A review of immunotherapy for stage 3 and metastatic NSCLC & the rationale for the ECOG-ACRIN EA5181 study. The oncologist Varlotto, J. M., Sun, Z., Ky, B., Upshaw, J., Katz, S. I., Fitzgerald, T. J., Wakelee, H., Diehn, M., Mankoff, D. A., Lovly, C., Belani, C., Oettel, K., Masters, G., Ramalingam, S., Pennell, N. A. 2021


ECOG-ACRIN EA5181 is a phase III prospective, randomized trial that randomizes patients undergoing chemo/radiation for locally advanced non-small cell lung cancer (LA- NSCLC) to concomitant durvalumab or no additional therapy with both arms receiving one year of consolidative durvalumab. Radiation dose-escalation failed to improve overall survival in RTOG 0617. However, conventionally-fractionated radiation to 60Gy with concomitant chemotherapy is associated with a high risk of local failure (38-46%). It is hoped that concomitant immunotherapy during chemo/radiation can help decrease the risk of local failure, thereby improving overall survival and progression-free survival with acceptable toxicity. In this article, we will review conventional chemo/radiation therapy for LA-NSCLC as well as the quickly evolving world of immunotherapy in the treatment of NSCLC and discuss the rationale and study design of EA5181. IMPLICATIONS FOR PRACTICE: Our article provides an up-to-date assessment of how immunotherapy is re-shaping the landscape of metastatic NSCLC and how the impact of this therapy is now rapidly moving into the treatment of patients with locally advanced NSCLC who are presenting for curative treatment. We will review the history of concurrent chemo/radiation, the recent publications of immunotherapy combined with chemotherapy or chemo/radiation, and our strategy for improving the OS of patients with locally advanced NSCLC by using concomitant immunotherapy with standard concurrent chemo/radiation.

View details for DOI 10.1002/onco.13725

View details for PubMedID 33594771