You have the ability to change outcomes in Stage III NSCLC

Medical advances in the past 10 years have improved outcomes for patients with Stage III NSCLC, including:

Procedures7

Staging2,3

Techniques8

Therapies9

With a distinct clinical presentation from metastatic (Stage IV) disease, Stage III NSCLC is localized and has different treatment goals.3,10,11

THE GOAL OF TREATMENT FOR PATIENTS WITH STAGE III NSCLC IS CURATIVE INTENT,

which is why evaluating each patient on a case-by-case basis is so important.1

 

Watch experts discuss the importance of staging

Accurate staging is essential for your patients with Stage III NSCLC

Staging can affect both prognosis and treatment selection.

In one study (N=75), 20% of patients with early-stage NSCLC were found to be understaged, potentially leading to suboptimal treatment decisions.12*

Accurate diagnosis and staging may increase the likelihood of:

  • Referral to an oncologist5
  • A patient receiving appropriate treatment13
  • Timely treatment, which has been shown to significantly improve survival rates14

*Patients underwent staging by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA).

Ensure pathologic staging is used to refine your patients’ diagnoses

Pathologic mediastinal staging offers increased sensitivity and specificity15,16

Sensitivity and specificity of clinical staging methods are low compared with pathologic staging methods.15

Yet, a post-hoc analysis showed overall invasive mediastinal staging was only utilized for 45% of patients with NSCLC.17

 
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Watch experts discuss the importance of referral to an oncologist

Encourage your patients to seek care from a medical oncologist

Referral to a medical oncologist can increase the likelihood of patients receiving appropriate and timely treatment, which has been associated with improved survival rates.13,14

 
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of patients presenting with Stage III NSCLC to a PCP or pulmonologist never receive care from other multidisciplinary team members, including oncologists18

  • Among patients with Stage III NSCLC who are treated by a medical oncologist, only ≈30-40% of patients receive care from multiple cancer specialists, including medical oncologists, radiation oncologists, and surgeons5

Your role in determining resectability

Collaboration across the thoracic care team is critical to determine resectability6

NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) recommend multidisciplinary evaluations prior to treatment.6

Resectability decisions should occur within a team, which may include a pulmonologist, pathologist, thoracic surgeon, radiation oncologist, and medical oncologist.

 
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of patients with Stage III NSCLC have unresectable disease19

When surgery is not an option, decisions around chemotherapy and radiation affect outcomes and potential treatment options.6,20

 

Watch key opinion leaders discuss topics in crt (Select a video from the playlist below)

cCRT is recommended in the NCCN Guidelines® for unresectable Stage III NSCLC6

Despite this recommendation, most patients do not receive concurrent chemoradiation therapy (cCRT)6,19

 
 

Less than 50%

of patients with Stage III NSCLC receive CRT19*

  • Patients should be evaluated by surgeons, medical oncologists, and radiation oncologists to determine appropriateness for cCRT6
  • Treatment with cCRT is given to patients with curative intent and offers patients additional treatment options in the Stage III disease setting1,21

*Estimation from Kantar Health US includes patients with Stage III NSCLC who received drug therapy, radiation, and no surgery. Drug therapy includes anti-cancer drugs such as cytotoxics, targeted therapies, and immunotherapies. It does not include supportive care agents.19

You may be able to improve your patients’ experiences during cCRT

Your patients may not be aware of advances in radiation technology and chemotherapy techniques

Intensity-modulated radiation therapy (IMRT) has been shown to increase efficacy and decrease toxicity9,22

Certain chemotherapy regimens and techniques can reduce associated toxicities8,23

Proactive management of patients experiencing toxicities can help them continue cCRT with fewer treatment interruptions23,24

 

Watch videos about managing crt-related toxicities (Select a video from the playlist below)

Stage IIIA, IIIB, and IIIC NSCLC Recommendations6

Pretreatment evaluation
  • PFTs (if not previously done)
  • Bronchoscopy
  • Pathologic mediastinal lymph node evaluation
  • Fluorodeoxyglucose PET/CT scan (if not previously done)
  • Brain MRI with contrast
Surgical Evaluation

 

Unresectable disease (N0-1)

 

Unresectable disease (N2 positive)

 

Unresectable disease (N3 positive)

Initial Treatment*

 

Definitive cCRT

 

Definitive cCRT

 

Definitive cCRT

Consolidation Immunotherapy

Durvalumab (Category 1)

Durvalumab (Category 1)

Durvalumab (Category 1)

For your patients who complete cCRT, consolidation immunotherapy may be an option6

The National Comprehensive Cancer Network® (NCCN®) recommends treatment with durvalumab (Category 1) for patients with unresectable Stage III NSCLC following cCRT.6*†‡

Pretreatment evaluation should include6:

  • Pulmonary function tests (if not previously done)
  • Bronchoscopy
  • Pathologic mediastinal lymph node evaluation
  • Fluorodeoxyglucose PET/CT scan (if not previously done)
  • Brain MRI with contrast

*For detailed recommendations, see the NCCN Guidelines for NSCLC (available at NCCN.org).

For performance status 0–1.

For patients with no disease progression after cCRT.

Adapted with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Non-Small Cell Lung Cancer. V.5.2019. © National Comprehensive Cancer Network, Inc. 2019. All rights reserved. The NCCN Guidelines® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. The NCCN Guidelines are a work in progress that may be refined as often as new significant data becomes available.

INDICATION

IMFINZI® (durvalumab) is indicated for the treatment of patients with unresectable Stage III non-small cell lung cancer (NSCLC) whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy.

SELECT IMPORTANT SAFETY INFORMATION

There are no contraindications for IMFINZI.

IMFINZI can cause immune-mediated adverse reactions, including immune-mediated pneumonitis, hepatitis, colitis or diarrhea, endocrinopathies (including thyroid disorders, adrenal insufficiency, type 1 diabetes, and hypophysitis), nephritis, dermatologic reactions, and other immune-mediated adverse reactions; infection; and infusion-related reactions. Please refer to the full Prescribing Information for important dosage modification and management information specific to adverse reactions.

Serious, potentially fatal risks were seen with IMFINZI. Serious adverse reactions occurred in 29% of patients with unresectable Stage III NSCLC receiving IMFINZI (n=475). The most frequent serious adverse reactions (≥2% of patients) were pneumonitis or radiation pneumonitis (7%) and pneumonia (6%). The most common adverse reactions with IMFINZI (≥20%) were cough (40%), fatigue (34%), pneumonitis or radiation pneumonitis (34%), upper respiratory tract infections (26%), dyspnea (25%), and rash (23%). Advise women not to become pregnant or breastfeed during treatment with IMFINZI and for at least 3 months after the last dose. The safety and effectiveness of IMFINZI have not been established in pediatric patients.

Please see complete Prescribing Information, including Medication Guide.

You may report side effects related to AstraZeneca products by clicking here.