Dr. Langer Discusses Treating Locally Advanced NSCLC

Corey J. Langer, MD, Professor of Medicine, Hematology/Oncology Division, University of Pennsylvania, Abramson Cancer Center, discusses the standard treatment paradigm for patients with locally advanced non-small cell lung cancer (NSCLC).

In general, Langer notes that these patients generally have a good prognosis. Their performance status is intact and they have less than a 5-10% loss in weight from baseline. If the tumor is unresectable, the standard of care is concurrent radiation therapy and chemotherapy, likely etoposide plus cisplatin or paclitaxel and carboplatin. Trials have investigated adding induction or consolidation therapy but none have shown any additional benefits.

Treating locally advanced NSCLC is counter-intuitive to other paradigms, Langer notes. For instance, in the adjuvant setting it is common to give four cycles of systemic chemotherapy, but in the locally advanced setting, where the disease burden is worse, an added benefit has not been observed from providing four or more cycles.

The addition of targeted therapies to concurrent radiation and chemotherapy has also failed to show a benefit. Trials looking at the addition of bevacizumab resulted in undue toxicities and the addition of tyrosine kinase inhibitors provided unclear results. Further trials are currently ongoing looking at vaccines and the EGFR antibody cetuximab.