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Denise Brock

Denise has over 30 years of varying experience in the healthcare arena.  In August 2009 she joined The Global Resource for Advancing Cancer Education as one of its first employees.  She has grown with the organization and now oversees the operational movement of programs, efficiency, and effectiveness within the organization, as well as the daily processes and functions.  


Lung Cancer Video Library - Spanish Language: Video #1 What is adjuvant chemotherapy for early stage NSCLC and why would it be recommended?
Denise Brock

All of us at the Global Resource for Advancing Cancer Education are very excited to introduce our newest project - the GRACE Spanish Lung Cancer Library.  This collection of videos with our Spanish speaking faculty will discuss the basics of lung cancer for Spanish speaking patients and caregivers.  For our first video, Antonio Calles, MD, Medical Oncologist, Thoracic Oncology Program, Hospital General Universitario, Gregorio Marraron, Madrid, Spain joined GRACE to discuss what is adjuvant chemotherapy for early stage NSCLC and why it would be recommended. 



TRANSCRIPTS - Spanish and English

¿Qué es la quimioterapia adyuvante para el cáncer pulmonar de células no pequeñas en estadio temprano? Y ¿En qué casos se recomendaría?

La quimioterapia adyuvante es la quimioterapia después de la cirugía. La cirugía es la piedra angular del tratamiento del cancer de pulmón no microcítico en estadio precoz. La quimioterapia ayuda a la cirugía a tener mejores resultados. Cuando se quita un cancer de pulmón en estadio precoz, normalmente la mayor parte de los pacientes se curan. Sin embargo, algunos recaen, esto es porque existen enfermedad micrometastásica que se debe de eliminar con tratamiento de quimioterapia. Esto no lo puede ver el cirujano, y los ensayos clínicos nos han demostrado que administrar quimioterapia después de la cirugía mejora la supervivencia de los pacientes con cancer.

Pero, ¿qué es la enfermedad localizada en cancer de pulmón no microcítico? Desafortunadamente, la mayoría de los pacientes con cancer de pulmón no microcítico se diagnostican en etapas avanzadas. Solamente entre un 20 y 25% de los pacientes se detectan en estadio precoces. Esto es en estadios I, II y algunos III.

Con la incorporación de las técnicas de diagnóstico precoz o de screening de cancer de pulmón, estamos diagnosticando cada vez más pacientes en etapa precoz. Para estos pacientes el tratamiento de elección, si no existen complicaciones, puede ser la cirugía. Otras alternativas son la radiocirugía pulmonar o SBRT.

Sabemos que conforme el estadio aumenta de I, II y III, las probabilidades de tener una recaída de cancer de pulmón aumentan. Los ensayos clínicos de quimioterapia adyuvante han demostrado de una manera sistemática y análisis conjuntos de esos ensayos clínicos, que el uso de quimioterapia reduce el riesgo de recaída y el riesgo de morir por recaída de su cancer de pulmón en aproximadamente un 50 a 70% a los 5 años se seguimiento.

¿Qué quimioterapia utilizamos en quimioterapia adyuvante? Normalmente utilizamos una combinación de dos fármacos; uno suele ser un platino y otro un fármaco de tercera generación, con el que más evidencia existe es con cisplatino y vinorelbina Sin embargo, otras combinaciones con gemcitabina, pemetrexed o paclitaxel han sido también testeadas y son eficaces.

Normalmente podemos elegir los esquemas en función de la histología. Cisplatino y pemetrexed se prefiere sobre otras combinaciones en sobretodo pacientes con histologías adenocarcinoma. El perfil de toxicidad es parecido en casi todos ellos y hay que tener cuidado en las toxicidades a largo plazo. Los esquemas de cisplatino a largo plazo han demostrado un aumento de eventos cardiovasculares a 10 años de seguimiento, con lo cual, además de recomendar la quimioterapia, se debe hacer terapias de cesación del uso del tabaco y de hábitos de vida saludable.

Aunque el cisplatino es la quimioterapia fundamental en el tratamiento adyuvante del cancer de pulmón, hay algunos efectos del cisplatino que no permite administrársela a todos los pacientes. Puede dar toxicidad renal, cardiaca y auditiva. La alternativa al cisplatino es el carboplatino, que con combinación de estos agentes que hemos comentando antes, obtiene unos resultados similares y son una buena alternativa para aquellos pacientes que no puede acceder a cisplatino.

What is the adjuvant chemotherapy for non-small cell lung cancer in early stage? And, on which cases would you recommend it?

Adjuvant chemotherapy is the post-surgery chemotherapy. Surgery is the peak point in the treatment of microcytic lung cancer in early stage. Chemotherapy works with surgery to get overall better results. When an early stage lung cancer is removed, most patients heal completely. However, some patients relapse because of the existence of a micro-metastatic disease that must be eliminated with chemotherapy. This cannot be seen by a surgeon, and clinical trials haven’t proved that post-surgery chemotherapy improves survival in cancer patients.

But, what is the localized disease on non-microcytic lung cancer? Unfortunately, most of microcytic lung cancer patients are diagnosed on advanced stages. Only about 20-25% of them are detected on earlier stages like I, II and some in III.

With the incorporation of early diagnostic techniques or lung cancer screening, we are diagnosing more patients in earlies stages. For these patients, the selected treatment, if there are no complications, could be surgery. Other alternatives include pulmonary radiosurgery or SBRT. We know that as the stages progress from I, II and III, the chances of having a relapse increase. Clinical trials using adjuvant chemotherapy have proved systematically that the use of chemotherapy reduces the risk of a relapse and death in about 50 to 70% after five years of follow up.

What chemotherapy do we use in adjuvant chemotherapy? Usually we use a combination of 2 drugs: one is usually platinum and the other is a third generation like cisplatin and vinorelbine. However, other combinations like gemcitabine, pemetrexed or paclitaxel have been tested and are effective.  

Usually, we can choose the treatment based on the histology. Cisplatin and pemetrexed is chosen over other combinations, especially in patients with traits of histological adenocarcinoma. The toxicity profile is similar in all of them, which is why we have to look for long-term toxicities. The schemes of cisplatin on long term have shown an increase of cardiovascular events in 10 years of follow up in which we can also recommend chemotherapy, stop smoking and healthy lifestyle habits.

Even though cisplatin is the fundamental chemotherapy in adjuvant treatment for lung cancer, there are some side effects that stop the prescription. It could cause renal and cardiac toxicity or hearing impairment. The alternative treatment to cisplatin is carboplatin, that in combination with the agents we’ve discussed, obtains similar results and is a good choice for patients that cannot use cisplatin.



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