The current treatment landscape in the UK for stage III NSCLC

Evison, Matthew; Limited, AstraZeneca Uk

doi:10.1038/s41416-020-01069-z

Cited by 75 publications

(55 citation statements)

References 38 publications

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“…However these patients not the N2 patients and they are the real N3. So as the Matthew Evison proposed, "potentially resectable stage III NSCLC" need the thorough pathological nodal staging (10). N2 NSCLCs are advanced and systemic diseases.…”

Section: Discussionmentioning

confidence: 99%

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Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database

et al. 2021

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BackgroundNon-small cell lung carcinoma (NSCLC) with ipsilateral and/or subcarinal mediastinal lymphatic spread (N2) is a heterogeneous disease. The role of surgical resection in patients with N2 NSCLC remains controversial and no survival-based definition of “resectable N2” exists. The purpose of this study is to evaluate the factors that potentially affect the survival of N2 NSCLC patients who receive surgical resection and to define “resectable N2” based on the survival benefits.MethodsData from the open Surveillance, Epidemiology, and End Results (SEER) database from the National Cancer Institute in the United States were used to construct a nomogram. Patients who received surgery between 2010 and 2015 for N2 NSCLC were included. Independent prognostic factors for survival identified through Cox regression analysis were used to create the nomogram. The C-index, receiver operating characteristics (ROC) analyses, calibration curves, and risk stratification were used to evaluate the nomogram. The nomogram was also validated using data from 222 patients from Peking Union Medical College Hospital (PUMCH). Furthermore, lung cancer–related deaths were compared using competitive risk analysis.ResultsIn total, 4267 patients were included in the SEER cohort. Male gender, old age, high T stage and grade, adenosquamous and squamous cell carcinoma, lower lobe and overlapping lesions, extended lobe or bilobectomy and pneumonectomy, no chemotherapy, radiation before and after surgery, positive number of lymph nodes, and lymph node ratio (LNR) were identified as independent risk factors for higher mortality. The nomogram was created using these parameters. The C-index was 0.665 (95% confidence interval (CI), 0.651-0.679) and 0.722 (95% CI, 0.620-0.824) in the SEER and PUMCH cohorts, respectively. The calibration curves showed satisfactory consistency between the predicted and actual survival status in both the SEER and PUMCH cohorts. Competitive risk analysis confirmed that the variables in the nomogram, except radiation, are risk factors for prognosis.Conclusions“Resectable N2” should be assessed by a multidisciplinary team. The novel nomogram developed in this study may help with clinical decision-making for this patient population.

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Section: Discussionmentioning

confidence: 99%

“…Resectable N2 refers to discrete lymph nodes with a short-axis diameter less than 2.5-3 cm with no extranodal extension into adjacent tissue structures (6,8,9). And it needs thorough pathological nodal staging completed (10). However, even for this type of N2, there is still much controversy over whether surgery is appropriate.…”

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confidence: 99%

Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database

et al. 2021

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“…Advanced-stage LUAC covers a variety of disease manifestations and has an equally complex range of multimodal treatment options, including systemic and local therapies (chemotherapy, radiation therapy, etc.) for remote and local symptom control, respectively ( Evison, 2020 ). With the application of biomarker-directed therapies targeting molecular changes (such as EGFR and BRAF V600E mutations, or ALK and ROS1 rearrangements), these therapies can prolong the survival of LC patients ( Arbour and Riely, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Signature for Lung Adenocarcinoma Patients Based on Cell-Cycle-Related Genes

Jiang

Liao

et al. 2021

Front. Cell Dev. Biol.

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ObjectiveTo screen lung adenocarcinoma (LUAC)-specific cell-cycle-related genes (CCRGs) and develop a prognostic signature for patients with LUAC.MethodsThe GSE68465, GSE42127, and GSE30219 data sets were downloaded from the GEO database. Single-sample gene set enrichment analysis was used to calculate the cell cycle enrichment of each sample in GSE68465 to identify CCRGs in LUAC. The differential CCRGs compared with LUAC data from The Cancer Genome Atlas were determined. The genetic data from GSE68465 were divided into an internal training group and a test group at a ratio of 1:1, and GSE42127 and GSE30219 were defined as external test groups. In addition, we combined LASSO (least absolute shrinkage and selection operator) and Cox regression analysis with the clinical information of the internal training group to construct a CCRG risk scoring model. Samples were divided into high- and low-risk groups according to the resulting risk values, and internal and external test sets were used to prove the validity of the signature. A nomogram evaluation model was used to predict prognosis. The CPTAC and HPA databases were chosen to verify the protein expression of CCRGs.ResultsWe identified 10 LUAC-specific CCRGs (PKMYT1, ETF1, ECT2, BUB1B, RECQL4, TFRC, COCH, TUBB2B, PITX1, and CDC6) and constructed a model using the internal training group. Based on this model, LUAC patients were divided into high- and low-risk groups for further validation. Time-dependent receiver operating characteristic and Cox regression analyses suggested that the signature could precisely predict the prognosis of LUAC patients. Results obtained with CPTAC, HPA, and IHC supported significant dysregulation of these CCRGs in LUAC tissues.ConclusionThis prognostic prediction signature based on CCRGs could help to evaluate the prognosis of LUAC patients. The 10 LUAC-specific CCRGs could be used as prognostic markers of LUAC.

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“…Despite the practice-changing results of the PACIFIC study and availability of durvalumab for patients with stage III unresectable NSCLC, the percentage of patients receiving curative-intent cCRT is small. Real-world data from the UK suggest that only 20-30% of stage III patients receive curative-intent CRT [5]. Similar low rates have been reported in Canada, with evidence of significant variation in the proportion of stage III patients who receive cCRT between provincial jurisdictions [15][16][17].…”

Section: Introductionmentioning

confidence: 53%

“…Curative-intent treatment for stage III NSCLC is multimodal, consisting of a combination of chemotherapy, radiation, and/or surgical resection, although the optimal sequence and modality is debated and highly case-specific [5]. The extensive staging work-up required to assess the feasibility for curative-intent treatment, and the need for consultation with a multidisciplinary team, further complicates the optimal, individualized management of stage III patients.…”

Section: Introductionmentioning

confidence: 99%

A Canadian Perspective on the Challenges for Delivery of Curative-Intent Therapy in Stage III Unresectable Non-Small Cell Lung Cancer

Brade¹,

Jao

et al. 2021

Current Oncology

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Stage III non-small cell lung cancer (NSCLC) comprises a highly heterogenous group of patients with regards to patient fitness and tumour size and distribution, resulting in a wide range of treatment goals and therapy options. Curative-intent multimodality treatment should be considered in all patients with stage III NSCLC. For patients with unresectable disease who are fit, have adequate lung function, and have a disease that can be encompassed within a radical radiation volume, concurrent chemoradiation therapy (cCRT) is the standard of care and can produce cure rates of 20–30%. Recently, consolidation immunotherapy with durvalumab has been recognized as the standard of care following cCRT based on significant improvement rates in overall survival at 4 years. The large heterogeneity of the stage III NSCLC population, along with the need for extensive staging procedures, multidisciplinary care, intensive cCRT, and now consolidation therapy makes the delivery of timely and optimal treatment for these patients complex. Several logistical, communication, and education factors hinder the delivery of guideline-recommended care to patients with stage III unresectable NSCLC. This commentary discusses the potential challenges patients may encounter at different points along their care pathway that can interfere with delivery of curative-intent therapy and suggests strategies for improving care delivery.

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The current treatment landscape in the UK for stage III NSCLC

Cited by 75 publications

References 38 publications

Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database

Identification of Resectable N2 in NSCLC: A Single Center Experience and Review of the SEER Database

Prognostic Signature for Lung Adenocarcinoma Patients Based on Cell-Cycle-Related Genes

A Canadian Perspective on the Challenges for Delivery of Curative-Intent Therapy in Stage III Unresectable Non-Small Cell Lung Cancer

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