Asian Thoracic Oncology Research Group expert consensus statement on optimal management of stage III non-small cell lung cancer.J Thorac Oncol 2019JT
Stage III non-small cell lung cancer (NSCLC) represents a heterogeneous disease for which optimal treatment continues to pose a clinical challenge. Recent changes in the American Joint Commission on Cancer (AJCC) staging to the 8th edition has led to a shift in TNM stage grouping and redefined the subcategories (IIIA-C) in stage III NSCLC for better prognostication. Although concurrent chemoradiotherapy (CCRT) has remained standard of care for Stage III NSCLC for almost 2 decades, contemporary considerations include the impact of different molecular subsets of NSCLC, role of tyrosine kinase inhibitors (TKIs) post-definitive therapy, and of immune checkpoint inhibitors following chemoradiotherapy. With rapid evolution of diagnostic algorithms and expanding treatment options, the need for interdisciplinary input - involving multiple specialists (medical oncologists, pulmonologists, radiologists and thoracic surgeons) has become increasingly important. The unique demographics of Asian NSCLC pose further challenges when applying clinical trial data into clinical practice. This includes differences in smoking rates, prevalence of oncogenic driver mutations, and access to healthcare resources including molecular testing, prompting the need for critical review of existing data and identification of current gaps. In this expert consensus statement by the Asian Thoracic Oncology Research Group (ATORG), an interdisciplinary group of experts representing Hong Kong, Korea, Japan, Taiwan, Singapore, Thailand, Malaysia and Mainland China was convened. Standard clinical practices for stage III NSCLC across different Asian countries were discussed from initial diagnosis, staging through to multi-modality approaches including surgery, chemotherapy, radiation, targeted therapies and immunotherapy.