Treatment of Unresectable Stage III or Node-Positive Stage II Non-Small Cell Lung Cancer
This protocol applies to patients with non-small cell lung cancer (NSCLC) for whom surgical resection is not an option — encompassing unresectable stage III disease and node-positive stage II disease not amenable to surgery.
Concurrent chemotherapy and radiotherapy is the established approach for patients with inoperable node-positive stage II and stage III NSCLC.
Definitive concurrent chemoradiation is recommended for both medically inoperable and anatomically unresectable disease across these stages.
Definitive concurrent chemoradiation with thoracic radiation therapy forms the foundation of management; the selection of consolidation therapy that follows is guided by molecular testing results.
Clinical goal: no disease progression following definitive concurrent chemoradiation.
References
Concurrent chemotherapy/RT is recommended for patients with inoperable stage II (node-positive) and stage III NSCLC.
Definitive concurrent chemoradiation is recommended for patients with medically inoperable stage II or III NSCLC.
Consolidation Therapy for Patients with Unresectable Stage II/III NSCLC, PS 0–1, and No Disease Progression After Definitive Concurrent Chemoradiation
Durvalumab 10 mg/kg IV every 2 weeks or 1500 mg every 4 weeks for up to 12 months (patients with a body weight of ≥30 kg) (category 1 for stage III; category 2A for stage II) (except tumors that are positive for EGFR exon 19 deletion or L858R mutation).
Osimertinib 80 mg once daily until disease progression (category 1 for stage III; category 2A for stage II) if EGFR exon 19 deletion or L858R mutation.
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