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Am Soc Clin Oncol Educ Book. 2019 Jan;39:553-562. doi: 10.1200/EDBK_237839. Epub 2019 May 17.

Updates in Local-Regionally Advanced Non-Small Cell Lung Cancer.

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1 The University of Texas MD Anderson Cancer Center, Houston, TX.
2 University of Michigan Rogel Cancer Center, University of Michigan Medical School, Ann Arbor, MI.
3 Division of Thoracic Surgery, Ronald Reagan UCLA Medical Center, Los Angeles, CA.


The landscape for therapy in local-regionally advanced non-small cell lung cancer (NSCLC) has shifted dramatically in the last year as a result of the PACIFIC trial, which demonstrated a significant survival benefit with the addition of 1 year of durvalumab after concurrent chemoradiation. This is a new standard of care for unresectable local-regionally advanced NSCLC and is the first trial to show that immunotherapy can increase survival in earlier-stage NSCLC. Several clinical trials are underway or in development to explore the role of adding immunotherapy to concurrent chemoradiation, followed by a year of immunotherapy or to even replace chemotherapy in this treatment paradigm. In resectable disease, adjuvant chemotherapy is still the standard of care for stage IB (tumors ≥ 4 cm) through stage III disease. However, new studies are investigating the role of adding immunotherapy to neoadjuvant chemotherapy or as adjuvant therapy for 1 year after resection. Molecular profiling for early-stage disease is not currently the standard of care, but several national clinical trials are studying the benefit of adding adjuvant-targeted therapies. This article will detail the current standard practices in early-stage and local-regionally advanced NSCLC and describe the evolving strategies that are under investigation that may further refine our current practice.

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