Quelles stratégies thérapeutiques pour les CBNPC de stade IIIB (T4N2/T1-T3N3) ?

Abstract

Approximately a quarter of the Non-small Cell Lung Cancer (NSCLC) patients with a locally advanced disease. This stage includes heterogeneous diseases in terms of initial clinical presentation and of histology. An optimal initial staging integrating a PET/CT and an injected brain imaging is necessary. Pulmonary function test is to be systematically realized when surgery is possible but also before radiotherapy. The therapeutic strategy is decided in a multidisciplinary board within an experienced team. Surgery is a possible option but generally preceded by a neo-adjuvant treatment. Most of NSCLC stage IIIB and IIIC patients receive a radiochemotherapy, a concomitant strategy is to be favored to a sequential one. Chemotherapy is based on platinum doublet should be started as early as possible. For the patients who could not benefit from concomitant chemotherapy a sequential normofractionnated or hypofractionnated radiotherapy, or even chemotherapy alone are possible alternatives to be discussed. A consolidation systemic treatment after radiochemotherapy by durvalumab, an anti-PD-L1 checkpoint immunotherapy will become probably a standard on the basis of the outcomes of the PACIFIC trial.