Management of Stage III Non-Small Cell Lung Cancer

Rapid Recommendation Update

Posted online June 4, 2024. DOI: 10.1200/JCO.24.01324

Updated Recommendation:

Recommendation 5.8.

Patients with unresectable stage III NSCLC with an EGFR exon 19 deletion or exon 21 L858R mutation may be offered consolidation osimertinib after definitive chemoradiotherapy^a.  (Evidence quality: Moderate; Strength of recommendation: Strong)

^aplatinum based chemotherapy and thoracic radiation given concurrently or sequentially.

Rapid Recommendation Update

Posted online June 4, 2023. DOI: 10.1200/JCO.21.02528.

Updated Recommendations:

Recommendation 3.2.

Patients with stage III NSCLC who are planned for surgical resection should receive neoadjuvant chemoimmunotherapy, neoadjuvant chemotherapy, or neoadjuvant concurrent chemoradiation. (Type: Evidence based, benefits outweigh harms; Evidence quality: High; Strength of recommendation: Strong)

Recommendation 4.2.

Patients with resected stage III NSCLC with EGFR exon 19 deletion or exon 21 L858R mutation should be offered adjuvant osimertinib after platinum-based chemotherapy. (Type: Evidence based; benefits outweigh harms; Evidence quality: High; Strength of recommendation: Strong)

References:

1. Forde PM, Spicer J, Lu S, et al: Neoadjuvant Nivolumab plus Chemotherapy in Resectable Lung Cancer. N Engl J Med 386:1973-1985, 2022
2. Wakelee H, Liberman M, Kato T, et al: Perioperative Pembrolizumab for Early-Stage Non–Small-Cell Lung Cancer. N Engl J Med, 2023
3. Herbst RS, Wu YL, John T, et al: Adjuvant Osimertinib for Resected EGFR-Mutated Stage IB-IIIA Non-Small-Cell Lung Cancer: Updated Results From the Phase III Randomized ADAURA Trial. J Clin Oncol 41:1830-1840, 2023
4. Roy S. Herbst, Masahiro Tsuboi, Tom John, Terufumi Kato, Margarita Majem, Christian Grohé, Jie Wang, Jonathan W. Goldman, Shun Lu, Wu-Chou Su, Filippo de Marinis, Frances A. Shepherd, Ki Hyeong Lee, Nhieu Le, Arunee Dechaphunkul, Dariusz M. Kowalski, Lynne Poole, Marta Stachowiak, Yuri Rukazenkov, Yi-Long Wu. Overall survival analysis from the ADAURA trial of adjuvant osimertinib in patients with resected EGFR‑mutated (EGFRm) stage IB–IIIA non-small cell lung cancer (NSCLC). ASCO Annual Meeting 2023. LBA3 ABSTRACT #401500.
5. Tsuboi M, Herbst RS, John T, et al: Overall Survival with Osimertinib in Resected EGFR-Mutated NSCLC. New England Journal of Medicine, 2023

2021 Guideline Abstract 

Published ahead of print December 22, 2021 DOI: 10.1200/JCO.21.02528

Megan E. Daly, Navneet Singh, Nofisat Ismaila, Mara B. Antonoff, Douglas A. Arenberg, Jeffrey Bradley, Elizabeth David,  Frank Detterbeck, Martin Fruh, Matthew A. Gubens, Amy C. Moore, Sukhmani K. Padda, Jyoti D. Patel, Tanyanika Phillips, Angel Qin, Clifford Robinson, and Charles B. Simone.

Purpose

To provide evidence-based recommendations to practicing clinicians on the management of disease in patients with stage III non–small-cell lung cancer (NSCLC).

Methods

An Expert Panel of medical oncology, thoracic surgery, radiation oncology, pulmonary oncology, community oncology, research methodology, and advocacy experts was convened to conduct a literature search, which included systematic reviews, meta-analyses, and randomized controlled trials published from 1990 through 2021. Outcomes of interest included survival, disease-free or recurrence-free survival, and quality of life. Expert Panel members used available evidence and informal consensus to develop evidence-based guideline recommendations.

Results

The literature search identified 127 relevant studies to inform the evidence base for this guideline.

Recommendations 

Evidence-based recommendations were developed to address evaluation and staging workup of patients with suspected stage III NSCLC, surgical management, neoadjuvant and adjuvant approaches, and management of patients with unresectable stage III NSCLC.