Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Oct:190:104108.
doi: 10.1016/j.critrevonc.2023.104108. Epub 2023 Aug 24.

New options and open issues in the management of unresectable stage III and in early-stage NSCLC: A report from an expert panel of Italian medical and radiation oncologists - INTERACTION group

Chiara Catania  1 , Andrea Riccardo Filippi  2 , Claudia Sangalli  3 , Gaia Piperno  4 , Marco Russano  5 , Carlo Greco  6 , Vieri Scotti  7 , Claudia Proto  8 , Chiara Bennati  9 , Marzia Di Pietro Paolo  10 , Angelo Platania  11 , Emanuela Olmetto  12 , Francesco Agustoni  13 , Nazario Teodorani  14 , Vincenzo Agbaje  15 , Alessandro Russo  16
Affiliations
Review

New options and open issues in the management of unresectable stage III and in early-stage NSCLC: A report from an expert panel of Italian medical and radiation oncologists - INTERACTION group

Chiara Catania et al. Crit Rev Oncol Hematol. 2023 Oct.

Abstract

Importance: After the PACIFIC trial, concurrent chemo-radiotherapy followed by consolidation therapy with durvalumab for 1 year (limited to PD-L1 tumour proportion score ≥ 1% in the EMA region) is the firmly established standard of care treatment for unresectable NSCLC patients. Several relevant questions are emerging with the growing use of this approach, posing novel challenges in clinical practice. Treatment of oncogene-addicted NSCLCs, management of mediastinal disease recurrence after surgery and the optimal management of patients progressing during or after durvalumab are now some of the most clinically relevant issues.

Observations: Patients with unresectable NSCLC harbouring EGFR and HER2 mutations or ALK/ROS1/RET /NTRK1,2,3 rearrangements are unresponsive to immunotherapy. Importance of knowing the tumour genotyping (NGS, preferable DNA and RNA) from the earliest stages of NSCLC, also for the possible use of immunotherapy both in the adjuvant and perioperative setting. In case of mediastinal disease recurrence after surgery, re-biopsy is essential to re-determine the histological and biological characteristics of the disease and the distinction of recurrence in curable and non-curable disease is of pivotal important for the optimal management of subsequent treatments.

Conclusions and relevance: Treatment of stage III NSCLC has always been controversial and challenging: Multidisciplinary approach is mandatory and defining resectability is a critical issue. Chemo-radiotherapy followed by maintenance Durvalumab is now the standard of treatment. Herein, we provide a comprehensive overview of the key challenges and open questions that we are currently facing in clinical practice, in unresectable stage III and in early-stage NSCLC, identifying the knowledge gaps and the possible solutions.

Keywords: Early stage lung cancer; Immunotherapy; Stage III NSCLC; Target therapy; Treatment strategy.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest Dr Catania reports advisory board role for AstraZeneca and compensated activity for projects for AstraZeneca. Dr Russo reports advisory board role for AstraZeneca, BMS, Novartis, Pfizer, and MSD, speaker bureau for AstraZeneca and BMS, and compensated activity for editorial projects for AstraZeneca, MSD, Novartis, and Roche.

MeSH terms

Substances