Consensus on the use of immune-related response criteria to evaluate the efficacy of immunotherapy in non-small cell lung cancer

Defining long-term survivors in metastatic lung cancer: insights from a Delphi study in Spain

The improvement in survival rates in metastatic lung cancer (mLC) has increased the number of survivors' special care needs. This study aimed to define and characterise these long-term survivors. A Delphi method with two successive rounds was conducted to reach a consensus (defined as an agreement ≥ 70%) on 56 items among 41 medical oncologists. The items included the definition of long-term survivors, their common characteristics, and oncological and non-oncological implications. The experts had an average age of 46 years, 53.7% were men, 90.2% attended for thoracic tumours, 40% had more than 15 years' experience in mLC, and 56.1% of managing > 50 patients/month. Consensus reached 53.6% in the first round and 73.2% in the second. The definition of long-term survivors reached 58.3% consensus, defined as overall survival ≥ 3 years and/or progression-free survival ≥ 2 years. Identification of common features obtained 76.2% consensus on adenocarcinoma subtype of non-small-cell lung cancer, high PD-L1 expression, absence of brain metastasis, and fewer than two metastatic locations. Consensus was reached on specialized medical follow-up to detect immune-mediated toxicities and second neoplasms (87.8%), on pharmacological/non-pharmacological treatment for fatigue (82.9%) and sexual dysfunction (85.4%); and also on the importance of support for work and social adaptation (92.7%), integration of primary and hospital care (90.2%), implementation of quality-of-life programmes (92.7%) and electronic media (73.2%). This consensus identifies common characteristics and highlights relevant implications that should guide the follow-up and clinical management of these patients, ensuring better care and quality of life.

Treatment patterns and real-world evidence for stage III non-small cell lung cancer in Central and Eastern Europe

Background

The aim of this project was to collect real-world evidence and describe treatment patterns for stage III non-small cell lung cancer in Central and Eastern Europe. Based on real-world evidence, an expert opinion was developed, and the unmet needs and quality indicators were identified.

Patients and methods

A systematic literature search and a multidisciplinary expert panel of 10 physicians from 7 countries used a modified Delphi process to identify quality indicators and unmet needs in patients with stage III non-small cell lung cancer. The profound questionnaire was used to characterize treatment patterns used for stage III non-small cell lung cancer, and a systematic review identified patterns in Central and Eastern Europe. The first questionnaire was completed by a group of medical oncologists, radiation oncologists and pneumologists. The panel of experts attended an in-person meeting to review the results of the questionnaire and to process a second round Delphi. An additional survey was then compiled and completed by the panel.

Results

A complete consensus was reached by the panel of experts on a set of evidence-based clinical recommendations. The experience-based questionnaire generated a highly variable map of treatment patterns within the region. A list of unmet needs and barriers to quality care were developed with near-unanimous consent of the panel of experts.

Conclusions

The current landscape of diagnostic and therapeutic approaches in Central and Eastern European countries is highly variable. We identified several significant barriers, mainly related to the availability of diagnostic and imaging methods and low rates of chemoradiotherapy with curative intention as initial treatment for unresectable stage III NSCLC.