This is Mark Kris from Memorial Sloan Kettering Cancer Center in New York City. I want to say a few words about the use of preoperative neoadjuvant induction therapy for patients with locally advanced lung cancers.
We know that even when clinical studies, including PET scans, suggest that cancer is localized, the likelihood of 5-year survival is too low. The risk for death by 5 years for any patient who appears to be a candidate for curative surgery exceeds the risk that would warrant adjuvant therapies in other diseases such as breast cancer. Thus, everyone with lung cancer is a potential candidate for adjuvant therapy at the time they are diagnosed. Yes, many, many issues are involved when choosing a proper adjuvant therapy for patients. Obviously this is an individualized decision that the doctors must make. But once again, I want to remind you of the opportunities we have to use neoadjuvant therapy and why neoadjuvant or induction chemotherapy is a better approach for patients with this degree of risk.
I bring this up now because the current edition of the National Comprehensive Cancer Networkguidelines[1] clearly states that when patients have reached a clinical stage II or stage III cancer—and many would say even stage Ib cancer—those patients are likely to be candidates for adjuvant therapy. Therefore, they are also candidates for neoadjuvant therapy.
Neoadjuvant Therapy Allows Monitoring of Treatment Effectiveness
Neoadjuvant therapy has the advantage of allowing the treating doctor to know whether that treatment is working. Some recent evidence from our institution—and I believe others have had this experience as well—shows that if a chemotherapy is not working in the neoadjuvant setting, it could be stopped and other therapies could be recommended.
The goal of neoadjuvant therapy is not to facilitate surgery. These are patients who have resectable lesions that their surgeons have determined to be operable. The goal of neoadjuvant therapy is to treat micrometastases.
Many programs are moving into this neoadjuvant space. Many trials are now being designed to test new therapies in that space. This has been a very effective strategy in breast cancer, and it has been used for nearly 30 years in lung cancers as well. I encourage physicians who care for patients undergoing evaluations for potentially curative surgeries to think of using neoadjuvant therapy if these patients have a condition and state of disease clinically that would necessitate adjuvant therapy postoperatively. This gives you the chance to assess therapy, to continue it if it is working or stop it if it is not working, and to recommend another therapy if the initial one proves unsuccessful.
Medscape Oncology © 2015 WebMD, LLC
Cite this: The Case for Neoadjuvant Therapy in Lung Cancer - Medscape - Jan 16, 2015.
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