Keypoints:
• The importance of staging and lymph node evaluation in treatment planning.
• The role of neoadjuvant chemoimmunotherapy and the impact of recent trial data, including the CHECKMATE 816 trial.
• The significance of actionable mutations and the use of targeted therapies like Osimertinib and Alectinib.
• The evolving role of ctDNA in treatment decisions and monitoring.
• Insights into the management of side effects associated with Osimertinib and Alectinib.
• The standard of care for unresectable stage 3 NSCLC, including concurrent chemoradiation and the use of Durvalumab.
In this episode of the Oncology Brothers podcast, we dived deep into the treatment landscape of early-stage non-small cell lung cancer (NSCLC) with our esteemed guest, Dr. Deepa Rangachari, a thoracic medical oncologist and fellowship program director at Beth Israel Deaconess Medical Center.
We began by discussing the importance of thorough staging and evaluation, including lymph node assessment and genomic testing, before determining the best treatment approach. For stage 1 NSCLC, surgery remains the standard of care, when surgery is not feasible then relying on stereotactic body radiation therapy is the most appropriate option. As we moved into stage 1B and beyond, we explored the shift towards neoadjuvant chemoimmunotherapy, particularly in patients without actionable mutations, and the significance of achieving a pathologic complete response (pCR) for improving survival outcomes.
Dr. Rangachari highlighted the recent updates from the CHECKMATE 816 trial, emphasizing the role of PD-L1 expression in treatment decisions. We also touched on the evolving role of circulating tumor DNA (ctDNA) in monitoring treatment response, although it remains largely investigational at this stage.
For patients with actionable mutations, we discussed the use of osimertinib for EGFR mutations and alectinib for ALK-positive disease, weighing the benefits of chemotherapy versus targeted therapy. Dr. Rangachari shared her insights on the importance of patient-centered decision-making, especially when considering the long-term implications of treatment.
As we transitioned to unresectable stage 3 disease, we reviewed the standard of care involving concurrent chemoradiation followed by durvalumab, and the implications of using osimertinib in this setting. We also addressed the challenges of managing side effects associated with these therapies, emphasizing the need for supportive care strategies to enhance patient quality of life.
In summary, this episode provided a comprehensive overview of the current treatment algorithms for early-stage NSCLC, highlighting the rapid advancements in the field and the critical role of personalized medicine.
Listen Podcast on Your Favourite Platform
