Treatment patterns and real-world evidence for stage III non-small cell lung cancer in Central and Eastern Europe
, , , , , , , , and | Oct 11, 2020
About this article
Article Category: Research Article
Published Online: Oct 11, 2020
Page range: 447 - 454
Received: Jun 09, 2020
Accepted: Jul 10, 2020
DOI: https://doi.org/10.2478/raon-2020-0058
© 2020 Milada Zemanova, Marko Jakopovic, Karmen Stanic, Małgorzata Łazar-Poniatowska, Martina Vrankar, Petronela Rusu, Tudor Ciuleanu, Davorin Radosavljevic, Krisztina Bogos, Sergiusz Nawrocki, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
Quality of care indicators in stage III non-small cell lung cancer found by our panel of experts
| Quality of care indicators | |
|---|---|
| 1. | The proportion of patients treated with chemoradiotherapy in radical treatment intention. |
| 2. | Improved survival (median OS, 5 years survival) over time. |
| 3. | Time from first symptoms to first contact with a lung cancer specialist, time from first contact with a lung cancer specialist to first treatment. |
| 4. | The proportion of patients with full histopathological/ molecular confirmation of the diagnosis – PET-CT, brain imaging, PD-L1. |
| 5. | The proportion of treatment decisions confirmed by a multidisciplinary team. |
Patterns in stage III non-small cell lung cancer diagnosis in Central and Eastern Europe region; % of patients treated in the medical center of particular panelists
| N | Mean (±SD) | Min-Max | |
|---|---|---|---|
| All stage III | 9 | 32% (± 13%) | 20%–65% |
| Stage IIIA | 9 | 37% (± 14%) | 20%–60% |
| Stage IIIB | 9 | 45% (± 12%) | 30%–60% |
| Stage IIIC | 9 | 18% (± 11%) | 6%–40% |
| X-Ray | 9 | 99% (± 3%) | 90%–100% |
| Chest CT | 9 | 98% (± 4%) | 90%–100% |
| Abdominal CT | 9 | 87% (± 19%) | 50%–100% |
| Brain CT | 9 | 58% (± 33%) | 12%–100% |
| Bronchoscopy | 9 | 93% (± 10%) | 75%–100% |
| EBUS | 9 | 37% (± 29%) | 9%–80% |
| PET-CT | 9 | 54% (± 30%) | 20%–80% |
| Bone scan | 9 | 15% (± 16%) | 0%–40% |
| Brain MRI | 9 | 14% (± 7%) | 2%–20% |
| PD-L1 reflex testing | 9 | 50% (±40%) | 2%–100% |
| PD-L1 results available Rates of PD-L1 results available of PD-L1 tests performed; CT = computed tomography; EBUS = endobronchial ultrasound; MRI = magnetic resonance imaging; PET-CT = positron emission tomography-computed tomography; SD = standard deviation | 9 | 56% (±31%) | 2%–100% |
Patterns in stage III non-small cell lung cancer diagnosis therapy; % of patients treated in the medical center of the particular panelist
| N | Mean (±SD) | Min–Max | |
|---|---|---|---|
| Radical treatment | 9 | 70% (±20%) | 30%–96% |
| Palliative treatment | 9 | 30% (±20%) | 4%–70% |
| Surgery | 9 | 17% (±6%) | 10%–25% |
| Chemotherapy | 8 | 13% (±16%) | 0%–48% |
| Radiotherapy | 8 | 15% (±9%) | 5%–25% |
| Concurrent chemoradiotherapy | 8 | 21% (±12%) | 0%–30% |
| Sequential chemoradiotherapy | 8 | 34% (±14%) | 18%–50% |
| Palliative radiotherapy | 8 | 60% (±33%) | 3%–90% |
| Best supportive care | 8 | 29% (±24%) | 10%–80% |
Main barriers in the treatment of stage III non-small cell lung cancer found by our panel of experts
| Main barriers | |
|---|---|
| 1. | Low chemoradiotherapy rates due to long waiting times for radiotherapy, especially for advanced RT techniques and/or radiotherapy and chemotherapy performed by different institutions. |
| 2. | Long referral process among different specialities (general practitioner, pneumologist, medical oncologist, radiotherapist). |
| 3. | Poor health literacy and social status of patients influence awareness of lung cancer symptoms, risk factors and treatment. |
| 4. | Late access to imaging and diagnostic procedures, especially PET-CT – long waiting times, low capacity. |
| 5. | Barriers to implementing targeted population screening programs. |
Patterns in stage III non-small cell lung cancer diagnosis organization of care; % of patients treated in the medical centers of particular panelists
| First contact physician | N | Mean (±SD) | Min-Max |
|---|---|---|---|
| General practitioner | 9 | 54% (± 27%) | 20%–90% |
| Pneumologist | 9 | 35% (± 29%) | 10%–95% |
| Medical oncologist | 9 | 9% (± 13%) | 0%–30% |
| Radiation oncologist | 9 | 3% (± 5%) | 0%–10% |
| Other | 9 | 5% (± 5%) | 0%–10% |
List of real-world evidence literature from the Central and Eastern Europe region
| Authors | Type of study, country | Treatment | Stages of NSCLC | Type of cancer | Population |
|---|---|---|---|---|---|
| Zemanová et al., 2020 | Registry, Czechia, Austria, Latvia, Serbia, Hungary, Poland | Surgery 23%, | IIIA 55%, | Squamous 53%, | 583 p., 78% males |
| Vrankar et al., 2018 | Observational, Slovenia | Induction CT in 3 cycles, | IIIA 57%, | Squamous 58%, | 102 p., 79% males |
| Ramlau et al., 2017 | Registry, Poland | Surgery 27%, | IIIA 12%, | Adenoc. 37%, | 696 p., 60% males |
| Podmaniczky et al., 2015 | Observational, Hungary | Platinum-based neoadjuvant CT | IIIA 60%, | Squamous 59%, | 46 p., 63% males |
| Jeremic, 2015 | Review, Serbia | Standard options treatment | NA | NA | NA |
| Georgieva el at., 2014 | Observational, Bulgaria | NA | III 2.4%, | Squamous 22%, | 42 p., 57% males |
| Zielinski et al., 2013 | Retrospective observational study, Poland | Staging | NA | NA | 899 p. |
| Squamous 41%, | |||||
| Kolodziejczyk et al., 2011 | Prospective study, Poland | Radical RT, | IIIA 31%, | adenoc. 8%, | 100 p., 78% males |
| no histology 4% | |||||
| Jeremic 2011 | Toxicity studies, Serbia | CCRT | NA | NA | 600 p. |
| Kepka 2011 | Observational, Poland | Surgery, RT, CT | NA | NA | 291 p. |
Evidence based clinical recommendations consensus
| Statement | 1st round average N = 9 | Final consensus | |
|---|---|---|---|
| 1. | All patients planned for stage III NSCLC treatment should undergo a diagnostic contrast-enhanced CT scan of the chest and upper abdomen followed by a PET or a combined PET-CT using a CT technique with adequately high resolution for initial staging purposes. | 4.8 | Consensus |
| 2. | All patients planned for curative stage III NSCLC treatment should receive brain imaging for initial staging. | 4.8 | Consensus |
| 3. | Concurrent CRT is the treatment of choice in patients evaluated as unresectable in stage IIIa, IIIb, and IIIc. | 4.6 | Consensus |
| 4. | If concurrent CRT is not possible - for any reason - sequential ChT followed by definitive RT represents a valid and effective alternative. | 4.8 | Consensus |
| 5. | An experienced multidisciplinary team is of paramount importance in any complex multimodality treatment strategy decision. | 4.9 | Consensus |
| 6. | In the absence of contraindications, the optimal ChT to be combined with radiation in stage III NSCLC should be platinum-based therapy. | 4.3 | Consensus |
| 7. | When delivered perioperatively, platinum-based combinations are considered the treatment of choice, in the absence of contraindications. | 4.6 | Consensus |
| 8. | In the stage III disease CRT strategy, two to four cycles of concomitant ChT should be delivered. | 4.9 | Consensus |
| 9. | In the perioperative setting, three to four cycles of platinum-based ChT are recommended. | 4.8 | Consensus |
| 10. | 60–66 Gy in 30–33 daily fractions is recommended for concurrent CRT. The maximum overall treatment time should not exceed 7 weeks. | 5.0 | Unanimity |
| 11. | In sequential approaches, RT delivered over a short overall treatment time is recommended. | 4.3 | Consensus |
| 12. | Adjuvant anti PD-L1 checkpoint inhibitor durvalumab is indicated for unresectable NSCLC with PD-L1 ≥ 1% without progression after chemoradiotherapy with a platinum-based regime. | 5.0 | Unanimity |