Inside the Clinic: Global Insights: Multidisciplinary Care of Stage III NSCLC - Episode 10
Transcript: Nicolas Girard, MD: The availability of durvalumab after chemoradiation clearly changed our organization and the management of patients. First, we need to plan up front the oral-treatment strategy—meaning delivery of chemotherapy, initiation of radiation therapy—and also plan up front the fact that the patient will receive immunotherapy consolidation. So we know that after the last delivery of radiation, we need the patient to have a CT [computed tomography] scan within 2 weeks after completion of radiotherapy and a consultation with the medical oncologist, so that we can initiate durvalumab within 3 weeks after completion of radiation in patients who do not have residual toxicity of treatment.
We also have a major change in the information of patients, meaning that when I see a new patient with unresectable stage III non—small cell lung cancer, PD-L1 [programmed death-ligand 1] positive, I give the information about chemotherapy and radiotherapy, but also I need to have the patient informed that after this treatment there will be 1 year of treatment with immunotherapy. This is very important for the patient. Otherwise if you have this consultation after completion of chemoradiation, and you inform the patient that, OK, you completed chemotherapy, radiotherapy, and now you need to have additional 1 year of treatment, some patients will not agree with that. So it’s very important to discuss with the patient about the global strategy, including chemoradiotherapy and also durvalumab consolidation. It’s very important, so that everyone is on the same line when initiating the global treatment strategy.
In some patients with stage III non—small cell lung cancer, we may have strategies that include chemoradiotherapy followed by surgery. Actually, this is not a majority of patients in France. In France, the current practice is more like androgen chemotherapy and then reassessment of surgery versus radiotherapy, and only a minority of patients actually have the strategy of chemoradiation followed by surgery. But this may be different in other European countries. For example, in Germany we have more patients treated with these strategies.
Currently we do not have that much information about the effect of adjuvant immunotherapy, including durvalumab. Trials are ongoing, multiple trials looking at the effect of adjuvant immunotherapy versus placebo. So we miss data to recommend durvalumab after a treatment sequence that would be chemoradiation followed by surgery.
Transcript Edited for Clarity