Adjuvant chemo or gefitinib

Portal Forums Lung/Thoracic Cancer NSCLC Early Stage/Surgery Adjuvant chemo or gefitinib

This topic contains 4 replies, has 4 voices, and was last updated by  onthemark 3 months, 2 weeks ago.

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December 18, 2017 at 1:17 am  #1293647    


Hello all
My mum was diagnosed with lung cancer and underwent lobectomy right upper lobe on october 27th, post surgical histopathology came up with T2aN0M0 staging as before surgery PET scan had her at T3N0M0, 2 hilar nodes were taken and tested for metastasis both were negative, mum was advised she needs chemo post surgery to be started by atleast 4 weeks, as it was an open surgery mum didnt recover by then but is much better now and has seen another oncologist for that, however this oncologist suggested mum can have geftinib instead and advised to send samples for genetic testing the results of which will take another month or so, tumour size was 2cmx2.5cm, but due to visceral pleural invasion mum was T2a, I would like to ask whether geftinib is commonly given post surgery in these types of cases? Has anyone had it??thank you for taking the time to read this, her margins were clear in the report. Thanks again

December 18, 2017 at 8:03 am  #1293648    
JimC Forum Moderator
JimC Forum Moderator

Hi jess123,

Welcome to GRACE. Congratulations on your mum’s excellent surgery results. Adjuvant therapy is given in an effort to eliminate any remaining cancer cells in the body. There isn’t good evidence that a short course of a targeted therapy (such as gefitinib) in the adjuvant setting provides a significant benefit. Targeted therapy tends to be given indefinitely, until there is evidence of progression, but when there is currently no evidence of disease, you don’t really know whether the targeted therapy is necessary, and continuing it indefinitely when you might already be cured is not an attractive option.

Dr. West discusses these issues here:

Forum moderator

Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then:

December 18, 2017 at 9:03 am  #1293649    
catdander forum moderator
catdander forum moderator

Hi jess123,

I’m sorry to know about your mum’s cancer but hope she is already cured. To address timing, Dr. Wakelee has written a very readable blog/post on the subject of curative resected nsclc treatments. On chemotherapy after surgery she writes,
“Chemotherapy after surgery seems to work best when started 4-8 weeks after surgery. Some patients will have recovered enough to receive treatment earlier than 4 weeks, but that is unusual. There is some data to support chemotherapy as far as 12 weeks after surgery, but if a patient has still not recovered enough for chemotherapy by 12 weeks after surgery, it is unclear that chemotherapy given later than this will be of any benefit.”

For the entire blog here’s the link.

Let us know how else we can help and very good luck,
forum moderator

December 18, 2017 at 3:08 pm  #1293654    


Thanks Jim and Janine for your quick replies, much appreciated

May 2, 2018 at 6:53 am  #1294353    


As discussed on a different thread and a recent paper by Dr. West, adjuvant therapy shows benefit up to 18 weeks after treatment, although it is not clear that a tumor of this size with pleural invasion should be treated adjuvantly with chemo.

See the discussion here:

10/2015 Chest xray found a nodule as part of a physical (no symptoms).
01/2016 Upper left lobe lingula preserving lobectomy stage 2b for 1.9 cm invasive adenocarcinoma with additional 2 mm AIS nodule found in pathology.
03-05/2016 Sixteen weeks of adjuvant cisplatin/vinorelbine.
07/2016 Durvalumab adjuvant clinical trial discontinued after 1st dose knocked out thyroid.
12/2016 Revised to stage 1b (due to VPI) after new guidelines for multifocal lepidic lung cancer.
07/2019 Next scan.

  • This reply was modified 3 months, 2 weeks ago by  onthemark.
  • This reply was modified 3 months, 2 weeks ago by  onthemark.
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