Therapeutic revolution for inoperable stage III non-small cell lung cancer in the immune era

Abstract

In the past, chemoradiotherapy (CRT) has been the standard of care for inoperable stage III NSCLC. Concurrent chemoradiotherapy (cCRT), if tolerable in patients, is the optimal treatment regimen. A meta-analysis has shown that cCRT results in a 5-year survival rate 4.5% longer than that with sequential chemoradiotherapy (sCRT) 1 . However, within 2 years after cCRT, approximately 30% of patients experience local recurrence, and approximately 40% develop distant metastasis 2 . Clinicians have explored induction chemotherapy 3 , consolidation chemotherapy 4 , and combination use with targeted drugs 2 , and found that none improve the prognosis.With the development of anti-PD-1/PD-L1 drugs, the PACIFIC study has revolutionized the therapeutic landscape for inoperable stage III NSCLC, in a manner that has been likened to a "tsunami". The PACIFIC study 5 was a randomized, double-blind phase 3 clinical study that enrolled patients with stage III NSCLC who had no progression after cCRT. These patients received consolidation therapy with durvalumab or placebo for 1 year. The primary endpoints of the study were

Simultaneous integrated dose reduction intensity-modulated radiotherapy effectively reduces cardiac toxicity in limited-stage small cell lung cancer

“…Advances in cancer immunotherapies for patients with NSCLC have led to significant improvement in survival 16 , but for patients with LS-SCLC the optimal dose-fractionation schedule of TRT remains debatable. While the Intergroup 0096 trial reported an improvement in survival for BID over QD radiotherapy patterns, traditional standard fractionation (QD) has remained the most common approach over the past decade, and is still very commonly used in the US 22 and China.…”

“…A previous study reported that different radiation doses are required to control clinical and subclinical lesions, and 50 Gy is an optimal dose for subclinical lesions 14 . Furthermore, immunotherapy has an increasingly important role in comprehensive treatment, and a combination of immune checkpoint inhibitors (ICIs) and TRT requires fewer radiation-related toxicities 15 , 16 .…”

Evaluating the Necessity of Adaptive RT and the Role of Deformable Image Registration in Lung Cancer with Different Pathologic Classifications

“…Research concerning anticancer drugs for SCLC is significantly less common than that for NSCLC [ 11 , 17 , 18 ]. Treatment progression for SCLC has remained largely unchanged over the past 20 years, generally comprising 4–6 cycles of chemotherapy with cisplatin and etoposide, RT, and prophylactic cranial irradiation.…”

Enhancement of anti-PD-L1 antibody plus anlotinib efficacy due to downregulation of PD-L1 in the micro-conduit endothelium within the tumor: a randomized double-blind trial

“…Defective immune cell function coupled with immunosuppressive factors in the tumor microenvironment (TME) results in cancer cells that evade recognition and destruction in patient with lung cancer. Given that patients with low tumor immune escape have a longer disease-free survival (DFS) 1 , immune checkpoint inhibitors (ICIs) have achieved long-term survival in patients with advanced non-small cell lung cancer (NSCLC) 2 and inoperable stage III NSCLC 3 . However, a significant number of patients do not respond to therapy or rapidly develop drug resistance 4,5 .…”