The optimal management of stage III NSCLC

The optimal management of stage III NSCLC continues to be a subject of intense discussion. During the 2024 European Lung Cancer Conference (ELCC), a debate was organized in which Prof Dr Corinne Faivre-Finn (The Christie NHS Foundation Trust, Manchester, UK) and Dr Jonathan Spicer (McGill University Health Center, Motréal, Canada) respectively made a case for the use of radiotherapy or surgery in these patients. Before entering the debate arena, Prof Dr Faivre-Finn joined Dr Mariana Brandao (Institut Jules Bordet, Brussels, Belgium) to share her position on this topic.

For Prof Faivre-Finn the treatment decision in stage III NSCLC is not a black-or-white story between resection or surgery. In clinical practice, the situation is much more nuanced and requires a tailored approach in which the right treatment strategy is used for the right patient. In recent years, stage III NSCLC has been a field of intensive research. These research efforts resulted in the establishment of chemoradiotherapy followed by consolidation durvalumab as the standard of care for unresectable patients. In addition, a long list of clinical trials have demonstrated the potential benefit of adjuvant, neo-adjuvant, or perioperative immunotherapy-based therapy in resectable stage III patients.

To data, there is a lack of prospective data comparing these two treatment approaches in stage III NSCLC patients. This can make treatment choices challenging, especially in ‘borderline resectable’ patients. When opting for a certain treatment approach it is important to look beyond hard clinical endpoints such as progression-free or overall survival and also take quality of life and patient preference into consideration. As such, treatment choices for stage III NSCLC patients require a multidisciplinary discussion and should always take into account the opinion of the individual patient.