Dr Curran on Developing Strategies for Stage III NSCLC Management

Wally Curran, MD, chief, Piedmont Oncology Institute, discusses current and developing treatment strategies for patients with stage III unresectable non–small cell lung cancer (NSCLC).

At the 2024 Winter Lung Cancer Conference, Curran gave a presentation on how the management of stage III unresectable NSCLC has evolved since the readout of the phase 3 PACIFIC trial (NCT02125461). In PACIFIC, adjuvant durvalumab (Imfinzi) resulted in an overall survival benefit vs placebo in patients with stage III unresectable NSCLC who had completed chemoradiation. Final results from another phase 3 trial (NCT04092283), may show the potential value of administering immunotherapy concurrently with chemoradiation in this population, Curran says. Other immunotherapy agents will also be evaluated in those with stage III NSCLC, Curran adds.

Since the readout of PACIFIC, studies have examined whether the combination of proton beam radiation and chemotherapy is superior to conventional radiation plus chemotherapy, Curran explains. The randomized phase 3 NRG RTOG 1308 trial (NCT01993810) of photon proton beam radiochemotherapy in patients with stage II to IIIB NSCLC completed enrollment in 2023, and results from this trial will be available in the coming years, Curran notes.

Furthermore, pilot studies are evaluating whether stereotactic body radiation therapy (SBRT) can be used during the radiotherapeutic treatment of patients with stage III disease, according to Curran. SBRT has been used in patients with earlier-stage NSCLC, and the phase 3 NRG-LU008 trial (NCT05624996) is investigating full-dose SBRT in patients with stage III disease. Shortening the course of radiotherapy via hypofractionated radiotherapy may also be an effective treatment approach for patients with stage III disease, Curran says.

Lastly, trials are evaluating the potential benefits of hippocampal sparing or hippocampal avoidance radiotherapy for patients with brain metastases, Curran explains. The landmark phase 3 NRG CC001 trial (NCT02360215) demonstrated that patients with brain metastases who received memantine hydrochloride plus hippocampal avoidance during whole-brain radiotherapy experienced less decline in global cognitive function and memory than those who received memantine plus whole-brain radiotherapy without hippocampal avoidance, Curran concludes.