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Clinical and Translational Oncology

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Open Access 01-05-2020 | Nintedanib | Research Article

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

Authors: D. Isla, J. de Castro, R. García-Campelo, P. Lianes, E. Felip, P. Garrido, L. Paz-Ares, J. M. Trigo

Published in: Clinical and Translational Oncology | Issue 5/2020

Abstract

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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Title: Treatment options beyond immunotherapy in patients with wild-type lung adenocarcinoma: a Delphi consensus
Authors: D. Isla
J. de Castro
R. García-Campelo
P. Lianes
E. Felip
P. Garrido
L. Paz-Ares
J. M. Trigo
Publication date: 01-05-2020
Publisher: Springer International Publishing
Keywords: Nintedanib
Cytostatic Therapy
Published in: Clinical and Translational Oncology / Issue 5/2020
Print ISSN: 1699-048X
Electronic ISSN: 1699-3055
DOI: https://doi.org/10.1007/s12094-019-02191-y

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