Jun 5, 2019

Lung Cancer for Radiation Oncologists — Part 2: Our interview with Dr Langer highlights the following topics and cases from his practice:

• Case: A woman in her mid-60s, a never smoker, with locally advanced, unresectable adenocarcinoma of the lung and an EGFR exon 18 tumor mutation receives CRT followed by consolidation durvalumab (00:00)
• Clinical significance and prognostic relevance of microsatellite instability testing in the management of lung cancer (1:29)
• Risk of recurrence after concurrent CRT for patients with Stage III NSCLC (3:05)
• Improvement in progression-free and overall survival with the addition of consolidation durvalumab after CRT for patients with Stage III NSCLC on the PACIFIC trial (5:25)
• Role of immune checkpoint inhibition in the treatment of locally advanced NSCLC with an EGFR tumor mutation (10:15)
• Perspective on the use of EGFR tyrosine kinase inhibitors in the adjuvant or neoadjuvant setting for patients with locally advanced NSCLC and EGFR tumor mutations (12:50)
• Initial diagnostic workup and disease management for patients with locally advanced NSCLC (17:17)
• RTOG-1308: An ongoing Phase III trial of photon versus proton CRT for patients with inoperable Stage II to Stage IIIB NSCLC (19:27)
• Role of proton beam RT in the treatment of locally advanced NSCLC (21:44)
• Rationale for the combination of RT and immune checkpoint inhibitors (24:20)
• Risk of pneumonitis with CRT (26:07)
• Design and results of the Phase III PACIFIC trial of durvalumab after CRT for unresectable Stage III NSCLC (27:55)
• Monitoring and management of the toxicities associated with immune checkpoint inhibitors (32:03)
• Use of durvalumab for patients with preexisting autoimmune disease and for transplant recipients (35:07)
• Results from the Phase II Hoosier Cancer Research Network LUN14-179 trial of consolidation pembrolizumab after CRT for unresectable Stage III NSCLC (36:45)
• Ongoing investigation of anti-PD-1/PD-L1 immune checkpoint inhibitors for locally advanced disease (38:56)
• Case: A man in his mid-80s, a former heavy smoker with multiple comorbidities, is diagnosed with locally advanced squamous cell carcinoma of the lung with a high PD-L1 TPS (tumor proportion score) (40:54)
• Use of liquid biopsies to detect targetable tumor mutations in patients with lung cancer (44:37)
• Case: A man in his mid-50s, a former smoker, is diagnosed with Stage IIIA mixed adenosquamous carcinoma of the lung with TTF-1 and p40 tumor mutations (47:17)
• Perspective on the use of anti-PD-1/PD-L1 antibodies as neoadjuvant therapy for patients with NSCLC (51:22)
• Case: A man in his early 70s, a current smoker, with adenosquamous carcinoma of the lung and a KRAS mutation receives SBRT (56:28)
• Optimal approach to RT for patients with locally advanced NSCLC (59:58)

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