Advances in systemic therapy for non-small cell lung cancer

BMJ ◽  
2021 ◽  
pp. n2363
Author(s):  
Meagan Miller ◽  
Nasser Hanna
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Small Cell ◽  
Small Cell Lung ◽  
Incurable Disease ◽  
Innovative Therapies ◽  
Standard Of Care Treatment

ABSTRACT Lung cancer remains a leading cause of cancer related mortality worldwide. Despite numerous advances in treatments over the past decade, non-small cell lung cancer (NSCLC) remains an incurable disease for most patients. The optimal treatment for all patients with locally advanced, but surgically resectable, NSCLC contains at least chemoradiation. Trimodality treatment with surgical resection has been a subject of debate for decades. For patients with unresectable or inoperable locally advanced disease, the incorporation of immunotherapy consolidation after chemoradiation has defined a new standard of care. For decades, the standard of care treatment for advanced stage NSCLC included only cytotoxic chemotherapy. However, with the introduction of targeted therapies and immunotherapy, the landscape of treatment has rapidly evolved. This review discusses the integration of these innovative therapies in the management of patients with newly diagnosed NSCLC.

Systemic and Radiation Therapy Approaches for Locally Advanced Non–Small-Cell Lung Cancer

2022 ◽  
Author(s):  
Kristin A. Higgins ◽  
Sonam Puri ◽  
Jhanelle E. Gray
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Circulating Tumor Dna ◽  
Small Cell ◽  
Concurrent Chemoradiation ◽  
Driver Mutations ◽  
Small Cell Lung

The treatment for locally advanced non–small-cell lung cancer has changed dramatically over the past several years, with consolidative immunotherapy after concurrent chemoradiation becoming the new standard of care. Five-year survival outcomes have substantially improved with this approach. Despite these advances, further improvements are needed as the majority of patients ultimately develop progression of disease. The next-generation immunotherapy trials are currently being conducted that include approaches such as concurrent immunotherapy and addition of other therapeutic agents in the concurrent and consolidative settings. Specific unmet needs continue to exist for patients who develop disease progression after concurrent chemoradiation and immunotherapy, as well as defining the best treatment for patients with driver mutations. Future directions also include refinement of radiation techniques to reduce toxicities as much as possible, as well as the use of circulating tumor DNA in the surveillance setting. The current scientific landscape shows promising approaches that may further improve outcomes for patients with locally advanced non–small-cell lung cancer.

scholarly journals Safety and Efficacy of Bevacizumab Plus Standard-of-Care Treatment Beyond Disease Progression in Patients With Advanced Non–Small Cell Lung Cancer

JAMA Oncology ◽  
2018 ◽  
Vol 4 (12) ◽  
pp. e183486 ◽  
Author(s):  
Cesare Gridelli ◽  
Javier de Castro Carpeno ◽  
Anne-Marie C. Dingemans ◽  
Frank Griesinger ◽  
Francesco Grossi ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Disease Progression ◽  
Cell Lung Cancer ◽  
Standard Of Care ◽  
Small Cell ◽  
Small Cell Lung ◽  
Safety And Efficacy ◽  
Care Treatment ◽  
Standard Of Care Treatment

Alteration in tumor immune microenvironment after chemo-radiotherapy for locally advanced non-small cell lung cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 8530-8530 ◽  
Author(s):  
Kazue Yoneda ◽  
Taiji Kuwata ◽  
Masataka Mori ◽  
Masatoshi Kanayama ◽  
Koji Kuroda ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Standard Of Care ◽  
Small Cell ◽  
Pathologic Response ◽  
Prognostic Impact ◽  
Small Cell Lung ◽  
Before And After

8530 Background: The consolidation treatment with durvalumab, an anti-PD-L1 antibody, after concurrent chemo-radiotherapy (CCRT) has become a new standard of care for locally advanced non-small cell lung cancer (LA-NSCLC). The rationale of the addition of anti-PD-L1 antibody is based on preclinical evidence suggesting that chemotherapy and radiotherapy may up-regulate PD-L1 expression on tumor cells. However, there has been reported no clinical evidence showing up-regulation of PD-L1 expression after CCRT. Methods: LA-NSCLC patients with paired sufficient histologic specimens for immune-histochemical analysis of tumoral PD-L1 expression (tumor proportion score, TPS) and stromal CD8-positive tumor-infiltrating lymphocyte density (CD8+density) before and after pre-operative treatment were eligible in this study. Twenty-three patients who underwent CCRT were reviewed in comparison with 18 patients who underwent chemotherapy. Results: PD-L1 expression was significantly enhanced after CCRT (median TPS, 48 from 1; P<0.01), but not after chemotherapy (median TPS, 7.5 from 1; P=0.62). No significant correlation between baseline TPS and TPS after CCRT (P=0.119). Stromal CD8+density was significantly increased after CCRT (median, 39 from 11; P<0.01) and after chemotherapy (median, 23 from 12; P<0.01). No significant correlation between baseline TPS and TPS after CCRT (P=0.378). Among CCRT cases, stromal CD8+density after treatment was significantly higher in cases with higher pathologic response to CCRT (median, 55 versus 27; P<0.01), and higher stromal CD8+density was a significant factor to predict a favorable survival after surgery (P=0.03 for recurrence-free survival; P=0.02 for overall survival). Conclusions: PD-L1 expression was significantly upregulated after CCRT regardless of baseline PD-L1 status, which may provide a pathologic rationale for the use of anti-PD-L1 agent after CCRT to improve the prognosis. Stromal CD8+density also increased after CCRT, which was correlated with pathologic response to CCRT and provided a significant prognostic impact.

Pharmacotherapy Update: Vinorelbine in the Treatment of non-small-cell Lung cancer

2010 ◽  
Vol 2 ◽  
pp. CMT.S4510
Author(s):  
Jean Trédaniel ◽  
Lionel Staudacher ◽  
Luis Teixeira ◽  
Sihem Sebbagh ◽  
Sébastien Bucquet ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Locally Advanced ◽  
Vinca Alkaloid ◽  
Standard Of Care ◽  
Small Cell ◽  
Small Cell Lung ◽  
Oral Vinorelbine ◽  
Tumour Activity

Non-small cell lung cancer (NSCLC) is the most deadly cancer in the world. Vinorelbine is an active vinca-alkaloid with a broad spectrum of anti-tumour activity. In particular, it has high activity in NSCLC, where a synergy with cisplatin has been demonstrated. Recently, oral vinorelbine has shown a similar activity and efficacy as compared to the intravenous formulation, giving to the patient an easier way of administration and increasing his comfort. Although surgery remains the best chance of cure for patients with resectable NSCLC, it is now accepted that postoperative cisplatin-based adjuvant chemotherapy significantly improves survival in patients with NSCLC. The combination of cisplatin and vinorelbine is the most active among all the adopted schedules. Patients presenting with locally advanced disease at diagnosis benefit from concomitant chemotherapy with cisplatin-vinorelbine regimen in combination with thoracic radiotherapy. Platinum-based combinations have become the standard of care for treating NSCLC. Vinorelbine–cisplatin combination is one of the proposed doublets for treating advanced, metastatic, NSCLC. Because of its favorable toxicity profile, vinorelbine has become a major compound as a treatment for elderly patients with advanced NSCLC.

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