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 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).

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.

Over the last several years, chemotherapy after surgery has become the standard strategy for improving survival compared to surgery alone, at least for stage II and IIIA patients who don't have mediastinal (N2) lymph nodes involved, and it's often used also for patients with stage IB NSCLC (no lymph nodes, but a larger tumor or tumor involvement with the pleural lining around the lung). However, another approach that has been studied, albeit less so than adjuvant (post-operative) chemotherapy is neoadjuvant (pre-operative, also known as induction) chemotherapy.