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).

, 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.

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Wally Curran, MD, discusses current and developing treatment strategies for patients with stage III unresectable non–small cell lung cancer. 

Walter J. Curran, Jr., MD, Executive Director, Winship Cancer Institute of Emory University, Associate Vice President, Woodruff Health Sciences Center, discusses new developments in the delivery of radiation for patients with lung cancer.

An analysis of a study which linked higher doses of radiation with worse outcomes stratified patients according to the centers they were treated. It found that patients enrolled at high-accruing medical centers had better outcomes then low-accruing centers. These results suggest that more training is needed on radiation practices at smaller center, said Curran.

Dr. Walter Curran on Developments in Radiation Delivery for Patients with Lung Cancer

Walter J. Curran, Jr, MD, Lawrence W. Davis Professor and Chair, Department of Radiation Oncology, Emory University School of Medicine, executive director, chair, Cancer Research, Winship Cancer Institute of Emory University, discusses a report that examined the effect of institutional clinical trial enrollment volume on survival of patients with stage III non-small cell lung cancer (NSCLC) treated with chemoradiation.

Curran says a phase III trial, done through the RTOG, evaluated a higher dose of radiation compared with a standard dose with concurrent chemotherapy for patients with stage III NSCLC. Results showed a poorer survival associated with the higher dose, which Curran says was unforeseen and somewhat counterintuitive.

In order to better understand the results of this study, researchers looked at the association between institutional experience in trial enrollment and the results of the trial. Curran says these findings showed that when institutions enrolled a larger number of patients on the trial, the survival of the patients was better compared with the patients that were enrolled in institutions that only enrolled a small amount of patients on the trial.

Curran says he is unsure if these results are due to experience, better coordination of multidisciplinary care, or better radiation technique. Two types of radiation were allowed in the study — a standard three-dimensional radiation and a more advanced type known as intensity-modulated radiation therapy (IMRT). Curran says the institutions that enrolled more patients tended to use more IMRT.

Previous studies have shown that for complicated surgical procedures, large degrees of experience are associated with better outcomes. Curran says perhaps the same thing is true for complex chemotherapy radiation treatment delivery.

Walter J. Curran, Jr, MD, discusses a report that examined the effect of institutional clinical trial enrollment volume on survival of patients with stage III non-small cell lung cancer (NSCLC) treated with chemoradiation.

Walter J. Curran, Jr., MD

Articles

Dr Curran on Developing Strategies for Stage III NSCLC Management

Dr. Walter Curran on Developments in Radiation Delivery for Patients with Lung Cancer

Dr. Curran on the Effect of Clinical Trial Enrollment on NSCLC Patients