ASCO: Chemotherapy Key Part of Curative Lung Cancer Therapies

“Cancer Network: Thank you for speaking with us today, Dr. Kris. First, can you tell us why this is an important topic for an education session? Is there a debate of the use of chemotherapy in treating lung cancer?

“Dr. Kris: I wouldn’t quite say that there is a debate, but there is an impression that the therapy of lung cancers has switched to targeted therapies or immune therapies. Looking at the ASCO abstracts this year that would be an easy conclusion to draw. But there is an indisputable fact that no matter what target you can identify in a patient’s tumor, be it PD-L1 or a BRAF mutation, at some point in a patient’s illness they will be receiving chemotherapy. As we look at entire care of people with lung cancer it is very important to remember that virtually every single one will receive chemotherapy, and that we need to pay attention to choosing the best chemotherapy. We also need to think about doing research in chemotherapy. Clearly, we can do a better job, and we need more research to find the best drugs. Also, we need to find a way to use them with our targeted therapies.”

Editor’s note: Targeted therapies and immunotherapies are all the rage now in cancer treatment. But there are still important roles for chemotherapy. This article gives a great overview of recent advancements in the use of chemotherapy in lung cancer treatment, and why we need further research to refine and improve the benefits of chemotherapy.

Neoadjuvant Chemotherapy Reduced Mortality in Upper Tract Urothelial Carcinoma

“Neoadjuvant chemotherapy following surgery extended 5-year survival rates in patients with urothelial carcinoma, according to results of a retrospective study.

“Researchers reported a 5-year survival rate of 80.2% among patients who received neoadjuvant chemotherapy vs. 57.6% for patients who underwent surgery without chemotherapy.”

Editor’s note: Neoadjuvant treatment is a first-step treatment given to shrink a tumor before surgery to remove it. Neoadjuvant treatment can be performed with a variety of methods, including radiation therapy and hormone therapy. In this case, chemotherapy was used as a neoadjuvant, and appeared to benefit patients.

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Meta-Analysis Shows Survival Benefit of Preoperative Chemotherapy in NSCLC

“In a systematic review and individual patient meta-analysis reported in The Lancet, the NSCLC Meta-analysis Collaborative Group found that neoadjuvant therapy for non–small cell lung cancer (NSCLC) was associated with a significant 13% reduction in risk of death. Significant benefits in recurrence-free survival and time to distant recurrence were also observed…

“Preoperative chemotherapy was associated with a 13% improvement in overall survival.

“Preoperative chemotherapy was associated with a 15% improvement in recurrence-free survival and a 31% improvement in time to distant recurrence.”

Editor’s Note: “neoadjuvant therapy” refers to chemotherapy given before tumor removal surgery in the hopes of improving the success of the surgery.

Radiation and Chemotherapy before Surgery Best Option in Patients with Stage IIIA(N2) NSCLC

Disagreement persists about the best treatment for non-small cell lung cancer (NSCLC) patients with stage IIIA(N2) disease, that is, cancer that has spread to lymph nodes just outside the lung. A recent study compared the outcomes of different treatments. Patients who had received neoadjuvant chemoradiotherapy (chemotherapy and radiation administered before surgery) followed by lobectomy (removal of the lung subsection containing the cancer) had higher 5-year survival rates than patients treated with:

-neoadjuvant chemoradiotherapy and pneumonectomy (removal of the whole lung containing the cancer);

-either lobectomy or pneumonectomy plus adjuvant therapy (chemotherapy and/or radiation administered after surgery);

-concurrent chemoradiotherapy (chemotherapy and radiation delivered at the same time, without surgery).

These findings suggest that neoadjuvant chemoradiotherapy followed by lobectomy is the preferable treatment for stage IIIA(N2) NSCLC.