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Dr. Jack West is a medical oncologist and thoracic oncology specialist, and Executive Director of Employer Services at the City of Hope Comprehensive Cancer Center in Duarte, CA.

Moving Toward Individualized Treatment Recommendations for Chemotherapy after Lung Cancer Surgery
Thu, 10/12/2006 - 11:32
Howard (Jack) West, MD, Associate Clinical Professor, Medical Oncology, Executive Director, Employer Services, Founder, President and CEO of GRACE

A recent trial by Olaussen and colleagues was just published in the New England Journal of Medicine that suggested that in the future oncologists may become better at identifying the patients who are more or less likely to benefit from chemotherapy after surgery for early stage non-small cell lung cancer. At this point, the marker that was being evaluated is not readily available and hasn’t been validated, but it’s a very promising lead. In this trial, the group with tumors that have low expression of this protein, called ERCC-1 (which repairs DNA damage induced from cisplatin-based chemo), did better with chemo than if they didn’t get it. The other group, who had high expression of ERCC-1 on their tumors, did better if they didn’t get chemo than if they did. Because chemo can have some unpleasant and sometimes dangerous side effects, clarifying who is more likely to benefit and who will get just side effects and no benefits would be a great help.

This adds to the conclusions from work of others, such as Dr. Rafael Rosell in Barcelona, Spain and by Dr. Gerold Bepler at Moffett Cancer Center in Tampa, FL, who have both done studies suggesting that tumor markers can soon help us predict who will benefit from certain types of chemotherapy and who will be less likely to benefit.

The limits of this study are that it was retrospective, or reviewing what was available after the fact, and that it included only tissue from a subgroup, about 40% of tumors from patients on the study. This work needs to be corroborated by further trials, especially ones that look at these questions prospectively (planned going into the study, so everyone’s tissue is included). These marker studies are not routinely performed or widely available. Before using such markers for clinical decision-making, we need to standardize how the marker studies are done and interpreted. However, this work is an early indication of how we hope to further treatment recommendations for patients with cancer in the near future.

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