Hello, I am seeking advise to make the best decision for my mother. In brief she had been diagnosed with stage 2a poorly differentiated squamous, NSCLC lung cancer in her left lobe (from her biopsy during which she developed pneumothorax because of her emphysema, but was controlled quickly).
The lesion was touching a Lymph node however all scans and tests came up clean for the rest of her body and brain. She successfully completed a min invasive VATS lobectomy in Zurich to remove the lobe and lymph node. Also removed 18 surrounding lymph nodes which all tested negative. We are still concerned about microscopic cells which could exist in the body. The oncologist recommended a "light" chemotherapy (4 sessions). I do not know the agents they recommended yet but should have them in the next day or so as we are getting the reports translated.
We are also considering immunotherapy as there have been recent break throughs in treatment of NSCLC with Pembrolizumab and Ipilimumab therapy. We live over seas and have identified many specialised clinics in Germany.
I am seeking any information that can help us make an educated decision. Is she a candidate for immunotherapy? Is there a standard Chemotherapy that is recommended for this situation? Please let me know if you require any more information.
Thanks for your help!
Reply # - August 1, 2016, 11:29 AM
Hi rafael,
Hi rafael,
Welcome to GRACE. I'm sorry that your diagnosis brings to you here, but the results of your surgery are quite encouraging. As far as chemo regimens used for adjuvant (post-surgery) chemotherapy, Dr. Wakelee discusses commonly used treatments in this podcast.
The problem with immunotherapy in this situation is that there is nothing by which to measure it's success or failure. If the next scan continues to show no evidence of disease, is that due to the immunotherapy? At that point, should the immunotherapy be continued? Even in the metastatic setting, it's still unclear how long immunotherapy should be administered after the cancer disappears, and that's an even tougher call when there was nothing visible at the start of therapy.
On the other hand, adjuvant chemotherapy is given for a finite number of cycles, such as your doctor has recommended, followed by scans at periodic intervals. Later, if recurrence is seen, then a new chemo regimen, targeted therapy or immunotherapy may be used.
JimC
Forum moderator
Reply # - August 1, 2016, 11:50 AM
Hi Jim, thanks for your
Hi Jim, thanks for your prompt response! I watched the podcast and she also mentions that there is nothing to measure the success as well with chemo. There were some Drs who recommended an aggressive chemo prior to the surgery for that reason, however being that it had touched the lymph node, most Dr recommended the surgery immediately as they said there was a chance that if the aggressive chemo did not work, she would be too weak to handle the surgery after. And we decided on the surgery first because of the "early" detection, stage 2a, of the diagnosis.
I am concerned that she mentions that by doing the chemo it only increases the chance of cure by 10%. In general, is there a big success rate, being that we have caught the cancer fairly early? Is there a general consensus of what the chance that the "microscopic" cells have spread is? (especially being that the cancer has not been detected anywhere else in the body or brain)
Thanks so much for your help!
Reply # - August 1, 2016, 02:12 PM
What made her stage IIA? Was
What made her stage IIA? Was it the size of the tumor or that it was involved with the one lymph node?
Chemo is recommended normally for this stage to clean up any stray cells that might be floating around.
Going for the cure is what you want with this lower stage. Though the cancer has not been detected via scan doesn't mean it's not there just that the cells are too small to form a tumor and have it show up on a scan.
Take care, Judy
P.S. I am not a medical professional but a two time cancer survivor and advocate.
Reply # - August 1, 2016, 04:49 PM
We don't deal too much in the
We don't deal too much in the break down in odds of cure and recurrence so I don't have them on me but accurate numbers can easily be found in places like cancer.gov
The important take away is that whatever the odds are of cure (for 2a poorly differentiated squamous nsclc that is resected with clean margins) the odds are 10% better when adjuvant chemo is added. This data was taken from a wide group of people with stage 2a nsclc who had surgery then did or didn't have added chemo.
Most doctors would push to get that extra 10 percentage points IF their patients are healthy enough to withstand it because a cure is better than any other option. Doctors, patients and caregivers can help make sure the patient going through adjuvant chemo is doing as well as possible and catch problems that could become devastating before they get too bad.
The problem with odds when discussing cancer treatment is that the numbers are from a large population of people but each one of those people fall somewhere on that spectrum that is almost never the median or the average. You're an individual and should always be treated as such.
I hope your mother does very very well and is or will be very very cured!
Janine