CE1 EVALUATION OF THE EVOLVING TREATMENT LANDSCAPE IN EARLY-STAGE/LOCALLY-ADVANCED NON-SMALL CELL LUNG CANCER (ES/LA-NSCLC): A FORWARD-LOOKING NETWORK META-ANALYSIS (NMA) FEASIBILITY STUDY

Abstract Background: Concurrent chemoradiotherapy (CCRT) is the cornerstone treatment for patients with locally advanced non-small cell lung cancer (LA-NSCLC). The aim of this study was to compare the efficacy and toxicity of different CCRT regimens in the treatment of LA-NSCLC by adopting a network meta-analysis.Methods: PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) were exhaustively searched to identify relevant studies from inception up to October 1, 2020. Direct and indirect evidence were combined to calculate the odds radio (OR) and its 95% confidence interval (CI), as well as to draw the surface under the cumulative ranking (SUCRA) curves. Cluster analyses were adopted to compare efficacy and toxicity of different CCRT regimens according to the similarity of 2 variables. Publication bias was detected by comparison-adjusted funnel plot.Results: Twenty-two studies were enrolled in this network meta-analysis, including 18 CCRT regimens: CCRT (cisplatin+etoposide), CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+carboplatin), CCRT (pemetrexed+cisplatin), CCRT (docetaxel+cisplatin), CCRT (S-1+cisplatin), CCRT (mitomycin+vindesine+cisplatin), CCRT (cisplatin+vinorelbine), CCRT (cisplatin), CCRT (etoposide+cisplatin+amifostine), RT, CCRT (5-FU), CCRT (paclitaxel+cisplatin), CCRT (irinotecan+carboplatin), CCRT (nedaplatin), CCRT (carboplatin+etoposide), CCRT (paclitaxel), and CCRT (carboplatin). The results indicated that the regimens with CCRT (cisplatin+etoposide), CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+cisplatin), CCRT (S-1+cisplatin), and CCRT (cisplatin+vinorelbine) had relatively better efficacy compared with other regimens. As for toxicity of different CCRT regimens, the CCRT (carboplatin+paclitaxel), CCRT (pemetrexed+cisplatin), and CCRT (docetaxel+cisplatin) were relatively lower.Conclusions: Our study demonstrated that CCRT (pemetrexed+cisplatin) and CCRT (carboplatin+paclitaxel) might be the best choice of CCRT regimens in the treatment of LA-NSCLC, and the 3-year overall survival (OS) rate of CCRT (pemetrexed+cisplatin) was the highest among these regimens.

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Segmentectomy or lobectomy for early-stage non-small-cell lung cancer: a systematic review and meta-analysis

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezz339 ◽

2020 ◽

Vol 57 (6) ◽

pp. 1051-1060 ◽

Cited By ~ 6

Author(s):

Thomas Winckelmans ◽

Herbert Decaluwé ◽

Paul De Leyn ◽

Dirk Van Raemdonck

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Cell Lung Cancer ◽

Early Stage ◽

Meta Analysis ◽

Small Cell ◽

Stage I ◽

Small Cell Lung ◽

Oncological Outcomes ◽

Stage Ia

Abstract OBJECTIVES The role of segmentectomy in early-stage non-small-cell lung cancer (NSCLC) remains a matter of debate. We performed a meta-analysis to evaluate the oncological outcomes following segmentectomy versus lobectomy for stage I, stage IA only and stage IA <2 cm only. METHODS We systematically searched the literature for articles reporting on overall survival (OS), cancer-specific survival (CSS) or recurrence-free survival (RFS). The hazard ratios (HRs) were retrieved and pooled using an inverse variance-weighted approach. RESULTS Twenty-eight studies were included in the analysis. In stage I, segmentectomy was found to be inferior to lobectomy for all 3 outcomes with HR: 1.25 (P = 0.01) for OS, 1.59 (P = 0.02) for CSS and 1.40 (P < 0.001) for RFS. In stage IA, the differences were significant for OS and CSS, though not for RFS with HR: 1.31 (P = 0.04), 1.56 (P = 0.02) and 1.22 (P = 0.11), respectively. In stage IA <2 cm, no significant differences were found between segmentectomy and lobectomy with HR: 1.13 (P = 0.37) for OS, 1.02 (P = 0.95) for CSS and 1.24 (P = 0.11) for RFS. CONCLUSIONS For stages I and IA, lobectomy showed superior results whereas for tumours <2 cm, our study did not find significant differences in oncological outcomes between both groups. These results suggest that segmentectomy might be a valuable alternative to lobectomy for NSCLC in tumours <2 cm.

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Immunotherapy and Radiation Therapy for Non-Small Cell Lung Cancer—A Stimulating Partnership

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0039-3399578 ◽

2020 ◽

Vol 41 (03) ◽

pp. 360-368

Author(s):

Ritchell van Dams ◽

Ye Yuan ◽

Clifford G. Robinson ◽

Percy Lee

Keyword(s):

Lung Cancer ◽

Small Cell Lung Cancer ◽

Metastatic Disease ◽

Cell Lung Cancer ◽

Early Stage ◽

Locally Advanced ◽

Small Cell ◽

Standards Of Care ◽

Small Cell Lung ◽

Early Stage Disease

AbstractNon-small cell lung cancer (NSCLC) is the most common subtype of lung cancer and the leading cause of cancer-related death. Although durable local control rates are high after surgical resection or definitive radiotherapy for early-stage disease, a substantial proportion of these patients eventually experience regional and/or distant failure and succumb to their metastatic disease. The discovery of immunotherapeutics and targeted biologics has revolutionized the treatment of locally advanced and metastatic disease, improving progression-free and overall survival when incorporated with the current standards of care. Notably, post-hoc analyses and early clinical trials provide a growing body of evidence to support a synergistic effect between radiation and immunotherapy for the treatment of NSCLC from early-stage to metastatic disease. Radiotherapy appears to be capable of not only potentiating the effect of immunotherapy in targeted lesions, but also eliciting an antitumor response in distant lesions without any direct exposure to radiation. This review explores the biologic basis of immunotherapy, targeted biologics, and radiotherapy as well as the preclinical and clinical data that support the combined use of radioimmunotherapy for early-stage, locally advanced, and metastatic NSCLC.

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