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Send us Fan MailThe July 2026 PBS update brings a number of important changes for oncology clinicians, with several new and expanded cancer medicine listings set to improve access to cancer treatments across breast, lung, blood and biliary tract cancers.In this episode, Rachael Babin and Professor Craig Underhill discuss the clinical significance of the latest Pharmaceutical Benefits Scheme changes, including who is now eligible for treatment, what these listings mean for multidisciplinary care and why comprehensive biomarker testing continues to grow in importance.In this episode:PBS listing for pertuzumab (Perjeta®) in high-risk HER2-positive early breast cancer Listing of alectinib (Alecensa®) for ALK-positive non-small cell lung cancer Osimertinib (Tagrisso®) listing for EGFR-mutated unresectable Stage III NSCLC following chemoradiation First PBS listing of romidepsin (Romidepsin-Reach®) for relapsed peripheral T-cell lymphoma First PBS listing of futibatinib (Lytgobi®) for FGFR2-altered advanced cholangiocarcinoma What the new broad (multi-cancer) PBS listing principles for PD-(L)1 inhibitors could mean for future cancer drug fundingFollow The PBS Update for regular discussions on PBS listings and oncology policy changes affecting Australian healthcare professionals.Visit the Show Notes for links to the PBS updates discussed in this episode and to send us audio feedback or questions for future episodes.Proudly produced by The Oncology Network
In this episode of JCO Article Insights, host Dr. Ece Cali Daylan interviews author Dr. Jeffrey Bradley about the article, "Simultaneous Durvalumab and Chemoradiotherapy in Unresectable Stage III Non–Small Cell Lung Cancer" by Bradley, et al published October 13, 2025. TRANSCRIPT Dr. Ece Cali: Welcome to this episode of JCO Article Insights. This is Dr. Ece Cali, JCO Editorial Fellow. Today I'm joined by Dr. Jeffrey Bradley, Professor of Radiation Oncology at the University of Pennsylvania, to discuss the manuscript, "Simultaneous Durvalumab and Platinum-Based Chemoradiotherapy in Unresectable Stage III Non-Small-Cell Lung Cancer: The Phase III PACIFIC-2 Study." The PACIFIC-2 study was a phase III, double-blind, randomized trial comparing the efficacy and safety of simultaneous durvalumab with concurrent chemoradiation followed by consolidation durvalumab to the concurrent chemoradiation followed by placebo in patients with unresectable stage III non-small cell lung cancer. The primary endpoint was progression-free survival by blinded independent central review. The secondary endpoints were overall response rate, overall survival, and safety. Three hundred twenty-eight patients were randomized 2:1 to durvalumab and placebo, respectively. Unfortunately, this trial did not meet its primary endpoint. There were no statistically significant differences in PFS or OS. The frequency of adverse events was similar between the two arms. Grade 3 or higher adverse events were observed in 53% of the patients in the durvalumab arm compared to 59% of the patients in the placebo arm. Of note, the frequency of pneumonitis was similar in the two arms. Approximately 28% of patients in each arm developed pneumonitis, and about 5% of the pneumonitis observed in each arm was grade 3 or higher in severity. Treatment discontinuation rates secondary to the adverse events were higher in the durvalumab arm, 25% compared to 12%. Adverse events leading to treatment discontinuation and death were more frequently seen in the durvalumab arm during the first four months of the treatment, which corresponds to the simultaneous administration of chemoradiation and durvalumab. Dr. Bradley, before we delve into the results, can you please explain the rationale for this study design and how this concept fits into the current treatment landscape? Dr. Jeffrey Bradley: Yeah, this trial came on the heels of PACIFIC after there was a progression-free survival benefit showed in PACIFIC that in the locally advanced unresectable population that consolidation immunotherapy, in this case durvalumab, had a progression-free survival benefit. A number of us in the clinical trial space thought to add concurrent immunotherapy in addition to consolidation immunotherapy that that would also improve outcomes for patients. So a number of trials were launched to follow up of PACIFIC. In this case, this is a phase III trial where the control arm was placebo. There was no overall survival results yet from PACIFIC, just a PFS benefit, and a number of countries across the world had not approved maintenance durvalumab in this space. So this trial looked at the experimental arm, which was concurrent immunotherapy, durvalumab, and chemoradiation followed by consolidation durvalumab versus placebo. Dr. Ece Cali: And if we were to focus on the safety profile first, an increased pneumonitis risk was a theoretical concern when immunotherapy is given concurrently with radiation. Do we see any major differences in the safety profile between the two arms in this trial? Dr. Jeffrey Bradley: No, and we were concerned about the addition of concurrent immunotherapy and chemoradiation, like you said, towards concern about increased pneumonitis rate, but we did not see increased pneumonitis in the experimental arm over placebo. And the grade 3 or higher, as you said, it was roughly 5%, more or less, in both arms, so we didn't see increase in pneumonitis toxicity with concurrent IO and chemoradiation. Dr. Ece Cali: But interestingly though, despite the lack of significantly increased toxicity with durvalumab, unfortunately, administering immunotherapy simultaneously with chemoradiation therapy did not improve survival. Lack of superiority of this treatment regimen, as you mentioned, is further confirmed across multiple similar negative trial readouts such as ECOG-ACRIN 5181 and CheckMate 73L. Dr. Bradley, in your view, what are some potential explanations for why this strategy did not pan out in clinical trials? Dr. Jeffrey Bradley: Regarding toxicity, let me go back and point out that we did see an increased number of immune-mediated adverse events. It was 34.7% in the concurrent immunotherapy arm versus 15.7% in the placebo arm. So that led to a higher number of discontinuations of immunotherapy which I think probably had an effect. So we didn't... there was an increased pneumonitis toxicity, but there were expected immune-mediated toxicities that caused people to stop giving immunotherapy. You can see that in the PFS curves. They were, you know, they crossed over after like a month, but initially there was lower PFS for the experimental arm, and then the experimental arm got better after we divided into four months, before four months and after four months. Dr. Ece Cali: For one reason or another, it looks like the simultaneous administration did not really improve outcomes. We now know that simultaneously giving them another concurrent radiation should really no longer be pursued in clinical trials for this patient population. Can you share with our audience what strategies are being studied in this setting and what trials to watch out for in the future? Dr. Jeffrey Bradley: Sure, I think when you add concurrent radiation to immunotherapy, there were more central tumors in this trial, I think you're killing lymphocytes and negating the effect of immunotherapy. So I think that's the smoking gun for this trial, for the ECOG trial, for the small cell trial that NRG reported, LU005, and other trials. So correct, I don't think there's any need to continue to pursue concurrent immunotherapy in this space of lung cancer. But that's not to say there aren't many other trials that are either ongoing, have accrued and awaiting results, or being planned for the next phase of clinical trials. We have a trial within NRG Oncology called NRG-LU008. It's a randomized phase III trial that is using an SBRT boost to a peripheral primary and chemoradiation to the nodes, because the primary tumor is the one that fails more often than the lymph nodes, and that's compared to PACIFIC in the control arm. PACIFIC-9 is another trial in the same line as the other PACIFIC trials. That one is using dual checkpoint inhibition versus the control arm being PACIFIC. So there are three arms in that trial, durva and oleclumab, durva and monalizumab versus the PACIFIC arm. And that trial is completed accrual, but we have no results from that study yet. Johnson & Johnson has a trial open looking at a nanoparticle. That's a radiosensitizer where bronchoscopy is used to inject the primary tumor and the lymph nodes with a radiosensitizer. That's a randomized phase ll trial that's ongoing. It's got three arms, two different doses of this radiosensitizing drug and then a control arm without injection at all. The control arm is again the PACIFIC arm. And then those of us within the NCI-based clinical trials evaluation program, CTEP, are proposing an intergroup trial that would compare induction chemo-immunotherapy followed by chemoradiation followed by maintenance immunotherapy versus PACIFIC in a phase III study. So I think there's other trials that are either completed, ongoing completed, or on the horizon to assess in this patient population. Dr. Ece Cali: Yeah, we definitely have an unmet need to improve survival outcomes for stage III patients, and it's great to hear that there are so many efforts looking at different strategies to improve outcomes for these patients. Thank you so much, Dr. Bradley, for this informative discussion and for sharing your insights. Any last thoughts? Dr. Jeffrey Bradley: Yeah, we need something, you know. PACIFIC was first reported in 2017, and we really haven't made progress in terms of changing that standard of care control for the last eight years. So we need progress in this area. Dr. Ece Cali: Yep, definitely. Thank you so much for joining, Dr. Bradley. And thank you for listening to JCO Article Insights. Please come back for more interviews and article summaries and be sure to leave us a rating and review so others can find our show. For more podcasts and episodes from ASCO, please visit asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. DISCLOSURES Dr. Bradley Honoria: Mevion Medical Systems, Inc. Consulting or Advisory Role: Varian, Inc, Genentech, Inc. Research Funding: Varian Medical Systems Dr. Cali Research Funding Company: BeiGene, Nuvalent, Inc., Astra Zeneca
CME credits: 1.25 Valid until: 31-07-2026 Claim your CME credit at https://reachmd.com/programs/cme/strategies-in-egfr-mutated-unresectable-stage-iii-nsclc/36149/ The rapid pace of therapeutic advances in lung cancer (LC) demands continual learning and adaptation from oncology clinicians. With new agents, indications, and biomarker-driven strategies emerging at an unprecedented rate, staying current is essential to delivering optimal care—but also increasingly challenging. This microlearning-based activity is designed to distill key clinical topics in a unique and digestible manner that can be easily integrated into a busy clinician's schedule. This activity will enable providers to engage in succinct, faculty-driven discussions addressing current gaps related to the diagnosis and individualized management of patients with early and advanced non-small cell lung cancer (NSCLC) as well as limited- and extensive-stage small cell lung cancer (SCLC).
CME credits: 1.25 Valid until: 31-07-2026 Claim your CME credit at https://reachmd.com/programs/cme/the-current-therapeutic-landscape-in-unresectable-stage-iii-nsclc/36148/ The rapid pace of therapeutic advances in lung cancer (LC) demands continual learning and adaptation from oncology clinicians. With new agents, indications, and biomarker-driven strategies emerging at an unprecedented rate, staying current is essential to delivering optimal care—but also increasingly challenging. This microlearning-based activity is designed to distill key clinical topics in a unique and digestible manner that can be easily integrated into a busy clinician's schedule. This activity will enable providers to engage in succinct, faculty-driven discussions addressing current gaps related to the diagnosis and individualized management of patients with early and advanced non-small cell lung cancer (NSCLC) as well as limited- and extensive-stage small cell lung cancer (SCLC).
CME credits: 1.25 Valid until: 31-07-2026 Claim your CME credit at https://reachmd.com/programs/cme/strategies-in-egfr-mutated-unresectable-stage-iii-nsclc/36149/ The rapid pace of therapeutic advances in lung cancer (LC) demands continual learning and adaptation from oncology clinicians. With new agents, indications, and biomarker-driven strategies emerging at an unprecedented rate, staying current is essential to delivering optimal care—but also increasingly challenging. This microlearning-based activity is designed to distill key clinical topics in a unique and digestible manner that can be easily integrated into a busy clinician's schedule. This activity will enable providers to engage in succinct, faculty-driven discussions addressing current gaps related to the diagnosis and individualized management of patients with early and advanced non-small cell lung cancer (NSCLC) as well as limited- and extensive-stage small cell lung cancer (SCLC).
CME credits: 1.25 Valid until: 31-07-2026 Claim your CME credit at https://reachmd.com/programs/cme/the-current-therapeutic-landscape-in-unresectable-stage-iii-nsclc/36148/ The rapid pace of therapeutic advances in lung cancer (LC) demands continual learning and adaptation from oncology clinicians. With new agents, indications, and biomarker-driven strategies emerging at an unprecedented rate, staying current is essential to delivering optimal care—but also increasingly challenging. This microlearning-based activity is designed to distill key clinical topics in a unique and digestible manner that can be easily integrated into a busy clinician's schedule. This activity will enable providers to engage in succinct, faculty-driven discussions addressing current gaps related to the diagnosis and individualized management of patients with early and advanced non-small cell lung cancer (NSCLC) as well as limited- and extensive-stage small cell lung cancer (SCLC).
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME information, and to apply for credit, please visit us at PeerView.com/BVU865. EBAC/CME credit will be available until October 7, 2025.Elevating Expectations, Broadening Impact: How to Leverage Immunotherapy and EGFR-Targeted Therapy to Improve Outcomes in Unresectable Stage III NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME information, and to apply for credit, please visit us at PeerView.com/BVU865. EBAC/CME credit will be available until October 7, 2025.Elevating Expectations, Broadening Impact: How to Leverage Immunotherapy and EGFR-Targeted Therapy to Improve Outcomes in Unresectable Stage III NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME information, and to apply for credit, please visit us at PeerView.com/BVU865. EBAC/CME credit will be available until October 7, 2025.Elevating Expectations, Broadening Impact: How to Leverage Immunotherapy and EGFR-Targeted Therapy to Improve Outcomes in Unresectable Stage III NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME information, and to apply for credit, please visit us at PeerView.com/BVU865. EBAC/CME credit will be available until October 7, 2025.Elevating Expectations, Broadening Impact: How to Leverage Immunotherapy and EGFR-Targeted Therapy to Improve Outcomes in Unresectable Stage III NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME information, and to apply for credit, please visit us at PeerView.com/BVU865. EBAC/CME credit will be available until October 7, 2025.Elevating Expectations, Broadening Impact: How to Leverage Immunotherapy and EGFR-Targeted Therapy to Improve Outcomes in Unresectable Stage III NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME information, and to apply for credit, please visit us at PeerView.com/BVU865. EBAC/CME credit will be available until October 7, 2025.Elevating Expectations, Broadening Impact: How to Leverage Immunotherapy and EGFR-Targeted Therapy to Improve Outcomes in Unresectable Stage III NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME information, and to apply for credit, please visit us at PeerView.com/BVU865. EBAC/CME credit will be available until October 7, 2025.Elevating Expectations, Broadening Impact: How to Leverage Immunotherapy and EGFR-Targeted Therapy to Improve Outcomes in Unresectable Stage III NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete EBAC/CME information, and to apply for credit, please visit us at PeerView.com/BVU865. EBAC/CME credit will be available until October 7, 2025.Elevating Expectations, Broadening Impact: How to Leverage Immunotherapy and EGFR-Targeted Therapy to Improve Outcomes in Unresectable Stage III NSCLC In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from AstraZeneca.Disclosure information is available at the beginning of the video presentation.
Data on the use of durvalumab after chemoradiotherapy transformed the standard of care for patients with unresectable stage III non-small cell lung cancer (NSCLC). “This is a real practice-changing observation from the PACIFIC trial,” said Robert A. Figlin, MD, the Steven Spielberg Family Chair in Hematology-Oncology at the Cedars-Sinai Cancer Center in Los Angeles. He recently spoke with Meghan Mooradian, MD, an instructor at Harvard Medical School in Boston, about her team's recent research assessing the protocol established by the PACIFIC study. “We really are hoping for a cure,” she said in describing how she makes decisions related to the timing of durvalumab after chemoradiotherapy. Dr. Mooradian also addressed toxicity concerns and shared what she sees as lingering questions related to disease progression. “What should we really be using next?” she asked. Dr. Mooradian reported consulting or advisory roles with AstraZeneca, the Bristol Myers Squibb Foundation, Istari Oncology, Regeneron, and Xilio Therapeutics; and other relationships with Aptitude Health, Curio Science, DAVA Oncology, and OncLive/MJH Life Sciences. Dr. Figlin reported various financial relationships.
Please visit answersincme.com/CFN860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, two experts in oncology discuss current and emerging treatments for unresectable stage I to III EGFR mutation–positive non–small-cell lung cancer. Upon completion of this activity, participants should be better able to: Review best practices for integrating biomarker testing into practice for stage I to III NSCLC; Describe the clinical profiles of current and emerging therapeutic approaches for the management of stage I to III NSCLC; and Outline multidisciplinary strategies to optimize the integration of a targeted approach into clinical practice for patients with stage I to III NSCLC.
Dr. Megan Daly presents the latest rapid recommendation update to the ASCO management of stage III NSCLC guideline, based on data from the phase III randomized LAURA trial, presented at the 2024 ASCO Annual Meeting, and subsequently published. She discusses the results of the trial, shares the updated recommendation from the expert panel, and the impact for both clinicians and patients. We also discuss future research in the area and exciting new developments to watch out for in the field. Read the full rapid update, “Management of Stage III Non-Small Cell Lung Cancer: ASCO Rapid Guideline Update” at www.asco.org/thoracic-cancer-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at www.asco.org/thoracic-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO-24-01324. Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Megan Daly from the University of California Davis Comprehensive Cancer Center, lead author on, “Management of Stage III Non–Small-Cell Lung Cancer: ASCO Rapid Guideline Update.” Thank you for being here today, Dr. Daly. Dr. Megan Daly: Thanks for having me, Brittany. Brittany Harvey: Great. Then before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Daly, who has joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then, to start us off on the content of this update, first, this guideline was updated based off new evidence presented at the 2024 ASCO Annual Meeting. Dr. Daly, could you describe the trial that prompted this rapid update to the management of stage III non-small cell lung cancer guideline? Dr. Megan Daly: The trial that prompted this update is the LAURA trial. The LAURA trial was a phase III randomized trial conducted in patients with unresectable stage III non-small cell lung cancer harboring EGFR mutations, either exon 19 deletions or L858R insertions. Patients in this trial were randomized 2:1 between the third generation EGFR tyrosine kinase inhibitor osimertinib or placebo, and osimertinib or placebo were continued until progression or other reasons for discontinuation. Osimertinib was found to provide a considerable benefit in progression free survival, with a hazard ratio of 0.16. The median progression free survival for patients randomized to osimertinib was 39.1 months, and for patients on the placebo arm, it was 5.6 months. We did not yet have overall survival data from the LAURA trial. The data is not mature, but the considerable progression free survival benefit noted with osimertinib has drawn a lot of interest to this trial. Brittany Harvey: Absolutely. Thank you for describing the results of those trials and the endpoints. So then, based on this new evidence, what is the updated recommendation from the guideline expert panel? Dr. Megan Daly: The updated recommendation from the panel is that patients with unresectable stage III non-small cell lung cancer with an EGFR exon 19 deletion or exon 21 L858R mutation may be offered consolidation osimertinib after definitive chemoradiotherapy, which can be either platinum-based chemotherapy and thoracic radiation given either concurrently or sequentially. Our evidence quality is moderate and the strength of the recommendation is strong. Brittany Harvey: Great. And thank you for reviewing both the strength of the recommendation there as well as the evidence quality rating. So it's great to have this new option for patients. So what should clinicians know as they implement this new recommendation? Dr. Megan Daly: I think it's important for clinicians to know when they're counseling patients about considering osimertinib to understand that first, the LAURA trial enrolled patients who had common EGFR mutations. So exon 19 deletions or L858R mutations. Patients with other uncommon EGFR mutations were not included in the trial. It's important to know that overall survival data is not yet mature. We do not know yet whether the use of consolidation osimertinib leads to a survival benefit at this time. We only know that it leads to a progression-free survival benefit as compared to placebo. I think it's also important to know that there was increased toxicity noted on the experimental arm. Grade 3 or higher adverse events was significantly higher with the use of osimertinib. So these are all important considerations when counseling patients and considering the use of osimertinib. Brittany Harvey: Absolutely. Those are definitely key points, as you mentioned, to consider. And you've already touched on this a little bit. But how does this change impact patients living with stage III non-small cell lung cancer? Dr. Megan Daly: We do see in the LAURA trial a rather remarkable benefit for progression-free survival. The progression-free survival, as I already mentioned, increased from 5.6 months median on the control arm to 39.1 months on the experimental arm with consolidation osimertinib. So this is an exciting new option for patients with unresectable stage III non-small cell lung cancer who have one of these mutations to extend their progression-free survival by almost three years. And we hope that this progression-free survival benefit will end up translating into a considerable overall survival benefit as well. So, certainly, the overall survival data is eagerly awaited. Brittany Harvey: Definitely, this is a promising option for patients, and we look forward to future readouts of long-term data on this trial. So that's one of the outstanding questions here. But what other outstanding questions are there regarding the management of stage III non-small cell lung cancer? Dr. Megan Daly: I think what many of us question when we look at this data is whether we could extrapolate to the use of other targeted agents with other less common oncogenic driver mutations. Unfortunately, the answer is we simply don't know yet. We hope to see some ongoing data in the resectable setting. Doing randomized trials with rare oncogenic drivers in unresectable stage III lung cancer is very difficult, unfortunately, and there's always a degree of extrapolation for clinicians when trying to figure out how to best manage our patients. But for me, that's one of the biggest outstanding questions I think specifically ties into interpreting the LAURA trial and other related trials in patients with oncogenic driver mutations. I think there's still many outstanding questions about how we continue to improve outcomes for our patients with unresectable stage III non-small cell lung cancer, questions about how we optimize our radiation regimens to have the best possible local control while reducing toxicity. We still need to continue to have randomized trials looking at questions on optimizing radiation, optimizing concurrent chemotherapy, whether there are any settings where we might be able to reduce or omit chemotherapy in place of some of these newer agents. These are all outstanding questions that hopefully will be answered over the next several years. We also continue to have open questions about when patients are more appropriate for surgery and more appropriate for non-surgical options, those borderline patients with N2 nodes who may technically be surgical candidates or could potentially be downstaged with neoadjuvant therapy. So, I think there's a lot of exciting work going on in stage III right now. Brittany Harvey: Absolutely. We'll look forward to that more data that you mentioned for more optimal individualized options for these patients with stage III non-small cell lung cancer. And I want to thank you so much for your time to rapidly update this guideline based off new evidence presented and then published. And thank you for your time today, Dr. Daly. Dr. Megan Daly: Thank you, Brittany. It's great to be on here. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline update, go to www.asco.org/thoracic-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
CME credits: 1.00 Valid until: 15-05-2025 Claim your CME credit at https://reachmd.com/programs/cme/differentiating-and-managing-pneumonitis-in-unresectable-stage-iii-nsclc-case-discussion/24393/ In this video series, learners will explore best practices for the use of immunotherapies in unresectable stage III NSCLC, including staging, determining resectability, applying clinical data, and managing toxicities.
CME credits: 1.00 Valid until: 15-05-2025 Claim your CME credit at https://reachmd.com/programs/cme/optimizing-consolidative-immunotherapy-in-unresectable-stage-iii-nsclc-case-discussion/24392/ In this video series, learners will explore best practices for the use of immunotherapies in unresectable stage III NSCLC, including staging, determining resectability, applying clinical data, and managing toxicities.
CME credits: 1.00 Valid until: 15-05-2025 Claim your CME credit at https://reachmd.com/programs/cme/consolidative-immunotherapy-in-unresectable-stage-iii-nsclc-with-oncogenic-drivers/24391/ In this video series, learners will explore best practices for the use of immunotherapies in unresectable stage III NSCLC, including staging, determining resectability, applying clinical data, and managing toxicities.
CME credits: 1.00 Valid until: 15-05-2025 Claim your CME credit at https://reachmd.com/programs/cme/immunotherapy-approaches-in-unresectable-stage-iii-nsclc-whats-on-the-horizon/24390/ In this video series, learners will explore best practices for the use of immunotherapies in unresectable stage III NSCLC, including staging, determining resectability, applying clinical data, and managing toxicities.
CME credits: 1.00 Valid until: 15-05-2025 Claim your CME credit at https://reachmd.com/programs/cme/consolidative-immunotherapy-following-scrt-vs-rt-only-in-stage-iii-nsclc/24388/ In this video series, learners will explore best practices for the use of immunotherapies in unresectable stage III NSCLC, including staging, determining resectability, applying clinical data, and managing toxicities.
CME credits: 1.00 Valid until: 15-05-2025 Claim your CME credit at https://reachmd.com/programs/cme/resolving-practice-barriers-to-consolidative-immunotherapy-in-stage-iii-nsclc/24386/ In this video series, learners will explore best practices for the use of immunotherapies in unresectable stage III NSCLC, including staging, determining resectability, applying clinical data, and managing toxicities.
Check out this week's QuadCast as we highlight the role of systemic therapy with SABR in oligometastatic disease, the role of immunotherapy in EGFR-mutated Stage III NSCLC, the role of mirtazepine in cancer-related anorexia, and more. Check out the website and subscribe to the newsletter! www.quadshotnews.com Founders & Lead Authors: Laura Dover & Caleb Dulaney Podcast Host: Sam Marcrom
In this episode of Lung Cancer Considered, host Dr. Stephen Liu leads a discussion on the role of neoadjuvant therapy for stage III NSCLC using a virtual tumor board format. This area has become increasingly complex of late, as we have seen several large studies report encouraging results with peri-operative immunotherapy and targeted therapy.
Out Landmarks of OncoPharm series returns to chronicle how treatment of stage III NSCLC has changed over time with an overview of three studies. 1. Dillman (1990) NEJM (sequential chemo --> RT): https://doi.org/10.1056/nejm199010043231403 2. Albain (1995) JCO (concurrent cisplatin/etoposide + RT): https://pubmed.ncbi.nlm.nih.gov/?term=7636530 3. Albain (2009) Lancet (concurrent cis/etposide + RT --> surgery --> consolidation chemo): https://doi.org/10.1016/s0140-6736(09)60737-6
Dr. Navneet Singh joins us again, this time to discuss the rapid recommendation update for stage III non-small cell lung cancer, incorporating updated data presented at the 2023 ASCO Annual Meeting. He discusses the new trials that prompted the guideline update and updated recommendations on adjuvant osimertinib for patients with EGFR exon 19 deletion or exon 21 L858R mutation, and the option of neoadjuvant chemoimmunotherapy for patients with stage III NSCLC. Read the update, "Management of Stage III Non-Small Cell Lung Cancer: ASCO Guideline Rapid Recommendation Update" at www.asco.org/thoracic-cancer-guidelines TRANSCRIPT This guideline, clinical tools, and resources are available at www.asco.org/thoracic-cancer-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest disclosures in the Journal of Clinical Oncology, https://ascopubs.org/doi/10.1200/JCO.23.01261 Brittany Harvey: Hello and welcome to the ASCO Guidelines podcast, one of ASCO's podcasts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all the shows, including this one, at asco.org/podcasts. My name is Brittany Harvey, and today I'm interviewing Dr. Navneet Singh from the Postgraduate Institute of Medical Education and Research in Chandigarh, India, Co-chair on “Management of Stage III Non-Small Cell Lung Cancer: ASCO Guideline Rapid Recommendation Update.” Thank you for being here, Dr. Singh. Dr. Navneet Singh: Thank you for having me. Brittany Harvey: Then, before we discuss this guideline, I'd just like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Singh, who is joining us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. So then, to dive into the content of this guideline, first, Dr. Singh, what prompted this rapid update to the ASCO management of stage III non-small cell lung cancer, which was initially published in 2021? Dr. Navneet Singh: There have been a number of studies that have involved patients with stage III non-small cell lung cancer since the publication of the stage III NSCLC management guidelines. Of note, three trials deserve special recognition and have actually formed the basis for this rapid update. These include the ADAURA trial for use of osimertinib as adjuvant treatment for completely resected stages Ib to IIIa NSCLC and harboring a sensitizing EGFR mutation. The other two trials have explored the use of PD-1 immune checkpoint inhibitor therapy in combination with chemotherapy as neoadjuvant treatment of potentially resectable stages I to III NSCLC. And these are the CheckMate 816 trial with nivolumab and the KEYNOTE-671 trial with pembrolizumab. Brittany Harvey: Great, thank you for that background. So then, based off these three new trials that you just mentioned, what are the updated recommendations issued in this rapid recommendation update? Dr. Navneet Singh: The first updated recommendation is based on the overall survival benefit observed in the ADAURA trial. And this recommendation is that patients with dissected stage III NSCLC and harboring an EGFR exon 19 deletion or an exon 21 L858R mutation should be offered adjuvant osimertinib after platinum-based chemotherapy. The second important update is that in the absence of contraindications, patients with stage III non-small cell lung cancer who are planned for surgical resection should receive a neoadjuvant combination of a platinum doublet chemotherapy, and immunotherapy. Now, both of these are based on high-quality evidence and have a strong strength of recommendation. Brittany Harvey: Understood. I appreciate you reviewing both the level of evidence and the strength of the recommendation for those as well. So then, what should clinicians know as these new recommendations are implemented? Dr. Navneet Singh: Now, it's very important for clinicians involved in the management of lung cancer to realize the importance of biomarker testing, something that was initially believed to have relevance only for metastatic disease. But now, with the availability of data indicating the benefit of immunotherapy and targeted therapy not just in metastatic disease but also in early-stage as well as locally advanced disease, clinicians need to ensure that biomarker testing, especially EGFR mutation and PD-L1 expression by approved and validated methods is performed in all patients with stages I to III non-small cell lung cancer. This is important to decide and select patients for the appropriate biological therapy, which is either targeted therapy or immunotherapy that can be used in conjunction with or following chemotherapy. I need to clarify here that the spectrum of biomarker testing that is recommended for metastatic disease is much larger than what is currently being advocated for early or locally advanced NSCLC. Brittany Harvey: Great, and I appreciate that clarification. So then you've just described what this guideline means for clinicians, but how does this rapid update impact patients diagnosed with stage III non-small cell lung cancer? Dr. Navneet Singh: Well, for patients with stage III non-small cell lung cancer, all the three trials that form the basis for this rapid update indicate very encouraging developments. The neoadjuvant chemo-immunotherapy approach is now the standard of care for potentially resectable stage III disease, as this combination has been shown to be superior to chemotherapy alone in terms of higher probability of achieving a complete or major pathological tumor response, as well as improving recurrence or event-free survival following surgical resection. Similarly, adjuvant osimertinib for resected stage III NSCLC patients having a sensitizing EGFR mutation has been shown to significantly improve overall survival compared to placebo. It is important to highlight here that osimertinib treatment in stage III NSCLC should be initiated following the completion of adjuvant chemotherapy. Brittany Harvey: Understood. So then this panel works to rapidly update this guideline, turning it around after the ASCO Annual Meeting. But what are the ongoing research developments that the panel is monitoring for future guideline updates? Dr. Navneet Singh: Well, the expert panel is eagerly awaiting overall survival data from the neoadjuvant chemo-immunotherapy trials. We have several unanswered questions which ongoing research will attempt to answer. And some of these questions include number one, whether adjuvant immunotherapy is beneficial for patients who have already received neoadjuvant chemo-immunotherapy, and if so, what is the optimal duration for the same? Second, is the three-year adjuvant osimertinib duration appropriate? Can lesser duration of treatment suffice for a subgroup of patients? And if so, it would lead to a reduction in both treatment costs as well as a reduction in potential treatment-related adverse effects. On the other hand, other patients in whom stopping at three years may not be warranted, and should patients with exon 19 deletion be treated differently from those with exon 21 L858R mutation? Third, does a similar adjuvant targeted therapy approach be warranted for ALK-rearranged NSCLC that has been surgically resected? And fourth, are there specific subgroups of patients undergoing neoadjuvant treatment in whom immunotherapy as a neoadjuvant treatment may not be effective? Examples are those with EGFR mutations or ALK rearrangements, or even those with no PD-L1 expression. Brittany Harvey: Absolutely. We'll look forward to finding the answer to those questions for future guideline updates. So I want to thank you so much for your work to rapidly update this guideline and thank you for your time today, Dr. Singh. Dr. Navneet Singh: Pleasure. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/thoracic-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO Guidelines app available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.
In this TOGA Podcast, we discuss what defines operability in locally advanced stage III NSCLC. A/Professor Tim Clay, Medical Oncologist from St John of God Subiaco and Rockingham General is joined by Professor Lucy Morgan, Board Chair of the Lung Foundation of Australia and Respiratory Physician from Concord & Nepean Hospitals; A/Professor Phillip Antippa, Cardiothoracic surgeon and the Head of Thoracic Surgical Services at the Royal Melbourne Hospital and the VCCC and also Dr Qurrat van den Blink, Radiation Oncologist from GenesisCare based in Perth (Joondalup) and Albany.
Practical Radiation Oncology associate section editor Ashley Weiner, MD, PhD, of University of North Carolina - Chapel Hill hosts a conversation on the ASTRO Radiation Therapy Summary of the ASCO Guideline on Management of Stage III Non-Small Cell Lung Cancer. Two of the authors, Charles Simone MD, of the New York Proton Center and Memorial Sloan Kettering Cancer Center and George Rodrigues, MD, PhD of the London Health Sciences Center and University of Western Ontario discuss the updated guidelines and review specific questions related to the management of patients with Stage III NSCLC. They focus on the key clinical questions around neoadjuvant therapy, adjuvant therapy, and definitive chemoradiotherapy for Stage III lung cancer with a thorough review of the guidelines and insights into their own clinical expertise in the multidisciplinary management of NSCLC.
In this episode of Lung Cancer Considered, host Dr. Stephen Liu, Director of Thoracic Oncology at Georgetown University, leads a discussion about the management of stage III NSCLC. Joining him are pulmonologist Dr. Martin Reck, Head of the Department of Thoracic Oncology and the Head of the Clinical Trials Department at the Lung Clinic Grosshansdorf and thoracic surgeon Dr. Paula Antonia Ugalde Figueroa, an Associate Surgeon in the Division of Thoracic Surgery at Brigham and Women's Hospital in Boston, MA. Dr. Reck has led many of the oncology trials that have defined the standard of care for lung cancer including KEYNOTE-024 and more recent efforts in stage III NSCLC like KEYNOTE-799. Dr. Ugalde has been a pioneer in minimally invasive surgery from her time as director of Thoracic Oncology research at Laval University in Quebec to her current position at the Dana Farber Cancer Institute. She is currently a member of the Board of Directors of IASLC.
Welcome to the Thoracic Oncology Group of Australasia Podcast series. Associate Professor Shankar Siva, Radiation Oncologist and current Cancer Council Victoria Colebatch Fellow who leads the SABR program at Peter MacCallum Cancer Centre discusses The Management of Stage III NSCLC in this podcast. Shankar is joined by Associate Professor Rachel Wong, Deputy Director of Oncology - Eastern Health, Adjunct Clinical Assoc Professor - Monash University and Clinical Research Fellow – WEHI and also Professor Drew Moghanaki, Chief of Thoracic Oncology, Department of Radiation Oncology at UCLA, Stanley Lezman and Nancy Stark Endowed Chair in Thoracic Radiation Oncology Research, Co-Director Greater Los Angeles Lung Precision Oncology Program and Co-Director Greater Los Angeles CSP NODES Program also joins us today. Our focus today is on what defines inoperable NSCLC, patient selection and how to manage the toxicities associated with treatment.Thank you to AstraZeneca for sponsoring this podcast.
Join our Expert Faculty, Drs. Joel W. Neal, MD, PhD and Victoria Sherry, DNP, CRNP, AOCNP as they discuss treatment principles across the continuum of care in unresectable, stage III NSCLC. During their presentations and discussion, they will examine the established treatment landscape for unresectable, stage III NSCLC as well as the emerging role of immunotherapy, and practical clinical considerations for anticipating, mitigating, and managing immune-related adverse events.Presented by Creative Educational Concepts, LLC.Supported through an independent educational grant from AstraZeneca.
Dr Jeffrey Bradley from the Emory University School of Medicine in Atlanta, Georgia, and Dr David Spigel from the Sarah Cannon Research Institute in Nashville, Tennessee, discuss the past, present and future management of unresectable Stage III non-small cell lung cancer. CME information and select publications here (http://www.researchtopractice.com/OncologyTodayStageIIINSCLC22).
An interview with Dr. Megan Daly from University of California in Davis, California and Dr. Navneet Singh from the Postgraduate Institute of Medical Education & Research in Chandigarh, India, co-chairs on “Management of Stage III Non–Small-Cell Lung Cancer: ASCO Guideline.” They summarize guideline recommendations on five subtopics – evaluation & staging, surgery, neoadjuvant therapy, adjuvant therapy, and unresectable disease. Read the full guideline at www.asco.org/thoracic-cancer-guidelines. TRANSCRIPT [MUSIC PLAYING] ANNOUNCER: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. BRITTANY HARVEY: Hello, and welcome to the ASCO Guidelines podcast series, brought to you by the ASCO Podcast Network, a collection of nine programs covering a range of educational and scientific content and offering enriching insight into the world of cancer care. You can find all the shows, including this one, at ASCO.org/podcasts. My name is Brittany Harvey, and today, I'm interviewing Dr. Megan Daley from University of California in Davis, California, and Dr. Navneet Singh from the Post-Graduate Institute of Medical Education and Research in Chandigarh, India, co-chairs on management of stage III non-small cell lung cancer ASCO guideline. Thank you for being here, Dr. Daley and Dr. Singh. MEGAN DALEY: Thank you for having us. NAVNEET SINGH: Thank you for having us, too. BRITTANY HARVEY: First, I'd like to note that ASCO takes great care in the development of its guidelines and ensuring that the ASCO conflict of interest policy is followed for each guideline. The full conflict of interest information for this guideline panel is available online with the publication of the guideline in the Journal of Clinical Oncology. Dr. Daley, do you have any relevant disclosures that are directly related to this guideline topic? MEGAN DALEY: I have research funding from EMD Serono, Merck, and Genentech. BRITTANY HARVEY: Thank you for those disclosures. Then Dr. Singh, do you have any relevant disclosures that are directly related to this guideline? NAVNEET SINGH: No, I have no financial conflicts of interest. BRITTANY HARVEY: Thank you. Getting into the content of this guideline, Dr. Singh, can you give us an overview of both the scope and the purpose of this guideline? NAVNEET SINGH: Yes, absolutely. So this guideline has been developed to assist clinicians involved in the management of patients with stage III non-small-cell lung cancer, or NSCLC, as we call it briefly. Now, stage III NSCLC represents one of the most heterogeneous subgroups of lung cancer. Consequently, it is also the subgroup in which the choice of multimodality treatment and the sequence of multimodality treatment varies significantly amongst clinicians, with variations being observed across institutes, as well as within an institute. And we sincerely hope that, with the help of this guideline, clinicians can accurately confirm the presence of stage III disease and offer the most appropriate treatment based on clinical and radiographic characteristics, as well as other medical factors that influence treatment decision-making. This evidence-based guidance also seeks to provide clarification on the common clinical dilemmas that clinicians may have while evaluating a patient with suspected or known stage III NSCLC. BRITTANY HARVEY: Thank you for that background information, Dr. Singh. Then, Dr. Daley, this guideline addresses five main sections, evaluation and staging, surgery, neoadjuvant therapy, adjuvant therapy, and unresectable disease. So starting with evaluation and staging, what are the key recommendations for workup for patients with suspected stage III non-small cell lung cancer? MEGAN DALEY: Our first recommendation for such patients is that they should undergo a history and physical exam and a CT scan of the chest and upper abdomen with contrast, unless it's contraindicated. If metastatic disease is not identified on CT, those patients should go on to a PET CT scan and MRI of the brain. If the patients are being considered for curative intent treatment, the guideline recommends pathologic mediastinal lymph node assessment. And we recommend that endoscopic techniques should be offered as the initial staging modality, if available. If not available, invasive surgical mediastinal staging should be offered. And finally, for patients who have suspected or confirmed stage III lung cancer, we recommend that multidisciplinary discussion should occur prior to any initiation of a treatment plan. BRITTANY HARVEY: Great, I appreciate your reviewing those recommendations. So following that, Dr. Singh, what does the guideline recommend regarding which patients with stage III non-small-cell lung cancer should be considered for surgical resection? NAVNEET SINGH: So in this guideline, the recommendation which has come forth is that for patients with stage IIIA, basically N2 disease, induction therapy should be followed by surgery with or without adjuvant therapy if several conditions are met. Basically, a complete resection of the primary tumor and the involved lymph nodes is deemed feasible, and three nodes or contralateral lymph nodes are deemed to be not involved, and the expected perioperative 90-day mortality is low, typically 5% or less. Another recommendation is that for selected patients with the P4N0 disease, surgical resection may be offered if medically and surgically feasible following multidisciplinary review. We would like to emphasize here that surgeons should always be involved in decisions regarding the feasibility of surgical resection. And they are an integral part of a multidisciplinary evaluation for surgical resection for stage III NSCLC patients. BRITTANY HARVEY: Great. Then Dr. Singh just reviewed who should be considered for surgical resection. So Dr. Daley, for patients with potentially resectable stage III non-small-cell lung cancer, what are the key recommendations for neoadjuvant therapy? MEGAN DALEY: Our first recommendation is that patients who are planned for a multimodality approach that will incorporate surgery should receive systemic neoadjuvant therapy. Second, that those patients with N2 disease who are planned for surgical resection should receive either neoadjuvant chemotherapy or neoadjuvant concurrent chemoradiation. And finally, for patients with a resectable superior sulcus tumor, neoadjuvant concurrent chemoradiation should be administered. BRITTANY HARVEY: Understood. Then in addition, Dr. Singh, for patients with resected stage III non-small-cell lung cancer, what are the key recommendations for adjuvant therapy? NAVNEET SINGH: So the panel came up with three recommendations for adjuvant treatment. The first is that patients with resected stage III NSCLC who did not receive neoadjuvant systemic therapy should be offered adjuvant platinum-based chemotherapy. The second recommendation which we came up was that for patients with resected stage III disease and presence of a sensitizing EGFR mutation-- classically, exon 19 deletion or the L858R exon 21 point mutation-- they may be offered adjuvant osimertinib, which is an EGFR inhibitor, after platinum-based chemotherapy. And this is based upon the ADAURA trial, which was published last year. And the third recommendation was that for patients with completely resected NSCLC and mediastinal involvement N2 disease, but without extracapsular extension, post-operative radiotherapy should not be routinely offered. BRITTANY HARVEY: OK. And then the last section of recommendations covers unresectable disease. So Dr. Daley, what does the guideline recommend regarding the management of unresectable stage III non-small-cell lung cancer? MEGAN DALEY: The guideline first recommends that these patients who have a good performance status should be offered concurrent, rather than sequential, chemoradiation, that concurrent chemotherapy delivered with radiation should include a platinum-based doublet, preferably cisplatin-etoposide, carboplatin-paclitaxel, or cisplatin-pemetrexed or cisplatin-vinorelbine. The patients who are not candidates for concurrent chemoradiation, but who are potentially candidates for chemotherapy, should be offered sequential chemoradiation, rather than radiation alone, that patients receiving concurrent chemoradiation should be treated to 60 gray. And that's based on the results of RTOG 0617. We also recommend within the guideline that doses higher than 60 gray and up to 70 gray could be considered for selected patients, with careful attention to doses to the heart, lung, and esophagus, among other organs. The guideline also recommends that patients receiving definitive radiation without chemotherapy, that hypofractionation using slightly larger doses could be considered-- over 2 gray per fraction, and up to 4 gray per fraction, and that patients without disease progression during concurrent chemoradiation should be offered consolidation durvalumab, based on the PACIFIC trial. BRITTANY HARVEY: Thank you both, then, for reviewing the key recommendations of this guideline. So, Dr. Singh, in your view, what is the importance of this guideline, and how does it impact clinicians? NAVNEET SINGH: I think this guideline will go a long way in helping clinicians who are involved in the diagnosis and treatment of lung cancer, especially stage III NSCLC. As mentioned earlier, this is a very heterogeneous disease. And there are several challenging situations, both in the context of diagnosis, as well as treatment. And using this guideline, which has an extensive evidence review, as well as the development of two very helpful algorithms, we sincerely hope that clinicians who are both in academic centers as well as in practice in the community are able to accurately diagnose stage III, appropriately stage it, and offer the best treatment, given the patient characteristics and the disease characteristics and available resources. BRITTANY HARVEY: Great. Those are important points. So then, finally, Dr. Daley, how will these guideline recommendations affect patients? MEGAN DALEY: Well, we hope very much that these guidelines will help patients consistently receive high-quality care for their stage III lung cancer. In particular, we're hoping that the recommendation from multidisciplinary assessment of patients prior to treatment is carefully followed. We're hoping that some of the recommendations surrounding the appropriate workup for patients may help ensure that all patients receive a thorough and complete workup prior to initiation of treatment. And the guideline, in particular, is highlighting some of the more recent developments in stage III lung cancer, such as the use of consolidation durvalumab based on the PACIFIC trial, the use of osimertinib in resectable disease based on the ADAURA trial. And we're hoping to make sure that these results are disseminated to practitioners everywhere so that patients can receive the latest and best care for their stage III lung cancer. BRITTANY HARVEY: Understood. Yeah, as you both mentioned, we hope that this has a positive impact for both clinicians and patients. So I want to thank you both for all of your hard work to develop this guideline and the evidence-based recommendations along with it. And thank you for taking the time to speak with me today, Dr. Daley and Dr. Singh. MEGAN DALEY: Thank you so much for having us. NAVNEET SINGH: Thank you. BRITTANY HARVEY: And thank you to all of our listeners for tuning into the ASCO Guidelines podcast series. To read the full guideline, go to www.asco.org/thoracic-cancer-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO guidelines app, available in iTunes or the Google Play store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode. [MUSIC PLAYING]
Go online to PeerView.com/DDV860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. The broad implications of the expanding role of cancer immunotherapies in lung cancer necessitate multidisciplinary collaboration, especially in the locally advanced setting where appropriate patient evaluation and selection for immune checkpoint inhibitors (ICIs) along with other multimodal therapies requires input from a medical oncologist, a radiation oncologist, as well as a thoracic surgeon, among other specialists. Effective communication and coordination of care are also essential in the management of patients with unresectable stage III non–small cell lung cancer (NSCLC) deemed to be good candidates for consolidation ICI therapy after chemoradiation. How should this be operationalized in real-world settings? Learn useful strategies from this PeerView MasterClass and Tumor Board based on a recent web broadcast, which delivers evidence-based guidance on the best practices related to multidisciplinary patient assessment and treatment planning to help you improve outcomes in your patients with stage III NSCLC. Our panel of experts navigates through the latest evidence, key challenges, and controversies, as well as debates a series of real cases to demonstrate how to individualize patient care in the midst of rapid research and clinical advances. Upon completion of this activity, participants should be better able to: Discuss the latest clinical evidence on cancer immunotherapy in unresectable stage III NSCLC, Collaborate with relevant specialists to stage lung cancer, assess tumor resectability, and develop individualized treatment plans for patients with stage III NSCLC, Integrate cancer immunotherapies into the management of patients with unresectable stage III NSCLC according to the latest evidence and guidelines, multidisciplinary/interprofessional perspectives, and patient treatment and quality of life goals, Apply effective strategies to identify and manage immune-related adverse events in patients receiving cancer immunotherapy for unresectable stage III NSCLC treatment.
Go online to PeerView.com/DDV860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. The broad implications of the expanding role of cancer immunotherapies in lung cancer necessitate multidisciplinary collaboration, especially in the locally advanced setting where appropriate patient evaluation and selection for immune checkpoint inhibitors (ICIs) along with other multimodal therapies requires input from a medical oncologist, a radiation oncologist, as well as a thoracic surgeon, among other specialists. Effective communication and coordination of care are also essential in the management of patients with unresectable stage III non–small cell lung cancer (NSCLC) deemed to be good candidates for consolidation ICI therapy after chemoradiation. How should this be operationalized in real-world settings? Learn useful strategies from this PeerView MasterClass and Tumor Board based on a recent web broadcast, which delivers evidence-based guidance on the best practices related to multidisciplinary patient assessment and treatment planning to help you improve outcomes in your patients with stage III NSCLC. Our panel of experts navigates through the latest evidence, key challenges, and controversies, as well as debates a series of real cases to demonstrate how to individualize patient care in the midst of rapid research and clinical advances. Upon completion of this activity, participants should be better able to: Discuss the latest clinical evidence on cancer immunotherapy in unresectable stage III NSCLC, Collaborate with relevant specialists to stage lung cancer, assess tumor resectability, and develop individualized treatment plans for patients with stage III NSCLC, Integrate cancer immunotherapies into the management of patients with unresectable stage III NSCLC according to the latest evidence and guidelines, multidisciplinary/interprofessional perspectives, and patient treatment and quality of life goals, Apply effective strategies to identify and manage immune-related adverse events in patients receiving cancer immunotherapy for unresectable stage III NSCLC treatment.
Go online to PeerView.com/DDV860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. The broad implications of the expanding role of cancer immunotherapies in lung cancer necessitate multidisciplinary collaboration, especially in the locally advanced setting where appropriate patient evaluation and selection for immune checkpoint inhibitors (ICIs) along with other multimodal therapies requires input from a medical oncologist, a radiation oncologist, as well as a thoracic surgeon, among other specialists. Effective communication and coordination of care are also essential in the management of patients with unresectable stage III non–small cell lung cancer (NSCLC) deemed to be good candidates for consolidation ICI therapy after chemoradiation. How should this be operationalized in real-world settings? Learn useful strategies from this PeerView MasterClass and Tumor Board based on a recent web broadcast, which delivers evidence-based guidance on the best practices related to multidisciplinary patient assessment and treatment planning to help you improve outcomes in your patients with stage III NSCLC. Our panel of experts navigates through the latest evidence, key challenges, and controversies, as well as debates a series of real cases to demonstrate how to individualize patient care in the midst of rapid research and clinical advances. Upon completion of this activity, participants should be better able to: Discuss the latest clinical evidence on cancer immunotherapy in unresectable stage III NSCLC, Collaborate with relevant specialists to stage lung cancer, assess tumor resectability, and develop individualized treatment plans for patients with stage III NSCLC, Integrate cancer immunotherapies into the management of patients with unresectable stage III NSCLC according to the latest evidence and guidelines, multidisciplinary/interprofessional perspectives, and patient treatment and quality of life goals, Apply effective strategies to identify and manage immune-related adverse events in patients receiving cancer immunotherapy for unresectable stage III NSCLC treatment.
Go online to PeerView.com/DDV860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. The broad implications of the expanding role of cancer immunotherapies in lung cancer necessitate multidisciplinary collaboration, especially in the locally advanced setting where appropriate patient evaluation and selection for immune checkpoint inhibitors (ICIs) along with other multimodal therapies requires input from a medical oncologist, a radiation oncologist, as well as a thoracic surgeon, among other specialists. Effective communication and coordination of care are also essential in the management of patients with unresectable stage III non–small cell lung cancer (NSCLC) deemed to be good candidates for consolidation ICI therapy after chemoradiation. How should this be operationalized in real-world settings? Learn useful strategies from this PeerView MasterClass and Tumor Board based on a recent web broadcast, which delivers evidence-based guidance on the best practices related to multidisciplinary patient assessment and treatment planning to help you improve outcomes in your patients with stage III NSCLC. Our panel of experts navigates through the latest evidence, key challenges, and controversies, as well as debates a series of real cases to demonstrate how to individualize patient care in the midst of rapid research and clinical advances. Upon completion of this activity, participants should be better able to: Discuss the latest clinical evidence on cancer immunotherapy in unresectable stage III NSCLC, Collaborate with relevant specialists to stage lung cancer, assess tumor resectability, and develop individualized treatment plans for patients with stage III NSCLC, Integrate cancer immunotherapies into the management of patients with unresectable stage III NSCLC according to the latest evidence and guidelines, multidisciplinary/interprofessional perspectives, and patient treatment and quality of life goals, Apply effective strategies to identify and manage immune-related adverse events in patients receiving cancer immunotherapy for unresectable stage III NSCLC treatment.
Go online to PeerView.com/DDV860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. The broad implications of the expanding role of cancer immunotherapies in lung cancer necessitate multidisciplinary collaboration, especially in the locally advanced setting where appropriate patient evaluation and selection for immune checkpoint inhibitors (ICIs) along with other multimodal therapies requires input from a medical oncologist, a radiation oncologist, as well as a thoracic surgeon, among other specialists. Effective communication and coordination of care are also essential in the management of patients with unresectable stage III non–small cell lung cancer (NSCLC) deemed to be good candidates for consolidation ICI therapy after chemoradiation. How should this be operationalized in real-world settings? Learn useful strategies from this PeerView MasterClass and Tumor Board based on a recent web broadcast, which delivers evidence-based guidance on the best practices related to multidisciplinary patient assessment and treatment planning to help you improve outcomes in your patients with stage III NSCLC. Our panel of experts navigates through the latest evidence, key challenges, and controversies, as well as debates a series of real cases to demonstrate how to individualize patient care in the midst of rapid research and clinical advances. Upon completion of this activity, participants should be better able to: Discuss the latest clinical evidence on cancer immunotherapy in unresectable stage III NSCLC, Collaborate with relevant specialists to stage lung cancer, assess tumor resectability, and develop individualized treatment plans for patients with stage III NSCLC, Integrate cancer immunotherapies into the management of patients with unresectable stage III NSCLC according to the latest evidence and guidelines, multidisciplinary/interprofessional perspectives, and patient treatment and quality of life goals, Apply effective strategies to identify and manage immune-related adverse events in patients receiving cancer immunotherapy for unresectable stage III NSCLC treatment.
Go online to PeerView.com/DDV860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. The broad implications of the expanding role of cancer immunotherapies in lung cancer necessitate multidisciplinary collaboration, especially in the locally advanced setting where appropriate patient evaluation and selection for immune checkpoint inhibitors (ICIs) along with other multimodal therapies requires input from a medical oncologist, a radiation oncologist, as well as a thoracic surgeon, among other specialists. Effective communication and coordination of care are also essential in the management of patients with unresectable stage III non–small cell lung cancer (NSCLC) deemed to be good candidates for consolidation ICI therapy after chemoradiation. How should this be operationalized in real-world settings? Learn useful strategies from this PeerView MasterClass and Tumor Board based on a recent web broadcast, which delivers evidence-based guidance on the best practices related to multidisciplinary patient assessment and treatment planning to help you improve outcomes in your patients with stage III NSCLC. Our panel of experts navigates through the latest evidence, key challenges, and controversies, as well as debates a series of real cases to demonstrate how to individualize patient care in the midst of rapid research and clinical advances. Upon completion of this activity, participants should be better able to: Discuss the latest clinical evidence on cancer immunotherapy in unresectable stage III NSCLC, Collaborate with relevant specialists to stage lung cancer, assess tumor resectability, and develop individualized treatment plans for patients with stage III NSCLC, Integrate cancer immunotherapies into the management of patients with unresectable stage III NSCLC according to the latest evidence and guidelines, multidisciplinary/interprofessional perspectives, and patient treatment and quality of life goals, Apply effective strategies to identify and manage immune-related adverse events in patients receiving cancer immunotherapy for unresectable stage III NSCLC treatment.
Go online to PeerView.com/DDV860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. The broad implications of the expanding role of cancer immunotherapies in lung cancer necessitate multidisciplinary collaboration, especially in the locally advanced setting where appropriate patient evaluation and selection for immune checkpoint inhibitors (ICIs) along with other multimodal therapies requires input from a medical oncologist, a radiation oncologist, as well as a thoracic surgeon, among other specialists. Effective communication and coordination of care are also essential in the management of patients with unresectable stage III non–small cell lung cancer (NSCLC) deemed to be good candidates for consolidation ICI therapy after chemoradiation. How should this be operationalized in real-world settings? Learn useful strategies from this PeerView MasterClass and Tumor Board based on a recent web broadcast, which delivers evidence-based guidance on the best practices related to multidisciplinary patient assessment and treatment planning to help you improve outcomes in your patients with stage III NSCLC. Our panel of experts navigates through the latest evidence, key challenges, and controversies, as well as debates a series of real cases to demonstrate how to individualize patient care in the midst of rapid research and clinical advances. Upon completion of this activity, participants should be better able to: Discuss the latest clinical evidence on cancer immunotherapy in unresectable stage III NSCLC, Collaborate with relevant specialists to stage lung cancer, assess tumor resectability, and develop individualized treatment plans for patients with stage III NSCLC, Integrate cancer immunotherapies into the management of patients with unresectable stage III NSCLC according to the latest evidence and guidelines, multidisciplinary/interprofessional perspectives, and patient treatment and quality of life goals, Apply effective strategies to identify and manage immune-related adverse events in patients receiving cancer immunotherapy for unresectable stage III NSCLC treatment.
Go online to PeerView.com/DDV860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. The broad implications of the expanding role of cancer immunotherapies in lung cancer necessitate multidisciplinary collaboration, especially in the locally advanced setting where appropriate patient evaluation and selection for immune checkpoint inhibitors (ICIs) along with other multimodal therapies requires input from a medical oncologist, a radiation oncologist, as well as a thoracic surgeon, among other specialists. Effective communication and coordination of care are also essential in the management of patients with unresectable stage III non–small cell lung cancer (NSCLC) deemed to be good candidates for consolidation ICI therapy after chemoradiation. How should this be operationalized in real-world settings? Learn useful strategies from this PeerView MasterClass and Tumor Board based on a recent web broadcast, which delivers evidence-based guidance on the best practices related to multidisciplinary patient assessment and treatment planning to help you improve outcomes in your patients with stage III NSCLC. Our panel of experts navigates through the latest evidence, key challenges, and controversies, as well as debates a series of real cases to demonstrate how to individualize patient care in the midst of rapid research and clinical advances. Upon completion of this activity, participants should be better able to: Discuss the latest clinical evidence on cancer immunotherapy in unresectable stage III NSCLC, Collaborate with relevant specialists to stage lung cancer, assess tumor resectability, and develop individualized treatment plans for patients with stage III NSCLC, Integrate cancer immunotherapies into the management of patients with unresectable stage III NSCLC according to the latest evidence and guidelines, multidisciplinary/interprofessional perspectives, and patient treatment and quality of life goals, Apply effective strategies to identify and manage immune-related adverse events in patients receiving cancer immunotherapy for unresectable stage III NSCLC treatment.
Dr. Aggarwal and Dr. Girard discuss the significance of the 5-year survival data from the pivotal PACIFIC trial and the real-world benefit of the study regimen in patients with unresectable stage III NSCLC.
Dr. Dietrich discusses the latest developments with immunotherapy and targeted therapy in stage III non–small cell lung cancer.
Featuring an interview with Dr Joel Neal, including the following topics: Analyze the biologic basis for the investigation of immune checkpoint inhibitors for nonmetastatic non-small cell lung cancer (NSCLC), and evaluate available and emerging data documenting the efficacy and safety of anti-PD-1/PD-L1 antibody-based approaches to (neo)adjuvant therapy. Review recent therapeutic advances with anti-PD-1/PD-L1 antibodies as monotherapy or in combination with chemotherapy or other immunotherapies for metastatic NSCLC, and discern how these approaches can be optimally employed in disease management. Appraise updated data on the efficacy of anti-PD-L1 antibody consolidation therapy for patients with unresectable Stage III NSCLC who have not experienced disease progression after standard platinum-based chemotherapy concurrent with radiation therapy, and discern how this strategy can be appropriately and safely integrated into routine clinical practice. Review published research data documenting the safety and efficacy of EGFR tyrosine kinase inhibitors alone or in combination with other systemic approaches for metastatic NSCLC with an EGFR tumor mutation, and discern how this information should be applied outside of a research setting. Assess the efficacy of commercially available ALK inhibitors for patients with metastatic NSCLC with an ALK rearrangement, and apply this understanding to the selection and sequencing of these drugs as first- and later-line therapy. Recognize other oncogenic pathways (ie, RET, MET, HER2, KRAS, ROS1) mediating the pathogenesis of tumors in unique patient subsets, and recall published and emerging data with commercially available and experimental agents exploiting these targets. Design an optimal approach to the clinical care of patients with small cell lung cancer, considering available and emerging clinical trial findings. Assess the biologic rationale for ongoing clinical trials evaluating novel agents and strategies for NSCLC, and counsel appropriate patients about availability and participation. CME information and select publications
Featuring slide presentations and related discussion from Dr Walter J Curran Jr and Ms Camille Usher, including the following topics: Immune Checkpoint Inhibition in the Management of Locally Advanced NSCLC — Walter J Curran Jr, MD (0:00) Case: A man in his mid-50s with unresectable Stage IIIA T2N2M0 squamous cell carcinoma of the lung who receives durvalumab after chemoradiation therapy — Dr Curran (11:42) Case: A woman in her mid-40s and a never smoker with Stage III NSCLC and an EGFR mutation — Dr Curran (14:32) Case: A man in his early 60s with locally advanced NSCLC and a recent myocardial infarction — Dr Curran (19:46) Case: A man in his early 70s and a past smoker who presents with a cough and fever and is diagnosed with Stage IIIB NSCLC — Camille Usher, MS, APRN NP-C (32:41) Case: A woman in her mid-70s and a smoker with a history of breast cancer who is diagnosed with lung adenocarcinoma — Ms Usher (47:27) Case: A woman in her early 60s with Stage IIIA T1bN2 adenocarcinoma of the lung — Ms Usher (52:40) Case: A man in his mid-70s who developed pneumonitis after chemoradiation therapy — Ms Usher (1:02:22) CME and NCPD information and select publications
This program includes faculty lectures by Drs Benjamin Levy of Johns Hopkins Sidney Kimmel Cancer Center and Stephen Liu of Georgetown University on immune checkpoint inhibitors after chemotherapy with radiation therapy for Stage III NSCLC and toxicity reported in the PACIFIC trial. Access NCPD information and select publications here.
Robert Figlin, MD, Steven Spielberg Family Chair in Hematology-Oncology, Cedars-Sinai Medical Center, and Victoria Villaflor, MD, Clinical Professor, Director Head and Neck Oncology at City of Hope, discuss unresectable stage III Non Small Cell Lung Cancer (www.azioinpractice.com)
Robert Figlin, MD, Steven Spielberg Family Chair in Hematology-Oncology, Cedars-Sinai Medical Center, and Victoria Villaflor, MD, Clinical Professor, Director Head and Neck Oncology at City of Hope, discuss unresectable stage III Non Small Cell Lung Cancer (www.azioinpractice.com)
Host: Jennifer Caudle, DO Guest: Kristin Higgins, MD Concurrent chemoradiation therapy is the recommended treatment for unresectable Stage III NSCLC patients. Dr. Jennifer Caudle is joined by Dr. Kristin Higgins to discuss advances in radiation that optimize the treatment plan and her best practices to help patients receive a full course of curative-intent treatment. US-32345 Last Updated 12/19
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