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Lung Cancer

Treatment of Early-stage Non-small Cell Lung Cancer

Summary & Participants

Surgery and radiation are the standard treatments for early-stage lung cancer. Now there's evidence chemotherapy may have a role, too. Listen as doctors explain.

Medically Reviewed On: July 05, 2008

Webcast Transcript

ANNOUNCER: It's to get those types of circulating cancer cells that doctors have traditionally used chemotherapy in treating other types of cancer.

There never had been any evidence this use of what is called "adjuvant" therapy had any value in lung cancer until recently.

EDWARD S. KIM, MD: The International Adjuvant Lung Trial was the largest trial ever reported in lung cancer. It consisted of 1900 patients who had stage I through III lung cancer and were surgically resected. Afterwards, they received one of four regimens of adjuvant chemotherapy. And the results showed that there was a benefit. This was 4.1 percent, a modest benefit, but very much similar to the review of studies reported in 1995 that showed a 5 percent at five years. Thus, based on the results of this study, adjuvant chemotherapy became the standard of care in early-stage lung cancer.

CHRISTOPHER G. AZZOLI, MD: This is big news. For the first time, we have data to justify giving patients chemotherapy after their surgery.

ANNOUNCER: But while chemotherapy is easier to manage than it has been in years past, it is still something many people want to avoid. And the research doesn't offer much help in deciding exactly which patients are most likely to benefit.

CHRISTOPHER G. AZZOLI, MD: The issue is, of course, if you're only improving five-year survival by 5 percent, you have to treat nearly twenty patients to save one. And so then there's the question: Which patient is the one who you're going to help?

EDWARD S. KIM, MD: I explain to a patient that there is some benefit. It's modest. But most patients want to be aggressive. They want to have their surgery done. They want the tumor taken out of them and they want treatment to try and give it as good a chance as possible to eradicate any cells that may be existing in their body at the time.

ANNOUNCER: Another possible use of chemotherapy in lung cancer might be even earlier, before surgery. It's called neoadjuvant therapy. The goal would be to shrink the tumor, to make surgery easier. And to kill cancer cell that may have already escaped from the original tumor.

EDWARD S. KIM, MD: Neoadjuvant approaches certainly have their place and that's why there are several studies looking at this approach. However, we have not seen a positive study in a controlled manner that has shown overall clinical benefit, and therefore, it is still considered experimental at this point, but still being tested.

ANNOUNCER: The studies in early stage non-small cell lung cancer usually use a platinum-based drug, plus one or more additional drugs, including vinorelbine, docetaxel, paclitaxel, and sometimes targeted therapies like cetuximab.

Doctors are gaining important knowledge and new tools in the treatment of lung cancer. But it remains a very serious disease. And no medical advance will ever counter the damage done by cigarettes, often by a remarkably small number of them.

CHRISTOPHER G. AZZOLI, MD: I think when you think about smoking and lung cancer risk, you have to think of a continuum. And, obviously, if you smoke a lot of cigarettes per day for many, many years, you have a much higher risk. If you smoked very little and for a short amount of time in your life, then you have a very low risk. But, if you smoked at all in your lifetime, greater than 100 cigarettes in your lifetime, your risk will always be slightly higher than someone who never smoked.

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