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Review
. 2024 Nov 8;31(11):6979-6999.
doi: 10.3390/curroncol31110514.

Update on Practical Management of Early-Stage Non-Small Cell Lung Cancer (NSCLC): A Report from the Ontario Forum

Parneet K Cheema  1   2 , Paul F Wheatley-Price  3 , Matthew J Cecchini  4 , Peter M Ellis  5 , Alexander V Louie  6 , Sara Moore  3 , Brandon S Sheffield  7 , Jonathan D Spicer  8 , Patrick James Villeneuve  9 , Natasha B Leighl  10
Affiliations
Review

Update on Practical Management of Early-Stage Non-Small Cell Lung Cancer (NSCLC): A Report from the Ontario Forum

Parneet K Cheema et al. Curr Oncol. .

Abstract

Therapeutic strategies for early-stage non-small cell lung cancer (NSCLC) are advancing, with immune checkpoint inhibitors (ICIs) and targeted therapies making their way into neoadjuvant and adjuvant settings. With recent advances, there was a need for multidisciplinary lung cancer healthcare providers from across Ontario to convene and review recent data from practical and implementation standpoints. The focus was on the following questions: (1) To what extent do patient (e.g., history of smoking) and disease (e.g., histology, tumor burden, nodal involvement) characteristics influence treatment approaches? (2) What are the surgical considerations in early-stage NSCLC? (3) What is the role of radiation therapy in the context of recent evidence? (4) What is the impact of biomarker testing on treatment planning? Ongoing challenges, treatment gaps, outstanding questions, and controversies with the data were assessed through a pre-meeting survey, interactive cases, and polling questions. By reviewing practice patterns across Ontario cancer centers in the context of evolving clinical data, Health Canada indications, and provincial (Cancer Care Ontario [CCO]) funding approvals, physicians treating lung cancer voiced their opinions on how new approaches should be integrated into provincial treatment algorithms. This report summarizes the forum outcomes, including pre-meeting survey and polling question results, as well as agreements on treatment approaches based on specific patient scenarios.

Keywords: adjuvant NSCLC; anaplastic lymphoma kinase (ALK); early-stage non-small cell lung cancer (NSCLC); epidermal growth factor receptor (EGFR); neoadjuvant NSCLC; programmed death ligand 1 (PD-L1).

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Conflict of interest statement

P.K.C. has received honoraria and/or has participated in advisory board meetings with Amgen, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Daichii Sankyo, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, and Pfizer; and has received a research grant from AstraZeneca, Bristol Myers Squibb, Gilead, GlaxoSmithKline, Hoffmann-La Roche, iTEOS Therapeutics, Merck, Taiho, and Takeda. P.W.-P. reports receiving consulting fees and/or honoraria from AbbVie, Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Daichi Sankyo, EMD Serono, GlaxoSmithKline, Guardant, Janssen, Jazz Pharmaceuticals, Lilly, Merck, Novartis, Pfizer, Roche, Sanofi, Takeda, and SteriMax; and has received research grants from Bristol Myers Squibb and Pfizer. M.J.C. has received honoraria and/or participated in advisory board meetings with Amgen, AstraZeneca, Eli Lilly, Merck, and Roche; has received institutional research funding from Eli Lilly and Merck; and holds equity in Need. P.M.E. has received honoraria and/or has participated in advisory board meetings with AstraZeneca, Bristol Myers Squibb, Janssen, Roche, Lilly, Merck, Sanofi, Novartis, and Pfizer. A.V.L. has received honoraria and/or has participated in advisory board meetings with AstraZeneca. S.M. has received honoraria and/or has participated in advisory board meetings with Amgen, AstraZeneca, Bristol Myers Squibb, Merck, and Pfizer. B.S.S. has participated in advisory board meetings with Amgen, AstraZeneca, Bayer, Eli Lilly, Janssen, Merck, Novartis, Pfizer, and Roche; has received honoraria from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, EMD Serono, Merck, Novartis, Pfizer, Roche, and Thermo Fisher; has received grant support from AstraZeneca, Biocartis, Boehringer Ingelheim, Eli Lilly, EMD Serono, Novartis, Pfizer, Roche, and Thermo Fisher; and has received research funding from AstraZeneca, Biocartis, Boehringer Ingelheim, Eli Lilly, EMD Serono, Novartis, Pfizer, Roche, and Thermo Fisher. J.D.S. has received honoraria and/or has participated in advisory board meetings with Amgen, AstraZeneca, Bristol Myers Squibb, Chemocentryx, Eisai, Merck, Novartis, Pfizer, Protalix Biotherapeutics, Regeneron, Roche, and Xenetic Biosciences; has received institutional research funding from AstraZeneca, Bristol Myers Squibb, CLS Therapeutics, Merck Sharp and Dohme, Pfizer, Protalix Biotherapeutics, Regeneron, and Roche; has received support for attending meetings or travel from AstraZeneca, Bristol Myers Squibb, and Merck; has participated on a clinical trial safety monitoring board for AstraZeneca; and has received equipment, materials, drugs, gifts, or other services via grants to his institution from AstraZeneca, Bristol Myers Squibb, Merck Sharp and Dohme, and Roche. P.J.V. declares no conflicts of interest. N.B.L. has received institutional research funding from Amgen, AstraZeneca, Bayer, Eli Lilly, EMD Serono, Guardant Health, Inivata, Janssen, Merck Sharp and Dohme, Novartis, Pfizer, Roche Canada, and Takeda; and has received travel, accommodations, or expenses from AstraZeneca, Guardant Health, Janssen, Merck Sharp and Dohme, Roche, and Sanofi.

Figures

Figure A1
Figure A1
Example of a rank score calculation.
Figure A2
Figure A2
Pre-meeting survey treatment preferences based on disease stage, histology, and PD-L1 expression: (a) stage IIA and IIB; (b) stage IIIA; (c) stage IIIB. Sx, surgery; CT, chemotherapy; ICI, immune checkpoint inhibitor; cCRT, concurrent chemoradiation therapy.
Figure A2
Figure A2
Pre-meeting survey treatment preferences based on disease stage, histology, and PD-L1 expression: (a) stage IIA and IIB; (b) stage IIIA; (c) stage IIIB. Sx, surgery; CT, chemotherapy; ICI, immune checkpoint inhibitor; cCRT, concurrent chemoradiation therapy.
Figure 1
Figure 1
Curative-intent strategies based on Current Health Canada Approvals and CCO/OH funding.
Figure 2
Figure 2
Preferred treatment approaches based on: (a) smoking history and PD-L1 expression, case #1; (b) nodal involvement, case #2; (c) genomic alterations, case #3. N indicates the number of participants that answered each question.
Figure 3
Figure 3
Heterogeneity of PD-L1 expression within small tumor biopsy. Property of Dr. Brendon Sheffield, Department of Laboratory Medicine, William Osler Health System (used with permission from B.S.S.).
See this image and copyright information in PMC

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