Dr. Mark Socinski, University of Pittsburgh Medical Center, compares the use of chemotherapy to chemo/radiation in the preoperative setting in stage IIIA lung cancer.

Dr. Mark Socinski, University of Pittsburgh Medical Center, describes the primary treatment options for stage IIIA NSCLC, including chemoradiation and surgery, and discusses trial evidence for each approach.

Thoracic Surgeon Dr. Eric Vallieres reviews the principle of giving chemotherapy prior to lung cancer surgery in order to improve survival and potentially make it possible to do a smaller lung surgery.

As part of the series co-sponsored by GRACE and LUNGevity, challenging cases in lung cancer discussed with multiple experts, here's one on the common but vexing scenario of a patient with mediastinal node-positive (stage IIIA N2) NSCLC. This is among the most controversial clinical settings in lung cancer, as illustrated by the wide range of answers of how the experts in this program would manage the same patient. Some of the experts even note that the way that such a patient would be managed at their center would depend on the people weighing in on the case.

Here is a continuation of the webinar discussion I did with Dr. Pennell a month ago, in which we discussed some of the most interesting presentations on lung cancer at ASCO 2010.

As I mentioned in my last post on the recent results on pre-operative (neoadjuvant) chemotherapy, the results of this work failed to achieve statistical significance but did appear to be associated with a degree of benefit comparable to the magnitude of benefit seen with post-operative (adjuvant) chemotherapy, but the neoadjuvant trials were smaller and therefore underpowered.

Post-operative, also known as adjuvant chemotherapy, is the established method for delivering systemic therapy to improve long-term outcomes beyond what surgery alone can deliver. An alternative approach, though, is to give treatment prior to surgery.

Here's an interview I did a few weeks before ASCO with Dr. Sarita Dubey, medical oncologist at the University of California at San Francisco. This podcast covers a discussion we had about her views on the role of chemotherapy for patients with resected or resectable early stage NSCLC.

Included below is a link to the audio mp3 version, a transcript, a pdf file of figures, and the video version of the podcast (with slides synchronized to the discussion).

Post-operative, or adjuvant, chemotherapy is a standard approach for higher risk patients with resected early stage NSCLC, based on several randomized trials that have been presented and published in the last few years that show a survival benefit from chemotherapy. All of the trials that have shown a statistically significant survival benefit have given chemotherapy after surgery, but it’s hard to envision why the same chemotherapy given before surgery wouldn’t be just as good or better.

In my last post I described the results of the ChEST trial that showed a borderline statistically significant improvement in survival of patients who received cisplatin/gemcitabine chemotherapy for stage IB to IIIA NSCLC prior to surgery. This study was very similar to another neoadjuvant chemotherapy trial, known as SWOG 9900, which also randomized patients to upfront surgery or 3 cycles of pre-operative chemotherapy followed by surgery.