Standard Treatment Options For Resected/resectable Stage Iiia Nsclc
Standard treatment options for resected/resectable disease include the following:
Despite careful preoperative staging, some patients will be found to have metastases to mediastinal N2 lymph nodes at thoracotomy.
The preponderance of evidence indicates that postoperative cisplatin combination chemotherapy provides a significant survival advantage to patients with resected NSCLC with occult N2 disease discovered at surgery. The optimal sequence of surgery and chemotherapy and the benefits and risks of postoperative radiation therapy in patients with resectable NSCLC are yet to be determined.
Surgery
If complete resection of tumor and lymph nodes is possible, such patients may benefit from surgery followed by postoperative chemotherapy. Current evidence suggests that lung cancer resection combined with complete ipsilateral mediastinal lymph node dissection is not associated with improvement in survival compared with lung cancer resection combined with systematic sampling of mediastinal lymph nodes in patients with stage I, II, or IIIA NSCLC.
The addition of surgery to chemoradiation therapy for patients with stage IIIA NSCLC did not result in improved OS in a phase III trial but did improve progression-free survival and local control.
Evidence :
Evidence :
Standard Treatment Options For Unresectable Stage Iiia Nsclc
Standard treatment options for patients with unresectable stage IIIA NSCLC include the following:
Chemoradiation therapy
The addition of sequential and concurrent chemotherapy to radiation therapy has been evaluated in prospective randomized trials and meta-analyses. Overall, concurrent treatment may provide the greatest benefit in survival with an increase in toxic effects.
Concomitant platinum-based radiation chemotherapy may improve survival of patients with locally advanced NSCLC. However, the available data are insufficient to accurately define the size of such a potential treatment benefit and the optimal schedule of chemotherapy.
Evidence :
Concurrent versus sequential chemoradiation therapy
Evidence :
After Lung Cancer Has Been Diagnosed Tests Are Done To Find Out If Cancer Cells Have Spread Within The Lungs Or To Other Parts Of The Body
The process used to find out if cancer has spread within the lungs or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. Some of the tests used to diagnosenon-small cell lung cancer are also used to stage the disease.
Other tests and procedures that may be used in the staging process include the following:
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Sample Size And Statistical Analysis
Although at least 15 patients were to be enrolled in each of the tumor-specific expansions, up to 45 to 60 patients could be enrolled in each tumor-specific expansion. The target sample size of up to 45 to 60 patients was based on differentiating 34.5% to 40% from 5% ORR in tumors with and without a relevant tumor biomarker, respectively . Examples of relevant tumor biomarkers included KRAS status and HR status . Assuming an equal number of patients having tumors with and without the biomarker, 45 or 60 patients provided approximately 85% power to differentiate 40% or 34.5% from 5% ORR, respectively. To maximize the power to detect the ORR difference between the biomarker groups, enrollment to a tumor-specific expansion could be adjusted to achieve approximately an equal number of patients having tumors with and without the biomarker.
Chio3 Trial: Chemotherapy Combined With Immune Checkpoint Inhibitor For Operable Stage Iiia/b Non
Sorry, not currently recruiting here
This is a single arm, phase II trial of combined neoadjuvant platinum doublet chemotherapy plus durvalumab followed by surgery, postoperative radiation and adjuvant durvalumab for 13 cycles for patients with potentially resectable stage IIIA and IIIB NSCLC . The primary objective of this study is to increase N2 nodal clearance to 50% or greater for combined platinum doublet chemotherapy with durvalumab induction therapy from historical rate of 30% for platinum doublet chemotherapy alone in patients with potentially resectable stage IIIA/B NSCLC.
San Diego, California and other locations
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Optimal Sequencing Of Pembrolizumab And Standard Platinum
Sorry, in progress, not accepting new patients
This is a multicenter randomized phase II to determine if the administration of standard platinum-based chemotherapy before MK-3475 in with Chemotherapy naive stage IV Non-small Cell Lung Cancer will improve the overall response rate compared to MK-3475 administered before chemotherapy. Patients will be given Pembrolizumab as maintenance up to 2 years: Carboplatin and paclitaxel or pemetrexed every 3 weeks x 4 cycles followed by pembrolizumab every 3 weeks for up to 2 years. Pembrolizumab every 3 weeks x 4 cycles followed by carboplatin and paclitaxel or pemetrexed every 3 weeks x 4 cycles followed by pembrolizumab every 3 weeks for up to 2 years.
La Jolla, California and other locations
Basket Study Of Entrectinib For The Treatment Of Patients With Solid Tumors Harboring Ntrk 1/2/3 Ros1 Or Alk Gene Rearrangements
open to eligible people ages 18 years and up
This is an open-label, multicenter, global Phase 2 basket study of entrectinib for the treatment of patients with solid tumors that harbor an NTRK1/2/3, ROS1, or ALK gene fusion. Patients will be assigned to different baskets according to tumor type and gene fusion.
La Jolla, California and other locations
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Dna Repair Deficiency In Nsclc
Deficiencies in DNA repair underlie many forms of cancer. If DNA repair is deficient, the frequency of unrepaired DNA damages increases, and these tend to cause inaccurate translesion synthesis leading to mutation. Furthermore, increased damages can elevate incomplete repair, leading to epigenetic alterations.
As indicated as in the article Carcinogenesis, mutations in DNA repair genes occasionally occur in cancer, but deficiencies of DNA repair due to epigenetic alterations that reduce or silence DNA repair-gene expression occur much more frequently in cancer.
Epigenetic gene silencing of DNA repair genes occurs frequently in NSCLC. At least nine DNA repair genes that normally function in relatively accurate DNA repair pathways are often repressed by promoter hypermethylation in NSCLC. One DNA repair gene, FEN1, that functions in an inaccurate DNA repair pathway, is expressed at an increased level due to hypo-, rather than hyper-, methylation of its promoter region in NSCLC.
Epigenetic promoter methylation in DNA repair genes in NSCLC
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A Study Of Atezolizumab And Tiragolumab Compared With Durvalumab In Participants With Locally Advanced Unresectable Stage Iii Non
open to eligible people ages 18 years and up
The purpose of this study is to evaluate the efficacy and safety of atezolizumab in combination with tiragolumab compared with durvalumab in participants with locally advanced, unresectable Stage III non-small cell lung cancer who have received at least two cycles of concurrent platinum-based chemoradiotherapy and have not had radiographic disease progression.
San Diego, California and other locations
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Purpose Of This Summary
This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of non-small cell lung cancer. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.
There Are Three Ways That Cancer Spreads In The Body
Cancer can spread through tissue, the lymph system, and the blood:
- Tissue. The cancer spreads from where it began by growing into nearby areas.
- Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.
- Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.
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Kras G12c Is An Oncogenic Driver Mutation In Multiple Cancer Types
KRAS mutations can play a role in some of the most common cancers, including lung, colorectal, and pancreatic cancers. The KRAS G12C mutation is an oncogenic driver occurring in approximately 13% of non-squamous non-small cell lung cancer , and 1-3% of other solid tumors, such as colorectal cancer.1,2,3
Watch this video to learn more about how KRAS G12C mutations contribute to oncogenesis.
S1403 Afatinib Dimaleate With Or Without Cetuximab In Treating Patients With Newly Diagnosed Stage Iv Or Recurrent Egfr Mutation Positive Non
Sorry, in progress, not accepting new patients
This randomized phase II/III trial studies how well afatinib dimaleate with cetuximab works and compares it with afatinib dimaleate alone in treating patients with newly diagnosed stage IV or recurrent , epidermal growth factor receptor mutation positive non-small cell lung cancer. Afatinib dimaleate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as cetuximab, may block tumor growth in different ways by targeting certain cells. It is not yet known whether afatinib dimaleate is more effective when given alone or with cetuximab in treating patients with non-small cell lung cancer.
La Jolla, California
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Study Of Amivantamab A Human Bispecific Egfr And Cmet Antibody In Participants With Advanced Non
open to eligible people ages 18 years and up
The purpose of study is to evaluate the safety, pharmacokinetics, and preliminary efficacy of Amivantamab as a monotherapy and in combination with lazertinib, and to determine the recommended Phase 2 dose , recommended Phase 2 combination dose , and to determine recommended Phase 2 Dose with combination chemotherapy in 21 day treatment cycle for participants with advanced non-small cell lung cancer .
La Jolla, California
Diagnosis And Staging Evaluation
History and Physical Examination
The diagnosis and preoperative staging of lung cancer begin with a good history and physical examination. When obtaining the history, the clinician should keep in mind the tendency for lung cancer to involve major airways and other central structures. Similarly, the patterns of metastatic dissemination and systemic manifestations must be considered when conducting the physical examination.
Patients should be questioned specifically about the presence of palpable masses, dysphagia, bone pain, headache, or changes in vision. Careful auscultation and percussion may suggest the presence of atelectasis or pleural effusion. Auscultation of the chest also may provide evidence of large-airway obstruction and pulmonary consolidation. Rhonchi and wheezing may provide some helpful treatment planning information. An enlarged liver may indicate hepatic metastases.
Palpation of the Neck and Supraclavicular Fossa
Discovery of adenopathy of the neck and supraclavicular fossa may allow both diagnosis and staging, by needle or open biopsy.
Imaging Studies
Chest radiographs
These provide initial helpful information in patients with new respiratory symptoms. Posteroanterior and lateral chest radiographs are fundamental in assessing the local extent of the primary tumor and also may provide valuable information regarding metastatic disease.
Chest CT from the lower neck to the mid level of the kidneys
PET
Adrenal gland
Obtaining a Tissue Diagnosis
Central lesions
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Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
There Are Several Types Of Non
Each type of non-small cell lung cancer has different kinds of cancer cells. The cancer cells of each type grow and spread in different ways. The types of non-small cell lung cancer are named for the kinds of cells found in the cancer and how the cells look under a microscope:
- Squamous cell carcinoma: Cancer that forms in the thin, flat cells lining the inside of the lungs. This is also called epidermoid carcinoma.
- Large cell carcinoma: Cancer that may begin in several types of large cells.
- Adenocarcinoma: Cancer that begins in the cells that line the alveoli and make substances such as mucus.
Other less common types of non-small cell lung cancer are: adenosquamous carcinoma, sarcomatoid carcinoma, salivary gland carcinoma, carcinoid tumor, and unclassified carcinoma.
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Vibostolimab Promising For Advanced Solid Tumors
medwireNews: Vibostolimab given alone or in combination with pembrolizumab is well tolerated and demonstrates antitumor activity in patients with advanced solid tumors, including non-small-cell lung cancer , show results of a first-in-human study of the antibody targeting the T cell immunoglobulin and immunoreceptor tyrosine-based inhibition domain.
ur data provide promising antitumor activity in patients with advanced solid tumors and PD-1/PD-L1-inhibitor-naïve patients with advanced solid tumors treated with vibostolimab plus pembrolizumab, and they support further investigation of the treatment combination, say Jiaxin Niu and colleagues.
The phase 1 study was spilt into two parts. For the first part, 76 patients with metastatic solid tumors were randomly assigned to receive vibostolimab, at escalating doses ranging from 2.1700.0 mg, alone or in combination with pembrolizumab 200 mg , every 3 weeks.
During a median follow-up of 34 months, over half of the patients in the monotherapy and combination arms had a treatment-related adverse event .
Among the vibostolimab monotherapy group, three patients had grade 34 TRAEs, with macropapular rash, anemia, and diarrhea each reported in one patient. In addition, TRAEs of grade 34 occurred in seven patients in the combination treatment group, including single incidences of macropapular rash, adrenal insufficiency, and increased alanine aminotransferase. There were no treatment-related deaths in either group.
Cancer May Spread From Where It Began To Other Parts Of The Body
When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.
- Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
- Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.
The metastatic tumor is the same type of cancer as the primary tumor. For example, if non-small cell lung cancer spreads to the brain, the cancer cells in the brain are actually lung cancer cells. The disease is metastatic lung cancer, not brain cancer.
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Smoking Is The Major Risk Factor For Non
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer not having risk factors doesn’t mean that you will not get cancer. Talk to your doctor if you think you may be at risk for lung cancer.
Risk factors for lung cancer include the following:
- Smoking cigarettes, pipes, or cigars, now or in the past. This is the most important risk factor for lung cancer. The earlier in life a person starts smoking, the more often a person smokes, and the more years a person smokes, the greater the risk of lung cancer.
- Being exposed to secondhand smoke.
- Being exposed to asbestos, arsenic, chromium, beryllium, nickel, soot, or tar in the workplace.
- Being exposed to radiation from any of the following:
- Radiation therapy to the breast or chest.
- Radon in the home or workplace.
Older age is the main risk factor for most cancers. The chance of getting cancer increases as you get older.
When smoking is combined with other risk factors, the risk of lung cancer is increased.
A Study Of Xmab23104 In Subjects With Selected Advanced Solid Tumors
open to eligible people ages 18 years and up
This is a Phase 1, multiple dose, ascending dose escalation study to define a MTD/RD and regimen of XmAb23104, to describe safety and tolerability, to assess PK and immunogenicity, and to preliminarily assess anti-tumor activity of XmAb23104 monotherapy and combination therapy with ipilimumab in subjects with selected advanced solid tumors.
San Diego, California
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A Dose Escalation And Cohort Expansion Study Of Nktr
Sorry, in progress, not accepting new patients
In this four-part study, NKTR-214 will be administered in combination with nivolumab in Part 1, in combination with nivolumab with or without various chemotherapies in Part 2, and with nivolumab and ipilimumab in Parts 3 & 4. In Part 1, the Recommended Phase 2 Dose of NKTR-214 in combination with nivolumab will be determined. In Part 2, NKTR-214 with nivolumab at the RP2D will be evaluated as first-line therapy and/or as second or third line therapy in select patients with Melanoma, Renal Cell Carcinoma , Non-Small Cell Lung Cancer , Urothelial Carcinoma , metastatic Breast Cancer and Colorectal Cancer . In addition, in Part 2, the RP2D of NKTR-214 with nivolumab and various chemotherapies and regimens in select cohorts of NSCLC patients will be determined. In Part 3, several different regimens of the triplet combination of NKTR-214 plus nivolumab and ipilimumab will be evaluated in select patients with RCC, NSCLC, Melanoma, and UC. In Part 4, the safety and efficacy of the triplet combination will be evaluated further in select patients with RCC, NSCLC, Melanoma and UC.
La Jolla, California
