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Review
. 2024 Jul;26(7):1647-1663.
doi: 10.1007/s12094-024-03382-y. Epub 2024 Mar 26.

Multidisciplinary approach for locally advanced non-small cell lung cancer (NSCLC): 2023 expert consensus of the Spanish Lung Cancer Group GECP

Aylen Vanessa Ospina  1 , Sergio Bolufer Nadal  2 , José Luis Campo-Cañaveral de la Cruz  3 , Jose Luis González Larriba  4 , Ivan Macía Vidueira  5 , Bartomeu Massutí Sureda  6 , Ernest Nadal  7 , Florentino Hernando Trancho  4 , Antonio Álvarez Kindelán  8 , Edel Del Barco Morillo  9 , Reyes Bernabé Caro  10 , Joaquim Bosch Barrera  11 , Virginia Calvo de Juan  3 , Joaquin Casal Rubio  12 , Javier de Castro  13 , Ángel Cilleruelo Ramos  14 , Manuel Cobo Dols  15 , Manuel Dómine Gómez  16 , Santiago Figueroa Almánzar  17 , Rosario Garcia Campelo  18 , Amelia Insa Mollá  17 , José Ramón Jarabo Sarceda  4 , Unai Jiménez Maestre  19 , Rafael López Castro  14 , Margarita Majem  20 , Alex Martinez-Marti  21 , Elisabeth Martínez Téllez  20 , David Sánchez Lorente  22 , Mariano Provencio  23   24
Affiliations
Review

Multidisciplinary approach for locally advanced non-small cell lung cancer (NSCLC): 2023 expert consensus of the Spanish Lung Cancer Group GECP

Aylen Vanessa Ospina et al. Clin Transl Oncol. 2024 Jul.

Abstract

Introduction: Recent advances in the treatment of locally advanced NSCLC have led to changes in the standard of care for this disease. For the selection of the best approach strategy for each patient, it is necessary the homogenization of diagnostic and therapeutic interventions, as well as the promotion of the evaluation of patients by a multidisciplinary oncology team.

Objective: Development of an expert consensus document with suggestions for the approach and treatment of locally advanced NSCLC leaded by Spanish Lung Cancer Group GECP.

Methods: Between March and July 2023, a panel of 28 experts was formed. Using a mixed technique (Delphi/nominal group) under the guidance of a coordinating group, consensus was reached in 4 phases: 1. Literature review and definition of discussion topics 2. First round of voting 3. Communicating the results and second round of voting 4. Definition of conclusions in nominal group meeting. Responses were consolidated using medians and interquartile ranges. The threshold for agreement was defined as 85% of the votes.

Results: New and controversial situations regarding the diagnosis and management of locally advanced NSCLC were analyzed and reconciled based on evidence and clinical experience. Discussion issues included: molecular diagnosis and biomarkers, radiologic and surgical diagnosis, mediastinal staging, role of the multidisciplinary thoracic committee, neoadjuvant treatment indications, evaluation of response to neoadjuvant treatment, postoperative evaluation, and follow-up.

Conclusions: Consensus clinical suggestions were generated on the most relevant scenarios such as diagnosis, staging and treatment of locally advanced lung cancer, which will serve to support decision-making in daily practice.

Keywords: Expert consensus; Immunotherapy; Locally advanced NSCLC; Neoadjuvant; Surgery.

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Conflict of interest statement

AVO reports consulting fees from Astra Zeneca, Pfizer, BMS, Merck Serono, Takeda, Roche. Payment or honoraria from Pfizer, Janssen, BMS, MSD, Astra Zeneca. Support for attending meetings and/or travel from Roche, Pfizer, MSD, Roche and Takeda. JLC reports payment or honoraria from Astellas and BMS. IMV reports support for attending meetings and/or travel from Roche. BMS reports payment or honoraria from Roche, BMS, MSD, Boehringer-Ingelheim and Pfizer. EN reports grants from Roche, Pfizer, BMS and Merck Serono. Consulting fees from Roche, Bristol Myers Squibb, MSD, Merck Serono, Sanofi, Pfizer, Lilly, Janssen, Amgen, Daiichi-Sankyo, Boehringer-Ingelheim, AstraZeneca, Takeda, Sanofi, Pierre Fabre and Qiagen. Payment or honoraria from Roche, BMS, MSD, Merck Serono, Sanofi, Pfizer, Lilly, Janssen, Amgen, Daiichi-Sankyo, Boehringer-Ingelheim, AstraZeneca, Takeda, Sanofi, Pierre Fabre and Qiagen. Support for attending meetings and/or travel from Roche, Takeda and MSD. Advisory Board fees from Roche and Apollomics. FHT reports payment or honoraria from BMS, Astra Zeneca and Roche. Payment for expert testimony from Astra Zeneca, Medtronic and BMS. Support for attending meetings and/or travel from Jonhson. EBM reports Support for attending meetings and/or travel from Merck Serono and MSD RBC reports grants from ROCHE. Payment or honoraria from ROCHE, BMS, Pfizer, MSD, Amgen, Takeda, Astra Zeneca. Advisory Board from Takeda, Roche, BMS, Astra Zeneca. JBB reports payment or honoraria from Astra Zeneca, Pfizer, MSD, BMS, Roche and Sanofi. Support for attending meetings and/or travel from Takeda and MSD. VCJ reports consulting fees from Roche, Astrazeneca, MSD, BMS, Takeda, Sanofi, Amgen. Payment or honoraria from Roche, BMS, MSD, Astrazeneca, Takeda, Pfizer, Janssen. Support for attending meetings and/or travel from Astrazeneca, Roche, MSD and Takeda. JC reports consulting fees from Astra Zeneca, BMS, Roche, MSD, Boehringer-Ingelheim, Janssen, Lilly, Sanofi, Takeda, Pfizer and Glaxo. Payment or honoraria from Astra Zeneca, Bristol Myers Squibb, Roche, MSD, Pfizer, Janssen, Takeda and Sanofi. Support for attending meetings and/or travel from Astra Zeneca, MSD, and Roche. Advisory Board fees from Astra Zeneca, BMS, Roche, MSD, Glaxo, Janssen and Gilead. MC reports consultant or Advisory Role fees from Novartis, AstraZeneca, Boehringer-Ingelheim, Roche, BMS, Lilly, MSD, Takeda, Pfizer, Kyowa, Sanofi, and Jansen. Research Funding from BMS. Speaker fees from Novartis, AstraZeneca, Boehringer-Ingelheim, Roche, BMS, Lilly, MSD, Takeda, Kyowa, Pierre-fabre, Novocure, Sanofi and Janssen. MDG reports consulting fees from Astra Zeneca, BMS, MSD, Pfizer, Roche and Takeda. Payment or honoraria from Astra Zeneca, BMS, MSD, Pfizer, Roche and Takeda. Support for attending meetings and/or travel from Astra Zeneca, MSD and Takeda. RGC reports Grants from MSD, Pfizer and BMS. Consulting fees from Roche, BMS, MSD, Sanofi, Takeda, Pfizer, Regeneron, Amgen, Roche and Astra Zeneca. Payment or honoraria from Roche, BMS, MSD, Sanofi, Takeda, Pfizer, Regeneron, Amgen, Astra Zeneca. Support for attending meetings and/or travel from Roche, MSD, Takeda, Pfizer, Astra Zeneca. Advisory Board fees from AZ. AIM reports payment or honoraria fees from Amgen, BMS, Roche and Takeda. Support for attending meetings and/or travel: Roche, Pfizer, and MSD. Advisory Board fees from Astra Zeneca, Sanofi and Pfizer. JRJS reports grant from Roche. Payment or honoraria from BMS. Support for attending meetings and/or travel from Medtronic. UJM reports advisory board fees from Astra Zeneca. MM reports payment or honoraria fees from Roche, Astra Zeneca, MSD, Pfizer, Helsinn, Cassen, Amgen, Janssen, Sanofi, Pierre Fabre, BMS, Takeda. Support for attending meetings and/or travel from MSD, Roche and Astra Zeneca. Grants from Roche, Astra Zeneca. AM reports consulting fees from Astra Zeneca / MedImmune, BMS, Roche AG, MSD and Pfizer. Payment or honoraria from Astra Zeneca/ MedImmune, BMS, Roche AG, MSD, Pfizer and Janssen. Payment for expert testimony from Astra Zeneca/ MedImmune. Support for attending meetings and/or travel from Astra Zeneca/ MedImmune, BMS, Roche, MSD, Pfizer and Lilly. Advisory Board fees from Astra Zeneca/ MedImmune, BMS, Roche and MSD. MP reports consulting fees from BMS, Astra Zeneca, MSD, Roche, Takeda. Support for attending meetings and/or travel and Payment or Honoraria from BMS, Astra Zeneca, MSD, Roche and Takeda. The others authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Expert consensus GECP suggestions: multidisciplinary approach algorithm for diagnosis and stating on patients with locally advanced non-small cell lung cancer. (NSCLC: non-small cell lung cancer, PD-L1: programmed death-ligand 1, EGFR: epidermal growth factor receptor, CT: computed tomography, PET-CT: positron emission tomography, FEV1: Forced Expiratory Volume In 1 Second, DLCO: Lung Diffusion Capacity for Carbon Monoxide, EUS TBNA: endobronchial ultrasound-guided transbronchial needle aspiration, EUS-FNA: endobronchial ultrasound-guided fine-needle aspiration.)
Fig. 2
Fig. 2
Expert consensus GECP suggestions: multidisciplinary approach algorithm for treatment on patients with locally advanced non-small cell lung cancer. (NSCLC: non-small cell lung cancer, PD-L1: programmed death-ligand 1, EGFR: epidermal growth factor receptor, FEV1: Forced Expiratory Volume in 1 Second, DLCO: lung diffusion capacity for carbon monoxide AJCC: American Joint Committee on Cancer.)
Fig. 3
Fig. 3
Expert consensus GECP suggestions: multidisciplinary approach algorithm for treatment on patients with locally advanced non-small cell lung cancer. (CT: computed tomography, PET-CT: positron emission tomography, FEV1: Forced Expiratory Volume in 1 Second, DLCO: lung diffusion capacity for carbon monoxide.)
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