Emerging Treatment Approaches and Multidisciplinary Management of Unresectable Stage III Non-Small Cell Lung Cancer

Panelists discuss how the resectability of stage III non-small cell lung cancer tumors remains controversial, particularly regarding the role of surgery in multi-station N2 disease and the optimal sequencing of multimodality therapy.

This video segment discusses defining resectability for Stage III lung cancer, the importance of a multidisciplinary approach to decision-making involving surgical, medical, radiation oncology, and diagnostic teams, and the role of patient engagement in tailoring treatment plans to individual priorities, risks, and physiological suitability.

This segment explores the role of biomarker testing in optimizing outcomes for non-small cell lung cancer (NSCLC), highlighting challenges in early-stage testing, the importance of multidisciplinary collaboration, and recent advances like the LAURA trial that emphasize the need for comprehensive biomarker assessment.

This segment discusses the importance of biomarker testing in lung cancer, challenges in implementation such as tissue adequacy and result delays, and strategies to enhance testing in both academic and community settings through local champions and education.

This segment transitions to discussing the management of unresectable non–small cell lung cancer (NSCLC), focusing on the distinctions between concurrent and sequential chemoradiation. It highlights patient selection, treatment tolerability, the role of advanced radiation technologies, and considerations for minimizing adverse effects while ensuring optimal outcomes.

This video discusses evolving treatment paradigms for locally advanced lung cancer, highlighting the impact of trials like PACIFIC on the role of chemoradiotherapy and consolidation therapy with durvalumab, the potential integration of circulating tumor DNA (ctDNA) for personalized treatment decisions, and the implications for both surgical and nonsurgical patient populations.

This video discusses the clinical considerations around pneumonitis in patients undergoing chemoradiation and immunotherapy, including how to distinguish between radiation-induced and immune-related pneumonitis, and the importance of consulting specialists to avoid prematurely discontinuing treatment like durvalumab.

This segment explores the use of stereotactic body radiation therapy (SBRT) for treating small peripheral lesions in patients with lymph node–positive cancer, compared with conventional intensity-modulated radiation therapy. It discusses the potential advantages of SBRT in reducing treatment duration, its theoretical biological effects, and ongoing studies like the LU008 phase 3 trial.

A 76-year-old woman with EGFR exon 19–positive adenocarcinoma and N3 disease undergoes chemoradiotherapy followed by osimertinib after a multidisciplinary evaluation and biomarker testing.

The discussion focuses on the LAURA trial, which demonstrated that osimertinib significantly improved progression-free survival in patients with EGFR-mutated (EGFRm) locally advanced non–small cell lung cancer (NSCLC) after chemoradiotherapy (CRT), establishing it as a new standard of care with manageable safety concerns.

The discussion explores promising future directions for managing locally advanced disease, focusing on combination immunotherapy approaches and the ongoing trials investigating their efficacy, as well as the potential role of combining chemotherapy (CRT) with immunotherapy in treatment regimens.

The expert discussion concludes with reflections on the rapid advancements in the treatment of locally advanced lung cancer, emphasizing the importance of personalized therapy, multidisciplinary collaboration, and continued progress in improving patient outcomes.