would also use durvalumab after sequential CT-RT
Conclusion
Durvalumab results are changing the treatment approach to stage III unresectable (and maybe resectable) NSCLC and planned strict adherence to the patient population as recruited to the PACIFIC study, was not demonstrated. This survey was released after the EMA approval of durvalumab and PD-L1 status seems to play a role in the treatment strategies, but surprisingly almost half of the clinicians will use durvalumab after sequential CT-RT without safety or efficacy data.
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P2.18 - Treatment of Locoregional Disease - NSCLC (ID 191)
- Event: WCLC 2019
- Type: Poster Viewing in the Exhibit Hall
- Track: Treatment of Locoregional Disease - NSCLC
- Presentations: 1
- Now Available
- Moderators:
- Coordinates: 9/09/2019, 10:15 - 18:15, Exhibit Hall
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P2.18-10 - Importance of the Multidisciplinary Tumor Board in the Treatment Strategy of Stage III Non-Small Cell Lung Cancer (NSCLC) (Now Available) (ID 1107)
10:15 - 18:15 | Presenting Author(s): Justin Benet
- Abstract
Background
Stage III Non-Small Cell Lung Cancer (NSCLC) represents a heterogeneous population with different treatment strategies, often in combination. The PACIFIC trial is changing practices. It is therefore necessary to evaluate our current practices in order to identify the patients that should most likely receive this treatment after chemoradiotherapy
Method
A database constructed from our weekly multidisciplinary thoracic oncology meetings was retrospectively screened from 01/2010 to 01/2017. Consecutive patients with stages III NSCLC were included. We aimed to describe proposed treatment strategies and those really performed
Result
Of the 411 patients studied, 249 had a stage IIIA NSCLC and 162 a stage IIIB NSCLC. Median age was 65 years [IQR 25%-75%, 58-72], 309 (75%) patients were male. The majority of the patients (n=270, 69%, 20 missing data) had an ECOG-Performance status of 0 or 1. Regarding histology, 199 (48%) patients had an adenocarcinoma and 199 (48%) a squamous cell carcinoma. Treatment strategies are described in Table 1. Sixty-nine (17%) patients received exclusive chemoradiotherapy, and 60 (15%) were planned for neoadjuvant chemotherapy for subsequent surgery. Among these 60 patients, after the first cycles of the initial chemotherapy, only 37 (62%) received surgery in accordance with the multidisciplinary meeting decision; 6 (10%) received concurrent chemoradiotherapy and 6 (10%) sequential chemoradiotherapy.
Conclusion
In our cohort, 8% (32/411) of the stage III patients benefited from a chemoradiotherapy upfront. According to the PACIFIC study, these patients could receive adjuvant immunotherapy. We could ask if the patients planned for surgery after neoadjuvant chemotherapy should not be initially proposed for a concurrent chemoradiotherapy to give them the opportunity to receive adjuvant immunotherapy. Survival analyses according to treatment strategy are ongoing
