Rationale for Investigation of Neoadjuvant Chemoimmunotherapy Before Chemoradiation in Unresectable Stage III Non–Small Cell Lung Cancer
Cet article examine la pertinence des études évaluant l'intérêt d'une chimio-immunothérapie avant une chimioradiothérapie pour un cancer du poumon non à petites cellules non résécable de stade III
Locally advanced non–small cell lung cancer (NSCLC) constitutes a third of new NSCLC diagnoses worldwide. For patients with unresectable disease, the historical standard treatment was definitive chemoradiation. Although survival outcomes slightly improved over time because of advancements in supportive care and stage migration with increased use of positron emission tomography/computed tomography (PET/CT) and brain magnetic resonance imaging, therapeutic intensification attempts with radiation dose escalation and chemotherapy induction failed to improve outcomes. A long-awaited paradigm shift arrived in the form of immunotherapy with the PACIFIC trial in which the addition of consolidation durvalumab after definitive chemoradiation provided a 5-year overall survival (OS) benefit of 10% (43% v 33%) and a median OS of 47.5 months.
Journal of Clinical Oncology , article en libre accès, 2025