2nd ESMO Consensus Conference in Lung Cancer: locally advanced stage III non-small-cell lung cancer

To complement the existing treatment guidelines, ESMO organises consensus conferences to focus on specific issues. The 2nd ESMO Consensus Conference on Lung Cancer included 35 experts who met to address several questions on non-small-cell lung cancer (NSCLC). Recommendations were made with reference to grade of recommendation and level of evidence. This paper focuses on locally advanced diseas

Routine molecular profiling of cancer: results of a one-year nationwide program of the French Cooperative Thoracic Intergroup (IFCT) for advanced non-small cell lung cancer (NSCLC) patients.

International audienceBackground: The molecular profiling of patients with advanced non-small-cell lung cancer (NSCLC) for known oncogenic drivers is recommended during routine care. Nationally, however, the feasibility and effects on outcomes of this policy are unknown. We aimed to assess the characteristics, molecular profiles, and clinical outcomes of patients who were screened during a 1-year period by a nationwide programme funded by the French National Cancer Institute. Methods This study included patients with advanced NSCLC, who were routinely screened for EGFR mutations, ALK rearrangements, as well as HER2 (ERBB2), KRAS, BRAF, and PIK3CA mutations by 28 certified regional genetics centres in France. Patients were assessed consecutively during a 1-year period from April, 2012, to April, 2013. We measured the frequency of molecular alterations in the six routinely screened genes, the turnaround time in obtaining molecular results, and patients' clinical outcomes. This study is registered with ClinicalTrials.gov, number NCT01700582. Findings 18 679 molecular analyses of 17 664 patients with NSCLC were done (of patients with known data, median age was 64·5 years [range 18–98], 65% were men, 81% were smokers or former smokers, and 76% had adenocarcinoma). The median interval between the initiation of analysis and provision of the written report was 11 days (IQR 7–16). A genetic alteration was recorded in about 50% of the analyses; EGFR mutations were reported in 1947 (11%) of 17 706 analyses for which data were available, HER2 mutations in 98 (1%) of 11 723, KRAS mutations in 4894 (29%) of 17 001, BRAF mutations in 262 (2%) of 13 906, and PIK3CA mutations in 252 (2%) of 10 678; ALK rearrangements were reported in 388 (5%) of 8134 analyses. The median duration of follow-up at the time of analysis was 24·9 months (95% CI 24·8–25·0). The presence of a genetic alteration affected first-line treatment for 4176 (51%) of 8147 patients and was associated with a significant improvement in the proportion of patients achieving an overall response in first-line treatment (37% [95% CI 34·7–38·2] for presence of a genetic alteration vs 33% [29·5–35·6] for absence of a genetic alteration; p=0·03) and in second-line treatment (17% [15·0–18·8] vs 9% [6·7–11·9]; p<0·0001). Presence of a genetic alteration was also associated with improved first-line progression-free survival (10·0 months [95% CI 9·2–10·7] vs 7·1 months [6·1–7·9]; p<0·0001) and overall survival (16·5 months [15·0–18·3] vs 11·8 months [10·1–13·5]; p<0·0001) compared with absence of a genetic alteration. Interpretation Routine nationwide molecular profiling of patients with advanced NSCLC is feasible. The frequency of genetic alterations, acceptable turnaround times in obtaining analysis results, and the clinical advantage provided by detection of a genetic alteration suggest that this policy provides a clinical benefit

The Accuracy of Clinical Staging of Stage I-IIIa Non-Small Cell Lung Cancer : An Analysis Based on Individual Participant Data

BACKGROUND: Clinical staging of non-small cell lung cancer (NSCLC) helps determine the prognosis and treatment of patients; few data exist on the accuracy of clinical staging and the impact on treatment and survival of patients. We assessed whether participant or trial characteristics were associated with clinical staging accuracy as well as impact on survival. METHODS: We used individual participant data from randomized controlled trials (RCTs), supplied for a meta-analysis of preoperative chemotherapy (+/- radiotherapy) vs surgery alone (+/- radiotherapy) in NSCLC. We assessed agreement between clinical TNM (cTNM) stage at randomization and pathologic TNM (pTNM) stage, for participants in the control group. RESULT: Results are based on 698 patients who received surgery alone (+/- radiotherapy) with data for cTNM and pTNM stage. Forty-six percent of cases were cTNM stage I, 23% were cTNM stage II, and 31% were cTNM stage IIIa. cTNM stage disagreed with pTNM stage in 48% of cases, with 34% clinically understaged and 14% clinically overstaged. Agreement was not associated with age (P = .12), sex (P = .62), histology (P = .82), staging method (P = .32), or year of randomization (P = .98). Poorer survival in understaged patients was explained by the underlying pTNM stage. Clinical staging failed to detect T4 disease in 10% of cases and misclassified nodal disease in 38%. CONCLUSION: This study demonstrates suboptimal agreement between clinical and pathologic staging. Discrepancies between clinical and pathologic T and N staging could have led to different treatment decisions in 10% and 38% of cases, respectively. There is therefore a need for further research into improving staging accuracy for patients with stage I-IIIa NSCLC.Peer reviewe

2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up

This manuscript provides recommendations for the diagnosis, treatment and follow-up of early stage non-small cell lung cancer developed during the 2nd ESMO Consensus Conference on Lung Cancer in May 201

2nd ESMO Consensus Conference on Lung Cancer: non-small-cell lung cancer first-line/second and further lines of treatment in advanced disease

This manuscript provides recommendations for first-line / second and further lines of treatment in advanced disease in non-small cell lung cancer (NSCLC). These recommendations were developed during the 2nd ESMO Consensus Conference on Lung Cancer in May 201

[Stage III NSCLC. The role of the chemotherapist]

International audienceStandard treatment for non resectable stage III non-small cell lung cancer consists of concurrent chemotherapy and thoracic radiotherapy. There is no standard chemotherapy regimen, and several cisplatin-based doublets can be used. Induction and consolidation chemotherapy have been shown to yield no survival benefit. Although maintenance gefitinib has no interest after concurrent chemoradiotherapy, there is a rational for the delivery of targeted therapies in combination with radiotherapy. Other strategies integrating targeted treatments and radiotherapy warrant investigations

[Follow up of non small cell lung cancer. Should patients be followed up after surgery for non-small cell lung cancer and how?]

International audienceINTRODUCTION: Survival of patients after surgery for non-small cell lung cancer is significantly impaired because of frequent fatal recurrences. Logically, follow-up should detect early recurrences, thus increasing chances of cure. STATE OF THE ART: Only nonrandomized studies have been published. These data show that: thoracic recurrences are the most frequent and the most frequently treated with curative intent; diagnosis of recurrences while patients are still asymptomatic might improve survival. Several guidelines have been published, with follow-up programs of variable intensity and with a recent tendency to reduce follow-up procedures to the only clinical visit with medical history and physical examination (American Society of Clinical Oncology, 2004). PERSPECTIVES: All these recommendations consider that there is a need for randomized data. Only one randomized trial is ongoing, conducted by the Intergroupe Francophone de Cancérologie Thoracique (IFCT). This study compares a minimal follow-up with physical examination and chest X-ray and a more intensive follow-up program reflecting the French everyday practice including physical examination, chest X-ray, thoracic CT scan and fiberoptic bronchoscopy. CONCLUSION: Follow-up might be interesting for patients operated on for a NSCLC. Its modality remain to be defined. As it is not possible to define the optimal follow-up after surgery for non-small cell lung cancer from existing data, the IFCT randomized study represents for pulmonologists, oncologists and thoracic surgeons a good opportunity to rationalize postoperative follow-up

[Follow up of non small cell lung cancer. Should patients be followed up after surgery for non-small cell lung cancer and how?]

International audienceINTRODUCTION: Survival of patients after surgery for non-small cell lung cancer is significantly impaired because of frequent fatal recurrences. Logically, follow-up should detect early recurrences, thus increasing chances of cure. STATE OF THE ART: Only nonrandomized studies have been published. These data show that: thoracic recurrences are the most frequent and the most frequently treated with curative intent; diagnosis of recurrences while patients are still asymptomatic might improve survival. Several guidelines have been published, with follow-up programs of variable intensity and with a recent tendency to reduce follow-up procedures to the only clinical visit with medical history and physical examination (American Society of Clinical Oncology, 2004). PERSPECTIVES: All these recommendations consider that there is a need for randomized data. Only one randomized trial is ongoing, conducted by the Intergroupe Francophone de Cancérologie Thoracique (IFCT). This study compares a minimal follow-up with physical examination and chest X-ray and a more intensive follow-up program reflecting the French everyday practice including physical examination, chest X-ray, thoracic CT scan and fiberoptic bronchoscopy. CONCLUSION: Follow-up might be interesting for patients operated on for a NSCLC. Its modality remain to be defined. As it is not possible to define the optimal follow-up after surgery for non-small cell lung cancer from existing data, the IFCT randomized study represents for pulmonologists, oncologists and thoracic surgeons a good opportunity to rationalize postoperative follow-up

Bevacizumab et cancer bronchique non à petites cellules (population cible en pratique quotidienne)

BESANCON-BU Médecine pharmacie (250562102) / SudocSudocFranceF

[Practice of perioperative chemotherapy for non small cell lung cancer]

International audienceBased on the studies published during the last 20 years, the surgery and chemotherapy combination has become a standard for patients with a stage II-IIIA operable non-small cell lung cancer. The survival advantage is better documented for adjuvant chemotherapy than for neo-adjuvant chemotherapy. However, there are advantages for the preoperative delivery of chemotherapy, which should not be neglected. The results of ongoing studies should help to define the respective indications of pre- and post-operative chemotherapy in the future. The recently updated "Standards, Options, and Recommandations", published on behalf on the Fédération Nationale des Centres de Lutte Contre le Cancer, define the current practice of perioperative chemotherapy according to the evidence-based medicine