Why Are Oncologists Deviating From Best Evidence in Stage III NSCLC?

Two years ago at the World Conference on Lung Cancer, investigators proudly declared concurrent chemoradiation (cCRT) followed by consolidation durvalumab as a new standard of care in stage III non–small cell lung cancer (NSCLC). Many outside experts agreed. Yet when I recently reviewed a web-based survey of practicing US medical oncologists' approach in this setting, I was struck by the discordance between what the literature tells us is best evidence-based treatment and the varied practices described by the survey's 150 respondents.

Multidisciplinary discussion is key for guiding treatment decisions in this indication, yet respondents said they presented only 55% of patients at live or virtual tumor boards. Despite the guidance offered by the PACIFIC trial, cCRT was used for only 48% of patients and, when actually administered, was followed by durvalumab for only 55%. Two thirds of the respondents reported a preference for consolidation chemotherapy following cCRT in a subset of patients, even though evidence indicates that such an approach adds toxicity and provides no demonstrated improvement in efficacy.

Of course, survey results are not actual practice data. However, we would expect that self-reported results would have a bias toward greater conformity with evidence-based standards rather than against them. And although these results were derived from a limited sample of oncologists, respondents had significant experience in managing lung cancer and were overall representative of US practice, with 82% based in community settings and 18% in academic centers.