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Treatment options beyond immunotherapy in patients with wild-type lung adenocarcinoma:: a Delphi consensus

    1. [1] Hospital Clinico Universitario de Valencia

      Hospital Clinico Universitario de Valencia

      Valencia, España

    2. [2] Complexo Hospitalario Universitario da Coruña

      Complexo Hospitalario Universitario da Coruña

      A Coruña, España

    3. [3] Hospital de Mataró

      Hospital de Mataró

      Barcelona, España

    4. [4] Hospital Universitario 12 de Octubre

      Hospital Universitario 12 de Octubre

      Madrid, España

    5. [5] Hospital Universitario Virgen de la Victoria

      Hospital Universitario Virgen de la Victoria

      Málaga, España

    6. [6] Medical Oncology Department, Hospital Universitario La Paz-IDIPAZ, Madrid, Spain
    7. [7] Oncology Department, Vall d’Hebron University, Vall d’Hebron Institute of Oncology, Barcelona, Spain
  • Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 22, Nº. 5, 2020, págs. 759-771
  • Idioma: inglés
  • Texto completo no disponible (Saber más ...)
  • Resumen
    • Purpose Immunotherapy-based approaches are standard first-line treatments for advanced/metastatic lung cancer or for chemoradiotherapy consolidation in locally advanced disease. Uncertainty on how to treat patients at disease progression prompted us to develop a consensus document on post-immunotherapy options in Spain for patients with advanced wild-type lung adenocarcinoma.

      Methods After extensive literature review, a 5-member scientific committee generated 33 statements in 4 domains: general aspects (n = 4); post-durvalumab in locally advanced disease (n = 6); post-first-line immunotherapy ± chemotherapy in advanced/metastatic disease (n = 11); and post-first-line platinum-based chemotherapy in advanced/metastatic disease (n = 12). A panel of 26 lung cancer experts completed 2 Delphi iterations through an online platform rating their degree of agreement/disagreement (first-round scale 1–5 and second-round scale 1–4, 1 = strongly disagree, 4/5 = strongly agree) for each statement. Second-round consensus: ≥ 70% of responses were in categories 1/2 (disagreement) or 3/4 (agreement).

      Results Consensus was reached for 2/33 statements in the first Delphi round and in 29/31 statements in the second round. Important variables informing treatment at disease progression with an immunotherapy-based treatment include: disease aggressiveness, previous treatment, accumulated toxicity, progression-free interval, PD-L1 expression, and tumour mutational burden. A platinum-based chemotherapy should follow a first-line immunotherapy treatment without chemotherapy. Treatment with docetaxel + nintedanib may be appropriate post-durvalumab in refractory patients or following progression to first-line chemotherapy + immunotherapy, or second-line chemotherapy after first-line immunotherapy, or first-line chemotherapy in some patients with low/negative PD-L1 expression, or second-line immunotherapy after first-line chemotherapy.

      Conclusions To support decision making following progression to immunotherapy-based treatment in patients with advanced wild-type lung adenocarcinoma, a consensus document has been developed.


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