Relevance of multi-disciplinary team approach in diagnosis and management of Stage III NSCLC.

Lung cancer is reported as the leading cause of cancer-related mortality worldwide. Non-small cell lung cancer (NSCLC) constitutes 80%-85% of all lung cancers. Diagnosis of NSCLC is a complex multistep process. The prognosis of NSCLC is poor as most of the patients are presented at the metastatic stage. The management of these patients needs the expertise of different specialists. A multidisciplinary team (MDT) comprising specialists from different disciplines has a substantial role in improving outcomes in these patients. This is feasible through extensive discussions, accurate evaluation of patients, reviewing medical records, implementing ideal treatment strategies, and merging local treatments with systemic treatment concepts. Therefore, the MDT approach for stage III NSCLC management can enable early treatment initiation, optimal treatment modalities, and reduce healthcare expenditure. Studies have shown that MDT can provide multimodality care facilitating the diagnosis and treatment of stage III NSCLC, resulting in survival benefit of these patients. Thus, it is imperative to collate scientific evidence to get an insight into the MDT approach in advanced NSCLC treatment. This review aims to summarize the impact of MDT on treatment rates, survival outcome, treatment guideline adherence, and quality of life (QoL) of stage III NSCLC patients.

Overall survival in stage IV EGFR mutation­positive NSCLC: Comparing first­, second­ and third­generation EGFR­TKIs (Review).

A substantial (40­60%) proportion of patients with non­small cell lung carcinoma (NSCLC) have epidermal growth factor receptor (EGFR) mutations, a crucial therapeutic target in NSCLC. Treatment strategies for patients with advanced­stage NSCLC have markedly changed, from the empirical use of cytotoxic agents to targeted regimens. EGFR tyrosine kinase inhibitors (TKIs), the first­line therapy for advanced NSCLC, are reported to be the most effective. Although progression­free survival (PFS) and objective response rates have long been used as endpoints, meeting these endpoints may not necessarily coincide with an increase in overall survival (OS) among patients with advanced lung cancer. Recently, the FLAURA study with the third­generation, irreversible, oral EGFR­TKI, osimertinib, demonstrated an extended median OS by 6.8 months compared with standard EGFR­TKIs, with a 20% reduction in the risk of mortality [osimertinib, 38.6; EGFR­TKIs, 31.8; hazard ratio (HR), 0.80; 95% confidence interval (CI), 0.641­0.997; P=0.046]; this was in addition to meeting the primary endpoint of clinically and statistically significant PFS. Osimertinib was also shown to lead to a statistically significant reduction in the risk of central nervous system disease progression (HR, 0.48; 95% CI, 0.26­0.86; P=0.014). Notably, 28% of patients remained on osimertinib treatment for 3 years, considerably longer than those in the comparator group (9%). The duration of first subsequent treatment with osimertinib was 25.5 months compared with 13.7 months with standard EGFR­TKIs (HR, 0.478; 95% CI, 0.393­0.581; P<0.0001). Thus, the long­term OS benefit with first­line osimertinib highlights a promising option in the management of stage IV NSCLC. The present narrative review compares the OS benefit of first­, second­ and third­generation EGFR­TKIs for patients with stage IV EGFR mutation­positive NSCLC and discusses their role in disease management.