Adenoquamous NSCLC and adjuvant chemo - 1259725

meswak
Posts:3

Hi, I am from India and new to this forum (and inspired by the amazing community here).

My mom (age 63 , non-smoker) had recurrent dry cough, low grade fever, weight loss, chest pain and weakness over a period of 2-3 months. She had several tests before PET-CT scan revealed active lung lesion with SUV of 22.5 (also SUV of 3.2, 2.6 in a couple of lymphnodes). A CT-guided needle biopsy suggested squamous cell carcinoma of lung (August 2013).

Subsequently, she underwent lobectomy of left upper lobe (Septmeber 2013). The surgical pathology report confirmed adenosquamous carcinoma, moderately differentiated. Tumour size was 6.7 * 3.4 * 3.1 cms. Report states "immunohistochemical stains recapitulate squamous and adenocarcinoma differentiation, former evidenced by positivity for p63 and CK 5/6, the latter being negative for p63 and CK 5/6 and a distinct stronger positivity for TTF-1". Overlying visceral pleura, surgical margins of resection are noted free of tumor extension. All perhilar, superior mediastinal, left interlobar lymphnodes are noted free of metastatic carcinoma. Staging was described as T3 N0 M0. She tested negative for ALK, KRAS and EGFR mutations.

She is recovering well post-surgery (except for vertigo for which she is taking meds) . The doctors are planning to start adjuvant chemotheraphy in mid-October. The oncologist advised carboplatin and taxol. What are the current standards for chemo treatment post-surgery for adenoquamous NSCLC ?? Are there any other suggested drugs ?? Any feedback is highly appreciated.

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Reply # - October 8, 2013, 05:23 AM

JimC
Posts: 2753

Hi meswak,

Welcome to GRACE. I'm sorry to hear of your mom's diagnosis, but her surgical results sound very good.

The most often used regimen for adjuvant chemotherapy is cisplatin/navelbine (vinorelbine). Cisplatin is also often combined with gemcitabine or docetaxel (taxotere). On the other hand, for various reasons some patients have other medical conditions which make them are unable to tolerate cisplatin, and in those cases carbo/taxol is used. You can see a chart of the NCCN guidelines used in the U.S. here: http://cancergrace.org/lung/files/2009/07/dr-dubey-interview-chemo-for-…

JimC
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Reply # - October 8, 2013, 05:49 PM

Dr West
Posts: 4735

In truth, carboplatin/paclitaxel is the most commonly used adjuvant chemotherapy regimen in the US, but it's not the best studied. In patients who can tolerate cisplatin, most experts favor a cisplatin-based combination, just as Jim noted. Carboplatin/paclitaxel is often favored because it's easier to tolerate.

There is no specific best option for adenosquamous NSCLC, but it's known that something in the range of 5% of NSCLC tumors have this kind of mixed histology. I think that any of the options that Jim mentioned would be a very fine choice, and the only one that would be a poor choice would be a platinum with Alimta (pemetrexed), since it wouldn't be expected to work against the squamous component. The other agents work comparably for either adenocarcinoma or squamous and should therefore be an effective option for the cancer as a whole.

For the record, I wouldn't say that carboplatin/paclitaxel is a clearly bad choice...there's enough evidence with it to say it's pretty comparable to cisplatin-based regimens, but it's not as well studied and isn't considered the gold standard.

Good luck.

-Dr. West

Reply # - October 8, 2013, 09:56 PM

meswak
Posts: 3

Thank you JimC and Dr.West for your most valuable advice.
We will seek second opinion about the possibility / suitability of cisplatin based regimen for my mom. Thanks once again to the community here !! It's an invaluable resource for patients and their family globally.

Reply # - October 21, 2013, 12:42 AM

meswak
Posts: 3

Just an update. We consulted another oncologist and he suggested cisplatin with gemcitabine based regime. We also gave him your inputs. He was confident she will be able to tolerate cisplatin after reviewing her reports and accordingly we went ahead with first chemo cycle last week. She is doing fine overall apart from some weakness and a feeling of mucous lump in throat (no difficulty in swallowing food though).

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