When I was a medical student, the question about lung cancer that was always asked on "the Boards" had to do with the difference between stage IIIA and stage IIIB non-small cell lung cancer (NSCLC). The reason this question was always asked is because patients with stage IIIA NSCLC might be considered for surgery, whereas patients with stage IIIB NSCLC would not be considered for surgery and instead would be treated with chemotherapy and radiation. The idea is that young doctors should be able to make that distinction and to direct patients to the appropriate specialist/treatment.

Three months ago, I discussed the press release from Abraxis reporting that the phase III trial of carbo/Abraxane (nanoparticle albumin-bound paclitaxel) vs. carbo/taxol (paclitaxel) showed a significant benefit for higher response rate in the Abraxane arm. Carboplatin was given one day every three weeks, as was taxol, and Abraxane was given every week (no break).

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.