Immunotherapy and Radiotherapy for Older Patients with Locally Advanced Non-Metastatic Non-Small-Cell Lung Cancer Who Are Not Candidates for or Decline Surgery and Chemotherapy: A Practical Proposal by the International Geriatric Radiotherapy Group

The standard of care for locally advanced non-small-cell lung cancer (NSCLC) is either surgery combined with chemotherapy pre- or postoperatively or concurrent chemotherapy and radiotherapy. However, older and frail patients may not be candidates for surgery and chemotherapy due to the high mortalit...

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Bibliographic Details
Published in:Cancers 2024-09, Vol.16 (17), p.3112
Main Authors: Nguyen, Nam P, Page, Brandi R, Giap, Huan, Dahbi, Zineb, Vinh-Hung, Vincent, Gorobets, Olena, Mohammadianpanah, Mohammad, Motta, Micaela, Portaluri, Maurizio, Arenas, Meritxell, Bonet, Marta, Lara, Pedro Carlos, Kim, Lyndon, Dutheil, Fabien, Natoli, Elena, Loganadane, Gokoulakrichenane, Lehrman, David, Bose, Satya, Kaur, Sarabjot, Blanco, Sergio Calleja, Chi, Alexander
Format: Article
Language:English
Subjects:
Apoptosis
Biomarkers
Biopsy
Cancer therapies
Chemotherapy
Clinical trials
Geriatrics
Immune checkpoint inhibitors
Immunotherapy
Ligands
Lung cancer
Lymphocytes
Medical prognosis
Metastases
Metastasis
Non-small cell lung carcinoma
Patients
PD-L1 protein
Radiation therapy
Risk assessment
Small cell lung carcinoma
Surgery
Toxicity
Tumors
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Summary:The standard of care for locally advanced non-small-cell lung cancer (NSCLC) is either surgery combined with chemotherapy pre- or postoperatively or concurrent chemotherapy and radiotherapy. However, older and frail patients may not be candidates for surgery and chemotherapy due to the high mortality risk and are frequently referred to radiotherapy alone, which is better tolerated but carries a high risk of disease recurrence. Recently, immunotherapy with immune checkpoint inhibitors (ICIs) may induce a high response rate among cancer patients with positive programmed death ligand 1 (PD-L1) expression. Immunotherapy is also well tolerated among older patients. Laboratory and clinical studies have reported synergy between radiotherapy and ICI. The combination of ICI and radiotherapy may improve local control and survival for NSCLC patients who are not candidates for surgery and chemotherapy or decline these two modalities. The International Geriatric Radiotherapy Group proposes a protocol combining radiotherapy and immunotherapy based on the presence or absence of PD-L1 to optimize the survival of those patients.
ISSN:2072-6694
2072-6694
DOI:10.3390/cancers16173112