GRACE :: Lung Cancer
Denise Brock

Lung Cancer Video Library – Spanish Language: Video #21 Treating stage IIIA N2 NSCLC

 
GRACE Cancer Video Library - Lung

 

We continue to provide informational videos for our Spanish speaking community and welcome Dr. Luis Raez, MD FACP FCCP, Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University.  Dr. Raez joined GRACE to discuss the basics of lung cancer.  In this 21st video for the Spanish lung cancer video library, Dr. Raez discusses treating stage llla N2 non-small cell lung cancer (NSCLC).


 

 

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TRANSCRIPTS – Spanish and English
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Tratamiento para el cáncer de pulmón de células pequeñas en estadio IIIA N2

Para estadios III de cancer de pulmón, el tratamiento es más complicado, porque se trata de una multimodalidad. Idealmente en unos pacientes con estadio III, tienen que ir a una reunión multidisciplinaria donde tengamos al cirujano, al radiooncólogo y al oncólogo médico porque muchas veces los pacientes en estadio III pueden ir a cirugía y después de la cirugía se les da quimioterapia y radiación (cuando hay compromiso mediastinal o estadio N2), sino a los pacientes en estadio III solo le damos quimioterapia adyuvante después de la cirugía.

El estadio III es complicado porque a veces el paciente no puede ser operado o no estamos seguros de que pueda ser operado. A veces, hay que disminuir el tamaño del tumor por lo que se da quimioterapia primero para reducir el tamaño y ya después se va a cirugía.

Hay varias combinaciones, a veces la tercera opción es que el paciente va a cirugía porque parece operable, pero después de la cirugía descubrimos que hay enfermedad mediastinal (ganglios comprometidos), entonces no solo se le da quimioterapia después de la cirugía, pero también se le tener que dar radiación.

Esas son las tres posibilidades que hay para un estadio III, por eso lo mejor es hacer una reunión multidisciplinaria para decidir en grupo qué es lo mejor para el cancer de pulmón en este estadio.


Treatment for small cell lung cancer in IIIA N2 stage

For lung cancer in stage III, the treatment is more complicated because it is multimodality. Ideally stage III patients should go to a multidisciplinary reunion with a surgeon, radio-oncologist and the oncologist, because sometimes these patients go into surgery and then receive chemotherapy and radiation (only when the mediastinum is affected or is in N2 stage), when they could only receive adjuvant chemotherapy after surgery.

Stage III is complicated because sometimes the patient cannot go into surgery or we are not sure if he is a candidate. Sometimes, we have to reduce the size of the tumor by giving chemotherapy first and then go into surgery. 

There are several combinations, sometimes the third option is the patient going into surgery, but after the procedure we sometimes identify mediastinum affection (lymph nodes are affected), so the treatment has to be of chemotherapy and radiation.

The three options for stage III treatment are available, but it is better to make a multidisciplinary reunion to decide which is the best treatment for the patient.


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #20 Treating Early Stage Non-Small Cell Lung Cancer (NSCLC)

 
GRACE Cancer Video Library - Lung

 

As we continue with information for our Spanish speaking community, we welcome Dr. Luis Raez, MD FACP FCCP, Chief of Hematology/Oncology and Medical Director at Memorial Cancer Institute, and Clinical Associate Professor of Medicine at Florida International University.  Dr. Raez joined GRACE to discuss the basics of lung cancer.  In this 20th video for the Spanish lung cancer video library, Dr. Raez discusses treating early stage non-small cell lung cancer (NSCLC).


 

 

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Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
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Tratamiento para el estadio temprano del cáncer de pulmón de células no pequeñas

A veces es difícil recordar cual es el estadio I o II y uno se puede perder hablando del estadio. En general, el estadio I y II son sencillos porque son tumores que son confinados al pulmón, son tumores que no han invadido el mediastino y son operables. Para el estadio I y II lo que haces es cirugía como primera intervención y dependiendo de los hallazgos patológicos después de la cirugía, hacemos quimioterapia porque muchas veces a pesar de que hemos resecado tumores pequeños, como del estadio IB que son tumores pequeños de 3.5 cm, hay un riesgo de recurrencia y mortalidad grande.

Desafortunadamente, incluso en la cirugía más perfecta que es el estadio IA que pueden ser tumores de 2cm de cáncer de pulmón, los pacientes no necesariamente se curan después de los 5 años. Vemos que una parte del 10 al 20% igual van a morir por la recurrencia del cáncer de pulmón, he ahí la necesidad de dar quimioterapia.

Ahora, la quimioterapia tampoco es para todos. Hay mucha evidencia clínica que para estadio II no es discusión, se da la quimioterapia de 4 ciclos de cisplatino más el agente de elección como etopósido, pemetrexed, vinorelbina, taxanes. Después de eso, solo es observación y seguimiento del paciente.

Para estadio IA, el beneficio de la quimioterapia no existe o no está documentado, por eso no hacemos quimioterapia. Por eso es un área de mucha investigación para tratar de clasificar que pacientes tienen un riesgo alto que justifique quimioterapia u otra intervención y que pacientes no. 


Treatment for early stage non-small cell lung cancer

Sometimes it’s difficult to remember which cases are stage I and which one are stage II, one can get lost talking about the stage. In general, stage I and II are simple because the tumor is not confined to the lung, they are tumors that have not invaded the mediastinum and are surgically removed. For stage I and II, what we have to is surgery as first intervention and depending on the pathological findings, we can then do a surgery. We do chemotherapy because sometimes despite the small resected tumors like in stage IB (tumors smaller than 3.5 cm), there is a high risk of recurrence and mortality.

Unfortunately, even in the most perfect surgery in stage IA, than can be tumors of over 2 cm, patients don’t necessarily heal after 5 years. We see that a part of 10 to 20% will still die for lung cancer recurrence, so we need to give chemotherapy.

Now, chemotherapy is not for everybody. There is clinical evidence that for stage II chemotherapy the option is to give 4 cycles of cisplatin and the choice agent like etoposide, pemetrexed, vinorelbine or taxanes. After that, it’s only observation and the follow up of the patient.


Dr West

Imprecision Medicine: Why Keytruda (Pembrolizumab) + Chemo for PD-L1+ NSCLC isn’t Ready for Prime Time

Let me start by saying that I’m a fan of the immune checkpoint inhibitor Keytruda (pembrolizumab) and consider it the new standard of care as a single agent (monotherapy) first line treatment for the subset of about 28-30% of patients with advanced NSCLC, either squamous or non-squamous, whose cancers have high level expression of PD-L1, defined as 50% or more cancer cells staining on the companion test for Keytruda (an antibody called 22c3).  It can lead to some terrific and long-lasting responses, but it works well only in a minority of patients; in fact, even in the cherry-picked population of patients with cancers that show high PD-L1 expression, the response rate is a little less than 50%, and it’s below 20% in patients with low or no PD-L1 expression. Merck just announced that the FDA has accepted a “supplemental Biologics License Application” (sBLA) that would broaden the FDA approval for Keytruda in NSCLC to all non-squamous NSCLC patients without an EGFR mutation or ALK rearrangement and without regard to PD-L1 expression, giving Keytruda in combination with chemotherapy (carboplatin and Alimta (pemetrexed)).  I think the evidence we have with this combination is encouraging and worthy of further study, but it shouldn’t be enough to lead to broad use as requested in the FDA filing. I think it’s a premature money grab that isn’t necessarily better for patients and is definitely bad for broad society. Let me explain why.

The evidence behind this strategy is from a cohort of patients (cohort G) from a larger study, KEYNOTE-021) of patients randomized to various chemo combinations with or without Keytruda. This particular trial did not have a threshold requirement for PD-L1 and enrolled 123 patients with a good performance status and advanced NSCLC to receive either carboplatin/Alimta alone or the same chemo with Keytruda at a fixed dose of 200 mg IV every 3 weeks. Patients who hadn’t progressed after 4 cycles would continue to receive maintenance Alimta (for the chemo only arm) or Alimta/Keytruda (for the chemo/immunotherapy arm) until progression or prohibitive side effects.

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Denise Brock

Lung Cancer Video Library – Spanish Language: Video #19 Second Line Therapy for NSCLC and ALK +

 
GRACE Cancer Video Library - Lung

 

For our 19th video in the GRACE Spanish Lung Cancer Library, Dr. Brian Hunis, Medical Director, Head and Neck Cancer Program, Memorial Cancer Institute, Miami, Florida, joined GRACE to discuss the basics of Lung Cancer for Spanish-speaking patients and caregivers.  In this video Dr. Hunis discusses second line therapy for non-small lung cell cancer patients with anaplastic lymphoma kinase (ALK) positive.


 

 

 

 


 

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TRANSCRIPTS – Spanish and English
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Terapia de segunda línea para pacientes con cáncer pulmonar de células no pequeñas y con la cinasa de linfoma anaplásico (CLA) positiva.

Para los pacientes que progresaron a crizotinib, en este momento hay dos fármacos: ceritinib que se puede considerar si el paciente progresa con crizotinib, y hay otro fármaco llamado alectinib que es la tercera línea para pacientes que progresan en terapia dirigida para ALK.

Lo que uno tiene que saber, es que, por la resistencia adquirida a uno de estos fármacos, uno tiene que checar la biopsia porque puede ser que el paciente no responda a estas terapias y necesite quimioterapia.


Second line therapy for non-small lung cell cancer and with anaplastic lymphoma kinase (CLA) positive

For patients that progressed to crizotinib, in this moment there are two drugs available: ceritinib that can be considered if the patient progresses with crizotinib and the other drug is alectinib which is a third line treatment for patients that progressed with ALK targeted treatment.

What we have to know is that, for acquired resistance to one of these drugs, one has to check the biopsy because the patient might not respond to these therapies and might need chemotherapy.


Denise Brock

Lung Cancer Video Library – Spanish Language: Video #18 Acquired Resistance to Targeted Therapies: Biology and Different Clinical Patterns

 
GRACE Cancer Video Library - Lung

 

For our 18th video in the GRACE Spanish Lung Cancer Library, Dr. Brian Hunis, Medical Director, Head and Neck Cancer Program, Memorial Cancer Institute, Miami, Florida, joined GRACE to discuss the basics of Lung Cancer for Spanish-speaking patients and caregivers.  In this video Dr. Hunis addresses acquired resistance to targeted therapies: biology and different clinical patterns.


 

 

 

 


 

How Did You Like This Video?

Please feel free to offer comments and raise questions in our Discussion Forums.


 

TRANSCRIPTS – Spanish and English
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Resistencia adquirida a las terapias dirigidas: Biología y diferentes patrones clínicos.

Lamentablemente inclusive en pacientes que tienen la translocación de ALK, eventualmente los pacientes van a desarrollar una resistencia adquirida, por lo cual la medicación con crizotinib no va a funcionar mas.

Por lo general, estos son pacientes que van a tener un prelapso o una recaída en sistema nervioso central o pulmón. Esos son pacientes a los cuales que uno va a considerar terapia de segunda línea o cambiar a quimioterapia.


Acquired resistance to targeted therapies: biology and different clinical patterns.

Unfortunately, even patients with ALK translocation will eventually develop an acquired resistance, resulting in crisotinib not working anymore.

In general, these patients will have a relapse or re-fall in the central nervous system or lung. In these patients, we will consider a second line therapy or change to chemotherapy.


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