1B nonsmall cell lung cancer - Chemo , Other options, or not? How decide ? - 1266265

Thu, 10/02/2014 - 16:26

Read on cancer.net, did not say yes or no. That for this type - is "debatable" to have more "therapy" or not. I'm wanting the "or not", but how do I know?

No evidence of ALK gene rearrangement, but an abnormal signal pattern of 3 or more fusion signals (greater than or equal to 3F) was observed in 44% of nuclei scored.

Finding is at or above cutoff value of 36% and suggests ALK gene amplification or polysomy of chromosome2

EGFR mutation not detected, ALK negative - Chrom 2 - ALK3, positive CK7, postive TTF1, negative CK20

not in brain, not in 7 lymph nodes, bronchial and vascular resection margins are negative for carcinoma

Had surgery to have removed one month ago...had right upper lob thoracotomy and right lobectomy, recovering now.

I am 63 yrs old. Had copd. Did not use oxygen in daytime, only at night - as pulmonary doc told me it would increase life span by using. Still on O2 4wks after surgery, level 2 to 2 1/2. Want to get off...but goes down when walking much.

Found your site: http://cancergrace.org/search-results?q=stage%201%20b%20lung%20cancer%2…
after posting question. Thank you.

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Dr West

The summary that post-operative systemic therapy is "debatable" is fair, even if it's ambiguous. The reality is that the value of further therapy is questionable for node-negative resected lung cancer. It is necessary to consider the balance between anticipated benefit of adjuvant chemotherapy, which is higher the higher the risk of recurrence is, and the risk of chemotherapy, which is higher in patients who are older and/or have other medical problems but is otherwise the same whether the risk of recurrence is high or low. In general, we don't favor it for patients with a node-negative lung cancer that is smaller than 4 cm in diameter; we consider it much more in patients with larger tumors, but it still depends on their health and willingness to undertake the risk of chemotherapy for undefined potential benefits.

At this time, there isn't a defined role for post-operative targeted therapies, and if they are considered, it is far more in patients with higher stage, higher risk disease, rather than stage I resected lung cancer.

Good luck.

-Dr. West


Thank you Dr. West for your reply. Greatly appreciated.

My tumor that was removed was 4.3 x 4 x 3.6 cm. Just AT the 4cm mark. It was 2.3 cm from the bronchial margin. The bronchial and vascular margins are grossly negative. It was rated 1B because it wasn't anyplace else they said. The oncologist that recommended "adjuvant chemo" said it was because it was "poorly differentiated margins", which I cannot find on any of the reports I have now. He didn't have my molecular report at the time of his recommendation. On the report it says my pulmonologist believed that I had stable emphysema for a lengthy period of time, and that there is no role for attempt for further optimization preoperatively. Does that mean he doesn't recommend further treatment?

What is immunotherapy? Is that different than adjuvant therapy? Is that also considered a "targeted therapy"?

Thank you so much for your opinion. Sincerely Nancy

Dr West

I don't think "poorly differentiated margins" makes sense, but a tumor is poorly differentiated if the tumor cells have degenerated to look very chaotic under the microscope and quite different from the normal cells they originated from. Poorly differentiated cancers have a somewhat less favorable survival, stage for stage, than well differentiated or moderately differentated cancers, though stage is still the biggest factor in determining prognosis.

I'm sure you can appreciate that I'm not in a position to interpret the meaning of a report I haven't read from a person I haven't met about a case I'm not directly involved in. The person best equipped to interpret what your pulmonologist meant by his statements is your pulmonologist.

The term immunotherapy refers to a range treatments that work by developing an immune response against the cancer. Though immune therapies are being actively studied in many cancers, including lung cancer, at this point the majority of the reseach with immunotherapy is in patients with advanced cancers, and then if proven to be beneficial (they are looking promising now), immunotherapies will be tested in earlier stage settings, such as post-surgery (adjuvant). Some might call immunotherapy targeted therapy, but that term is usually used to define treatments specifically against an identified molecular target such as an EGFR mutation or ALK rearrangement. Targeted thrapies are following the same pattern I described for immunotherapies, except they are a few years ahead, having been proven beneficial for patients with metastatic NSCLC but are still being studied and not yet established as beneficial as adjuvant therapy.

You can learn more about the state of the art in thinking about adjuvant therapy in this summary (though a few years old, the standards haven't changed since then):


-Dr. West