The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R): Real-World Data on Stage III Non-Small Cell Lung Cancer Patients Treated With Curative Chemoradiation

Dieleman, Edith; Woude, Lisa van der; Os, Rob van; Bockel, L. Van; Coremans, I.; Es, C. Van; Jaeger, Katrien De; Knol, Hans Peter; Kolff, Willemijn; Koppe, F.; Pomp, J.; Reymen, Bart; Schinagl, Dominic A.X.; Spoelstra, F.; Tissing-Tan, C.; Zyp, N. van der Voort van; Wel, A. van der; Wijsman, Robin; Dielwart, M.F.; Wiegman, Erwin M.; Damhuis, Ronald; Belderbos, J.

doi:10.1016/j.cllc.2022.11.008

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…A reduced performance status, comorbidity and sex were identified as poor prognostic factors in other studies as well as in the present study [ 37 , 38 , 39 ]. Negative prognostic factors such as poorer performance status and severe comorbidity did not only influence prognosis but could also decrease treatment tolerance [ 40 ]. Other study groups have also found CRP serum levels to be an unfavorable prognostic factor for NSCLC patients [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

Long-Term Survival in Patients with Oligometastatic Non-Small Cell Lung Cancer by a Multimodality Treatment—Comparison with Stage III Disease

Guberina,

Pöttgen,

Guberina

et al. 2024

Cancers

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Background: In patients with oligometastatic NSCLC, a cT3–cT4 primary tumor or an cN2/cN3 lymph node status was reported to be associated with unfavorable outcome. The aim of this study was to assess the importance of definitive or neoadjuvant thoracic radiochemotherapy for long-term outcome of these patients in order to find more appropriate treatment schedules. Methods: Analysis of the West Cancer Centre (WTZ) institutional database from 08/2016 to 08/2020 was performed. Patients with primary synchronous OMD, all without actionable driver mutations, who received definitive thoracic radiochemotherapy (RCT) or neoadjuvant RCT followed by surgery (trimodality treatment) were included. Survival outcome is compared with stage III NSCLC. Results: Altogether, 272 patients received concurrent radiochemotherapy. Of those, 220 presented with stage III (158 with definitive RCT, 62 with trimodality approach). A total of 52 patients had OMD patients with cT3/cT4 or cN2/cN3 tumors. Overall survival (OS) at five years for OMD patients was 28.3% (95%-CI: 16.4–41.5%), which was not significantly different from OS of patients with stage III NSCLC treated with definitive or neoadjuvant RCT (34.9% (95%-CI: 27.4–42.8%)). However, the PFS of OMD patients at five years or last follow-up was significantly worse than that of stage III patients (13.0% vs. 24.3%, p = 0.0048). The latter was due to a higher cumulative incidence of distant metastases in OMD patients (50.2% vs. 20.4% at 48 months, p < 0.0001) in comparison to stage III patients. A cross-validated classifier that included severe comorbidity, ECOG performance status, gender and pre-treatment serum CRP level as the most important factors in the univariable analysis, was able to divide the OMD patient group into two equally sized groups with a four-year survival rate of 49.4% in the good prognosis group and 9.9% in the poor prognosis group (p = 0.0021). Laboratory chemistry and clinical parameters, in addition to imaging and high-precision therapies, can help to predict and improve prognosis. Conclusions: A multimodality treatment approach and local metastases-directed therapy in addition to chemoimmunotherapy can lead to good long-term survival in patients with cT3/cT4 or cN2/cN3 OMD NSCLC without severe comorbidities and in good performance status and is therefore recommended.

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Section: Discussionmentioning

confidence: 99%

Long-Term Survival in Patients with Oligometastatic Non-Small Cell Lung Cancer by a Multimodality Treatment—Comparison with Stage III Disease

Guberina,

Pöttgen,

Guberina

et al. 2024

Cancers

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“…In the elderly subgroup aged ≥65 years, there was a prolonged PFS (HR=0.74, 95% CI: 0.54-1.01) and a 5-year OS (HR=0.79, 95% CI: 0.60-1.05), although the differences were not statistically significant. A retrospective study conducted using real-world data from the Netherlands ( 91 ) involved 2,942 patients with stage III NSCLC who underwent radical chemoradiotherapy (CRT). The study categorized patients into two groups: cCRT and sequential chemoradiotherapy (seqCRT).…”

Section: Optimization Strategymentioning

confidence: 99%

Optimization of treatment strategies for elderly patients with advanced non-small cell lung cancer

Chen,

Ying,

Qin

et al. 2024

Front. Oncol.

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Lung cancer stands as a malignant neoplasm bearing the highest burden of morbidity and mortality within the elderly population on a global scale. Among the lung cancer subtypes, non-small cell lung cancer (NSCLC) prevails as the most prevalent. As age advances, elderly patients often present with an increased prevalence of comorbidities, diminished organ reserve function, and alterations in drug pharmacokinetics, including absorption, distribution, metabolism, and clearance. These factors collectively contribute to a reduction in their capacity to tolerate therapeutic interventions. Regrettably, there exists a paucity of research data and evidence regarding the management of elderly patients afflicted by advanced lung cancer. This article endeavors to compile and elucidate strategies for the enhancement of treatment approaches, with the aim of aiding clinical decision-making. Prior to the selection of clinical treatment modalities for elderly patients with advanced NSCLC, a comprehensive assessment should be conducted, taking into account various facets, including tumor characteristics, patient age, physiological status, and the presence of comorbidities. The treatment strategy should be implemented in a tiered fashion, thereby affording the opportunity for the tailoring of individualized therapeutic approaches for elderly patients afflicted by advanced NSCLC. The demographic of elderly patients confronting advanced NSCLC presents a complex landscape marked by intricate underlying conditions, necessitating the imperative optimization of treatment strategies.

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“…CRT followed by immunotherapy may offer a challenging and potentially harmful path to recovery for vulnerable NSCLC patients. Previous studies with CRT alone reported an incidence of ≥ grade 3 toxicity of about 20% ( 5 ) and that CRT-induced pneumonitis was an important toxicity impacting quality of life ( 6 ). Pneumonitis ≥ grade 3 has been reported in up to 10% of patients receiving CRT alone ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with failure to start consolidation durvalumab after definitive chemoradiation for locally advanced NSCLC

et al. 2023

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IntroductionThe introduction of consolidation immunotherapy after chemoradiotherapy has improved outcome for patients with locally advanced non-small cell lung cancer. However, not all patients receive this treatment. This study identifies factors associated with failure to start durvalumab as consolidation therapy with the aim of optimizing treatment, supportive care and prehabilitation to ensure that more patients complete the planned treatment.Materials and methodsPatients from two clinical trials and a named patient use program, were included in this study. All patients received platinum-doublet chemotherapy concomitant with radiotherapy to a total dose of 60-66 gray. Patient characteristics, cancer treatment, toxicity, performance status and laboratory data before and after chemoradiotherapy were recorded and patients who never started durvalumab were compared with those who did.ResultsA total of 101 patients were included, of which 83 started treatments with durvalumab after chemoradiotherapy. The 18 patients who did not start durvalumab had significantly higher lactate dehydrogenase at baseline and a worse performance status, cumulative toxicity and higher c-reactive protein after completed chemoradiotherapy. Data also suggest that pre-treatment diabetes and reduced hemoglobin and/or diffusion capacity of the lungs for carbon monoxide contribute to the risk of treatment abruption.ConclusionTreatment plan disruption rate was 18%. Systemic inflammation and performance status were associated with failure to receive durvalumab after chemoradiation. Further studies are needed to confirm findings and prospective trials should investigate whether prehabilitation and supportive treatment could help more patients finishing the planned treatment.Clinical Trial Registrationclinicaltrials.gov, identifier NCT03798535; NCT04392505.

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The Dutch Lung Cancer Audit-Radiotherapy (DLCA-R): Real-World Data on Stage III Non-Small Cell Lung Cancer Patients Treated With Curative Chemoradiation

Cited by 7 publications

References 12 publications

Long-Term Survival in Patients with Oligometastatic Non-Small Cell Lung Cancer by a Multimodality Treatment—Comparison with Stage III Disease

Long-Term Survival in Patients with Oligometastatic Non-Small Cell Lung Cancer by a Multimodality Treatment—Comparison with Stage III Disease

Optimization of treatment strategies for elderly patients with advanced non-small cell lung cancer

Factors associated with failure to start consolidation durvalumab after definitive chemoradiation for locally advanced NSCLC

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