SCS04: Lung Cancer Tumor Board®: Mastering Advances in Managing Unresectable and Metastatic NSCLC—Immunotherapy, Targeted Therapies, and Emerging Strategies-Mastering Advances in Managing Unresectable and Metastatic NSCLC Immunotherapy, Targeted Therapies, and Emerging Strategies

Mastering Advances in Managing Unresectable and Metastatic NSCLC Immunotherapy, Targeted Therapies, and Emerging Strategies

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The document highlights recent advances and strategies in treating unresectable and metastatic non-small cell lung cancer (NSCLC), focusing on immunotherapy, targeted therapies, and emerging approaches. It covers treatment options for a clinical case of a 62-year-old woman with unresectable stage III lung adenocarcinoma, detailing potential treatments such as neoadjuvant or perioperative chemo-immunotherapy, concurrent chemoradiotherapy with or without durvalumab, and surgery followed by adjuvant chemotherapy.<br /><br />Several studies and clinical trials are reviewed, such as the PACIFIC trial, which establishes concurrent chemoradiotherapy followed by durvalumab as the standard of care (SoC) for unresectable stage III NSCLC. The document presents results from the PACIFIC study, showing five-year progression-free survival (PFS) and overall survival (OS) linked to PD-L1 expression and provides real-world insights from the PACIFIC-R trial.<br /><br />Other highlighted studies include the COAST trial, which explores combinations of durvalumab with oleclumab or monalizumab for treating stage III unresectable NSCLC. Additionally, the document mentions KEYVIBE-006, a Phase 3 trial comparing pembrolizumab and vibostolimab (anti-TIGIT) with concurrent chemoradiotherapy and consolidation therapy against durvalumab for Stage III NSCLC. The CheckMate 73L trial investigates nivolumab and ipilimumab with chemoradiotherapy versus durvalumab.<br /><br />For patients with NSCLC harboring EGFR mutations, concurrent chemoradiotherapy followed by osimertinib emerges as the new SoC. The document concludes that though concurrent chemoradiotherapy followed by durvalumab remains the foundational treatment, multiple ongoing efforts and novel combinations promise further improvements in patient outcomes. These emerging strategies, exemplified by the PACIFIC 8 and PACIFIC 9 studies, aim to enhance treatment efficacy for this challenging cancer subset.

Asset Subtitle

Biagio Ricciuti

Keywords

NSCLC

immunotherapy

targeted therapies

chemoradiotherapy

durvalumab

PACIFIC trial

EGFR mutations

osimertinib

pembrolizumab

nivolumab