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early stage NSCLC

Denise Brock

Lung Cancer Video Library – Spanish Language: Video #43 The Treatment of Early Stage Non-Small Cell Lung Cancer

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We are pleased to continue this series of informational videos for our Spanish speaking community.  GRACE is pleased to welcome Dr. Rafael Santana-Davila, Assistant Professor with the University of Washington School of Medicine and Seattle Cancer Care Alliance.  In this 43rd video for the Spanish lung cancer video library, Dr. Santana-Davila joined GRACE to discuss  the treatment of early stage non-small cell lung cancer.


 

 

 

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TRANSCRIPTS – Spanish and English
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Tratamiento de Cancer de Células no Pequeñas Cuando Están en un Estadio Temprano

Treatment of Early Stage Non-small Cell Lung Cancer

 

Rafael Santana-Davila, MD
Assistant Professor of Medicine
University of Washington Seattle Cancer Care Alliance
Seattle, Washington

 

Spanish TRANSCRIPT

El cancer de pulmón cuando se encuentra en estadio I o II, el mejor tratamiento es cirugía tratando de quitar el cancer. En la mayoría de las veces, lo que se hace es llevar el paciente a cirugía, quitar el cancer de donde está quitando todo el lóbulo del pulmón y muchos de los ganglios de alrededor. Si los ganglios no están involucrados, el tratamiento es quirúrgico sin ninguno otro tratamiento adicional. Si los ganglios están involucrados, se dará también quimioterapia adyuvante después de la cirugía para erradicar pequeñas células que estén en otros lados del cuerpo. El objetivo del tratamiento es tratar de curar al paciente.

El problema de muchos pacientes es que la cirugía puede ser muy peligrosa porque el pulmón de estos pacientes no es sano y quitar un lóbulo de un pulmón pude ser muy dañino. En estos casos, también se puede tratar con una radiación local. 


  

English TRANSCRIPT

When the lung cancer is in stage one or two, the best treatment is surgery to try to remove the cancer. In most cases, the patient goes into surgery where they eliminate the cancer by removing the lobe of the lung and some of the lymph nodes nearby. If the lymph nodes are not involved, the treatment is only surgical. However, if the lymph nodes are involved, after the surgery the patient has to take adjuvant chemotherapy to eradicate small cells that are in other parts of the body. The main goal is to try to cure the patient.

The problem in some patients is that surgery can be very dangerous because the lung in these patients is not a healthy lung, so by removing its lobe can be quite harmful. In these cases, the treatment can be just local radiation.


GRACE Video

ECOG 1505 Study: No Benefit of Post-Operative Avastin in Early Stage Lung Cancer Patients

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WCLC_2015_No_Benefit_Post_Op_Avastin_Early_NSCLC

 

Drs. Ben Solomon, Leora Horn, & Jack West review trial result and implications of ECOG 1505 trial that showed no benefit to addition of Avastin (bevacizumab) to adjuvant chemotherapy for early stage NSCLC.

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How Did You Like This Video?

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

 

Transcript

Dr. West:  So, we just finished the presidential symposium at the World Conference on Lung Cancer, here in Denver. There were a few high-profile presentations there, including one that was anxiously anticipated, that was presented by Heather Wakelee, a colleague of ours, who presented the ECOG 1505 trial of chemotherapy with or without Avastin (bevacizumab), the anti-angiogenic agent, as post-operative therapy for patients with a resected lung cancer. Unfortunately, a totally negative trial, I’d say. Do you think there was anything to be gleaned from that, or do you think it even might have some negative effects on its use outside of that setting, like metastatic disease, Leora?

Dr. Horn:  So, I don’t think I was surprised by the results, I think I was disappointed, but I don’t think it’s going to really change how Avastin is used outside of — in metastatic disease, outside of the adjuvant setting. I think there’ll be some interesting subset analysis to come out — so things like, is there a difference between the different chemotherapy regimens that were used? Because, I know, in places like the U.S., we extrapolate the metastatic data to the adjuvant setting, and some of the biomarker data.

Dr. West:  Ben, what did you think?

Dr. Solomon:  Yeah, I’d agree completely with Leora, I mean, it was a big study, 1,500 patients enrolled, and I think it gives us a definitive answer about bevacizumab in the adjuvant setting — there was no difference in outcomes whether you had bevacizumab or not. But it is a different situation to the metastatic setting, these patients had no residual disease, and even pre-clinically, we know that the efficacy of bevacizumab may be different in primaries versus metastases. So, I think, in this situation, we maybe need to take a little bit of care from extrapolating from the adjuvant to the metastatic setting.

Dr. West:  What’s the pattern in Australia, in terms of how widely used bevacizumab, or Avastin, is in metastatic disease? I would say it’s certainly used as a standard of care in the U.S., and I think in various parts of the world, but it’s not something that is, certainly, uniformly used in every possibly eligible patient.

Dr. Solomon:  Yes — so, in Australia, I think our sort of usage pattern is a bit closer to the European usage — so, bevacizumab is very rarely used, and partly this reflects the fact that it’s not reimbursed. And I think we’re influenced by the AVAiL data, which didn’t show an improvement in survival, in contrast to the ECOG study which did. So, bevacizumab can only be used in the setting where patients pay for it, and as a consequence, isn’t really a part of common practice.


GRACE Video

Do You Seek and Do You Use Molecular Marker Information in Patients with Early Stage NSCLC?

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Dr. Karen Kelly of University of California, Davis, presents her current view on using molecular markers in early stage non-small cell lung cancer and explains the RADIANT study that she leads.


GRACE Video

Dr. Heather Wakelee: How Should We Use Molecular Marker Information for Management of Earlier Stage Non-Small Cell Lung Cancer?

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Dr. Heather Wakelee from Stanford University discusses the open question of whether patients with resectable or locally advanced NSCLC should have testing for molecular markers, as well as how we might use this information in clinical practice.


Dr West

Case in Point: Recommending Post-Operative Chemo for a Patient with a Smaller NSCLC Tumor but High-Risk Features

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This is the first in a series of “uncut” videos that I’m starting that will focus on illustrative cases from my clinic that highlight some broader teaching points.  This particular video is on the decision-making process that led me to recommend adjuvant chemotherapy for a patient who underwent surgery for a 3.5 cm lung adenocarcinoma without lymph node involvement. Though this size is under the threshold we often use for recommending post-operative chemo, which is 4 cm, her particular cancer had some other features that made me concerned it may represent a high enough risk to favor additional treatment, in combination with her overall good health and desire to pursue a more aggressive approach if there is a good rationale for it.

As always, I’d welcome your thoughts, questions, objections, etc., as well as any feedback you want to offer about the format of using clinical cases to review broader concepts.  And any ideas for topics are also welcome.


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