International consensus on radiotherapy in metastatic non-small cell lung cancer

Z.F. Zhu; J.J. Ni; X.W. Cai; S.F. Su; H.Q. Zhuang; Z.Z. Yang; M. Chen; S.L. Ma; C.H. Xie; Y.P. Xu; J.C. Li; H. Ge; A.W. Liu; L.J. Zhao; C.Z. Rao; C.Y. Xie; N. Bi; Z.G. Hui; G.Y. Zhu; Z.Y. Yuan; J. Wang; L.N. Zhao; W. Zhou; C.H. Rim; A. Navarro-Martin; B.L. Vanneste; D. De Ruysscher; J.I. Choi; J. Jassem; J.Y. Chang; L. Kepka; L. Kasmann; M.T. Milano; P. Van Houtte; R. Suwinski; A. Traverso; H. Doi; Y.G. Suh; G. Noel; N. Tomita; R.O. Kowalchuk; T.T. Sio; B.S. Li; B. Lu; X.L. Fu

doi:10.21037/tlcr-22-644

International consensus on radiotherapy in metastatic non-small cell lung cancer

Z.F. Zhu^*, J.J. Ni, X.W. Cai, S.F. Su, H.Q. Zhuang, Z.Z. Yang, M. Chen, S.L. Ma^*, C.H. Xie, Y.P. Xu, J.C. Li^*, H. Ge, A.W. Liu, L.J. Zhao, C.Z. Rao, C.Y. Xie, N. Bi, Z.G. Hui, G.Y. Zhu^*, Z.Y. YuanJ. Wang, L.N. Zhao, W. Zhou, C.H. Rim, A. Navarro-Martin, B.L. Vanneste, D. De Ruysscher, J.I. Choi, J. Jassem, J.Y. Chang, L. Kepka, L. Kasmann, M.T. Milano, P. Van Houtte, R. Suwinski, A. Traverso, H. Doi, Y.G. Suh, G. Noel, N. Tomita, R.O. Kowalchuk, T.T. Sio^*, B.S. Li^*, B. Lu^*, X.L. Fu^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for most cases. While radiotherapy has historically served as a palliative modality in metastatic NSCLC, considerable advances in its technology and the continuous development of cutting-edge therapeutic agents, such as targeted therapy and immune checkpoint inhibitors (ICIs), are increasing its role in the multi-disciplinary management of the disease.Methods: International radiotherapy experts were convened to consider and reach consensuses on the clinical utilities of radiotherapy in metastatic NSCLC, with the aim to provide patient-focused, up to date, evidence-based, recommendations to assist cancer specialists in the management of patients with metastatic NSCLC worldwide.Results: Timely radiotherapy can offer rapid symptom alleviation and allow subsequent aggressive treatment approaches in patients with heavy tumor burden and/or oncologic emergencies. In addition, appropriate incorporation of radiotherapy as concurrent, consolidation, or salvage therapy makes it possible to achieve long-term survival, or even cure, for patients with oligo-metastatic disease. Cranial radiotherapy plays an important role in the management of brain metastasis, potentially augmenting the response and prolonging survival associated with targeted agents and ICIs. However, key questions remain, such as the appropriate choice of radiation techniques, optimal sequence of systemic therapies and radiotherapy, and optimal patient selection for such combination strategies. Although a strong rationale for combining radiotherapy and ICIs exists, its optimal parameters in this setting remain to be established.Conclusions: In the modern era, radiotherapy serves not only as a palliative tool in metastatic NSCLC, but also plays active roles in patients with oligo-focal disease, CNS metastasis and receiving ICIs.

Original language	English
Pages (from-to)	1763-1795
Number of pages	33
Journal	Translational Lung Cancer Research
Volume	11
Early online date	14 Sept 2022
DOIs	https://doi.org/10.21037/tlcr-22-644
Publication status	Published - Sept 2022

Keywords

Non-small cell lung cancer
radiotherapy
oligo-metastasis
brain metastasis
immune checkpoint inhibitor
BODY RADIATION-THERAPY
TYROSINE KINASE INHIBITORS
IMMUNE CHECKPOINT INHIBITORS
LONG-TERM SURVIVAL
PALLIATIVE THORACIC RADIOTHERAPY
POSITRON-EMISSION-TOMOGRAPHY
1ST-LINE SYSTEMIC THERAPY
LOCAL ABLATIVE THERAPY
PHASE I/II TRIAL
BRAIN METASTASES

Access to Document

10.21037/tlcr-22-644Licence: CC BY-NC-ND

Cite this

Zhu, Z. F., Ni, J. J., Cai, X. W., Su, S. F., Zhuang, H. Q., Yang, Z. Z., Chen, M., Ma, S. L., Xie, C. H., Xu, Y. P., Li, J. C., Ge, H., Liu, A. W., Zhao, L. J., Rao, C. Z., Xie, C. Y., Bi, N., Hui, Z. G., Zhu, G. Y., ... Fu, X. L. (2022). International consensus on radiotherapy in metastatic non-small cell lung cancer. Translational Lung Cancer Research, 11, 1763-1795. https://doi.org/10.21037/tlcr-22-644

@article{c93be6352df947859c2593933b5a3568,

title = "International consensus on radiotherapy in metastatic non-small cell lung cancer",

abstract = "Background: Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for most cases. While radiotherapy has historically served as a palliative modality in metastatic NSCLC, considerable advances in its technology and the continuous development of cutting-edge therapeutic agents, such as targeted therapy and immune checkpoint inhibitors (ICIs), are increasing its role in the multi-disciplinary management of the disease.Methods: International radiotherapy experts were convened to consider and reach consensuses on the clinical utilities of radiotherapy in metastatic NSCLC, with the aim to provide patient-focused, up to date, evidence-based, recommendations to assist cancer specialists in the management of patients with metastatic NSCLC worldwide.Results: Timely radiotherapy can offer rapid symptom alleviation and allow subsequent aggressive treatment approaches in patients with heavy tumor burden and/or oncologic emergencies. In addition, appropriate incorporation of radiotherapy as concurrent, consolidation, or salvage therapy makes it possible to achieve long-term survival, or even cure, for patients with oligo-metastatic disease. Cranial radiotherapy plays an important role in the management of brain metastasis, potentially augmenting the response and prolonging survival associated with targeted agents and ICIs. However, key questions remain, such as the appropriate choice of radiation techniques, optimal sequence of systemic therapies and radiotherapy, and optimal patient selection for such combination strategies. Although a strong rationale for combining radiotherapy and ICIs exists, its optimal parameters in this setting remain to be established.Conclusions: In the modern era, radiotherapy serves not only as a palliative tool in metastatic NSCLC, but also plays active roles in patients with oligo-focal disease, CNS metastasis and receiving ICIs.",

keywords = "Non-small cell lung cancer, radiotherapy, oligo-metastasis, brain metastasis, immune checkpoint inhibitor, BODY RADIATION-THERAPY, TYROSINE KINASE INHIBITORS, IMMUNE CHECKPOINT INHIBITORS, LONG-TERM SURVIVAL, PALLIATIVE THORACIC RADIOTHERAPY, POSITRON-EMISSION-TOMOGRAPHY, 1ST-LINE SYSTEMIC THERAPY, LOCAL ABLATIVE THERAPY, PHASE I/II TRIAL, BRAIN METASTASES",

author = "Z.F. Zhu and J.J. Ni and X.W. Cai and S.F. Su and H.Q. Zhuang and Z.Z. Yang and M. Chen and S.L. Ma and C.H. Xie and Y.P. Xu and J.C. Li and H. Ge and A.W. Liu and L.J. Zhao and C.Z. Rao and C.Y. Xie and N. Bi and Z.G. Hui and G.Y. Zhu and Z.Y. Yuan and J. Wang and L.N. Zhao and W. Zhou and C.H. Rim and A. Navarro-Martin and B.L. Vanneste and {De Ruysscher}, D. and J.I. Choi and J. Jassem and J.Y. Chang and L. Kepka and L. Kasmann and M.T. Milano and {Van Houtte}, P. and R. Suwinski and A. Traverso and H. Doi and Y.G. Suh and G. Noel and N. Tomita and R.O. Kowalchuk and T.T. Sio and B.S. Li and B. Lu and X.L. Fu",

note = "Funding Information: Center) and Tiantian Guo (Fudan University Shanghai Cancer Center) for data collecting and manuscript drafting. Finally, we thank Jinming Yu (Shandong Cancer Hospital Affiliated to Shandong University), Lvhua Wang (Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College) and Ping Wang (Tianjin Medical University Cancer Institute and Hospital) for their guidance and kindly support in this project. The authors also appreciate the academic support from the AME Lung Cancer Collaborative Group. Funding: The study was supported by the Science and Technology Commission of Shanghai Municipality (Nos. 20Y11913500 and 19411965900) and the Hospital Development Center of Shanghai (No. SHDC2020CR4010). Funding Information: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups. com/article/view/10.21037/tlcr-22-644/coif). DDR{\textquoteright}s institution received grants from BMS, AstraZeneca, Philips Health, and Beigene. JIC received speaker honoraria from Varian Medical Systems. JYC received research grant from BMS and consulting fees from Legion Healthcare Partners. Lukas K{\"a}smann received honoraria from AMGEN. MTM received a speaker fee from Astra Zeneca and royalties from Wolters Kluwer. HD received research grant from Japan Society for the Promotion of Science and lecture fee from AstraZeneca. TTS provides strategic and scientific recommendations as a member of the Advisory Board and speaker for Novocure, Inc., which is not in any way associated with the content presented in this manuscript. The other authors have no conflicts of interest to declare. Publisher Copyright: {\textcopyright} 2022 AME Publishing Company. All rights reserved.",

year = "2022",

month = sep,

doi = "10.21037/tlcr-22-644",

language = "English",

volume = "11",

pages = "1763--1795",

journal = "Translational Lung Cancer Research",

issn = "2226-4477",

publisher = "AME Publishing Company",

}

Zhu, ZF, Ni, JJ, Cai, XW, Su, SF, Zhuang, HQ, Yang, ZZ, Chen, M, Ma, SL, Xie, CH, Xu, YP, Li, JC, Ge, H, Liu, AW, Zhao, LJ, Rao, CZ, Xie, CY, Bi, N, Hui, ZG, Zhu, GY, Yuan, ZY, Wang, J, Zhao, LN, Zhou, W, Rim, CH, Navarro-Martin, A, Vanneste, BL, De Ruysscher, D, Choi, JI, Jassem, J, Chang, JY, Kepka, L, Kasmann, L, Milano, MT, Van Houtte, P, Suwinski, R, Traverso, A, Doi, H, Suh, YG, Noel, G, Tomita, N, Kowalchuk, RO, Sio, TT, Li, BS, Lu, B & Fu, XL 2022, 'International consensus on radiotherapy in metastatic non-small cell lung cancer', Translational Lung Cancer Research, vol. 11, pp. 1763-1795. https://doi.org/10.21037/tlcr-22-644

TY - JOUR

T1 - International consensus on radiotherapy in metastatic non-small cell lung cancer

AU - Zhu, Z.F.

AU - Ni, J.J.

AU - Cai, X.W.

AU - Su, S.F.

AU - Zhuang, H.Q.

AU - Yang, Z.Z.

AU - Chen, M.

AU - Ma, S.L.

AU - Xie, C.H.

AU - Xu, Y.P.

AU - Li, J.C.

AU - Ge, H.

AU - Liu, A.W.

AU - Zhao, L.J.

AU - Rao, C.Z.

AU - Xie, C.Y.

AU - Bi, N.

AU - Hui, Z.G.

AU - Zhu, G.Y.

AU - Yuan, Z.Y.

AU - Wang, J.

AU - Zhao, L.N.

AU - Zhou, W.

AU - Rim, C.H.

AU - Navarro-Martin, A.

AU - Vanneste, B.L.

AU - De Ruysscher, D.

AU - Choi, J.I.

AU - Jassem, J.

AU - Chang, J.Y.

AU - Kepka, L.

AU - Kasmann, L.

AU - Milano, M.T.

AU - Van Houtte, P.

AU - Suwinski, R.

AU - Traverso, A.

AU - Doi, H.

AU - Suh, Y.G.

AU - Noel, G.

AU - Tomita, N.

AU - Kowalchuk, R.O.

AU - Sio, T.T.

AU - Li, B.S.

AU - Lu, B.

AU - Fu, X.L.

N1 - Funding Information: Center) and Tiantian Guo (Fudan University Shanghai Cancer Center) for data collecting and manuscript drafting. Finally, we thank Jinming Yu (Shandong Cancer Hospital Affiliated to Shandong University), Lvhua Wang (Cancer Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College) and Ping Wang (Tianjin Medical University Cancer Institute and Hospital) for their guidance and kindly support in this project. The authors also appreciate the academic support from the AME Lung Cancer Collaborative Group. Funding: The study was supported by the Science and Technology Commission of Shanghai Municipality (Nos. 20Y11913500 and 19411965900) and the Hospital Development Center of Shanghai (No. SHDC2020CR4010). Funding Information: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups. com/article/view/10.21037/tlcr-22-644/coif). DDR’s institution received grants from BMS, AstraZeneca, Philips Health, and Beigene. JIC received speaker honoraria from Varian Medical Systems. JYC received research grant from BMS and consulting fees from Legion Healthcare Partners. Lukas Käsmann received honoraria from AMGEN. MTM received a speaker fee from Astra Zeneca and royalties from Wolters Kluwer. HD received research grant from Japan Society for the Promotion of Science and lecture fee from AstraZeneca. TTS provides strategic and scientific recommendations as a member of the Advisory Board and speaker for Novocure, Inc., which is not in any way associated with the content presented in this manuscript. The other authors have no conflicts of interest to declare. Publisher Copyright: © 2022 AME Publishing Company. All rights reserved.

PY - 2022/9

Y1 - 2022/9

N2 - Background: Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for most cases. While radiotherapy has historically served as a palliative modality in metastatic NSCLC, considerable advances in its technology and the continuous development of cutting-edge therapeutic agents, such as targeted therapy and immune checkpoint inhibitors (ICIs), are increasing its role in the multi-disciplinary management of the disease.Methods: International radiotherapy experts were convened to consider and reach consensuses on the clinical utilities of radiotherapy in metastatic NSCLC, with the aim to provide patient-focused, up to date, evidence-based, recommendations to assist cancer specialists in the management of patients with metastatic NSCLC worldwide.Results: Timely radiotherapy can offer rapid symptom alleviation and allow subsequent aggressive treatment approaches in patients with heavy tumor burden and/or oncologic emergencies. In addition, appropriate incorporation of radiotherapy as concurrent, consolidation, or salvage therapy makes it possible to achieve long-term survival, or even cure, for patients with oligo-metastatic disease. Cranial radiotherapy plays an important role in the management of brain metastasis, potentially augmenting the response and prolonging survival associated with targeted agents and ICIs. However, key questions remain, such as the appropriate choice of radiation techniques, optimal sequence of systemic therapies and radiotherapy, and optimal patient selection for such combination strategies. Although a strong rationale for combining radiotherapy and ICIs exists, its optimal parameters in this setting remain to be established.Conclusions: In the modern era, radiotherapy serves not only as a palliative tool in metastatic NSCLC, but also plays active roles in patients with oligo-focal disease, CNS metastasis and receiving ICIs.

AB - Background: Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for most cases. While radiotherapy has historically served as a palliative modality in metastatic NSCLC, considerable advances in its technology and the continuous development of cutting-edge therapeutic agents, such as targeted therapy and immune checkpoint inhibitors (ICIs), are increasing its role in the multi-disciplinary management of the disease.Methods: International radiotherapy experts were convened to consider and reach consensuses on the clinical utilities of radiotherapy in metastatic NSCLC, with the aim to provide patient-focused, up to date, evidence-based, recommendations to assist cancer specialists in the management of patients with metastatic NSCLC worldwide.Results: Timely radiotherapy can offer rapid symptom alleviation and allow subsequent aggressive treatment approaches in patients with heavy tumor burden and/or oncologic emergencies. In addition, appropriate incorporation of radiotherapy as concurrent, consolidation, or salvage therapy makes it possible to achieve long-term survival, or even cure, for patients with oligo-metastatic disease. Cranial radiotherapy plays an important role in the management of brain metastasis, potentially augmenting the response and prolonging survival associated with targeted agents and ICIs. However, key questions remain, such as the appropriate choice of radiation techniques, optimal sequence of systemic therapies and radiotherapy, and optimal patient selection for such combination strategies. Although a strong rationale for combining radiotherapy and ICIs exists, its optimal parameters in this setting remain to be established.Conclusions: In the modern era, radiotherapy serves not only as a palliative tool in metastatic NSCLC, but also plays active roles in patients with oligo-focal disease, CNS metastasis and receiving ICIs.

KW - Non-small cell lung cancer

KW - radiotherapy

KW - oligo-metastasis

KW - brain metastasis

KW - immune checkpoint inhibitor

KW - BODY RADIATION-THERAPY

KW - TYROSINE KINASE INHIBITORS

KW - IMMUNE CHECKPOINT INHIBITORS

KW - LONG-TERM SURVIVAL

KW - PALLIATIVE THORACIC RADIOTHERAPY

KW - POSITRON-EMISSION-TOMOGRAPHY

KW - 1ST-LINE SYSTEMIC THERAPY

KW - LOCAL ABLATIVE THERAPY

KW - PHASE I/II TRIAL

KW - BRAIN METASTASES

U2 - 10.21037/tlcr-22-644

DO - 10.21037/tlcr-22-644

M3 - Article

C2 - 36248338

SN - 2226-4477

VL - 11

SP - 1763

EP - 1795

JO - Translational Lung Cancer Research

JF - Translational Lung Cancer Research

ER -