Case in Point: Recommending Post-Operative Chemo for a Patient with a Smaller NSCLC Tumor but High-Risk Features

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This is the first in a series of "uncut" videos that I'm starting that will focus on illustrative cases from my clinic that highlight some broader teaching points.  This particular video is on the decision-making process that led me to recommend adjuvant chemotherapy for a patient who underwent surgery for a 3.5 cm lung adenocarcinoma without lymph node involvement.

Interview with Dr. Sarita Dubey on Chemo for Early Stage NSCLC

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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).

Pre-Operative Chemotherapy as an Alternative to Post-Operative Chemo: Evidence of Stage-Dependent Survival Benefit

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In contrast with post-operative chemotherapy, which has become a standard treatment approach to reduce the probability of recurrence of resected stage II and IIIA NSCLC (still pretty controversial for stage IB), pre-operative chemotherapy (also known as neoadjuvant, or induction chemotherapy) is less well studied and isn’t a typical approach.

The Case Against Post-Operative Chemotherapy for Stage I NSCLC

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Over the last several years, chemo for resected early stage NSCLC has become a standard of care, but while it's pretty widely accepted for stage II and IIIA patients after surgery, the role for chemo is much more debatable for stage I patients. I'll try to explain why, starting with the downside, and then turn to some of the reasons to consider it.

Post-Operative Radiation Therapy: Helpful or Harmful?

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I've discussed the trials that have led to a general recommendation in favor of chemotherapy after surgery for patients who have stage II and IIIA NSCLC, with some ongoing questions about the value in stage IB NSCLC. I haven't touched the issue of post-operative radiation therapy, but the question comes up from members who ask about the evidence for or against radiation, and how it might be given.

What are the Right Drugs for Adjuvant (Post-Operative) Chemotherapy?

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For many patients with early stage, resected NSCLC, chemotherapy after surgery may be a strong consideration to minimize the chance of the cancer returning, in which cases, it is often not possible to cure it. Several clinical trials over the past few years have shown benefits from chemo combinations, but which ones would be the leading considerations now?