Exploring Neoadjuvant Treatment in NSCLC

Benny Weskler, MBA, MD, FACS, FACCP, professor of cardiothoracic surgery, Drexel University College of Medicine, as well as the system chief of thoracic surgery, Allegheny Health Network (AHN), and chief of the Division of Thoracic Surgery at the Department of Cardiothoracic Surgery at Allegheny General Hospital, discusses the introduction of immune checkpoint inhibitors in the neoadjuvant setting for patients with non–small cell lung cancer (NSCLC).

According to Weskler, deciding to give patients preoperative chemotherapy, radiation, or chemoradiation depends on the stage of their disease, along with other factors. Each institution uses radiation differently and has their own protocol. At AHN, the use of neoadjuvant radiation is reserved for special cases as some research suggests that radiation does not add to results among patients with lung cancer.

In addition, Weskler explains the ongoing role of chemotherapy, radiation, and surgery in this space and how updates in the field have shaped the way they are utilized for patients with NSCLC as previously, preoperative chemotherapy with or without radiation was the standard of care in this patient population.

Transcription:

0:10 | First of all, neoadjuvant treatment is treatment before surgery. The idea here is to treat the tumor while its blood supply has not been disrupted by surgical intervention. In patients with stage III disease, the standard of care, until recently, was preoperative chemotherapy with or without radiation, and the radiation was added as per each institution. Each institution has its own protocol. There is some data that suggests that the radiation does not add to results.

0:53 | And when we talk about results in lung cancer, we are talking about overall survival, so that is the chance of somebody being alive in 5 years. That is really where this has gone. Until recently, we used standard chemotherapy, usually platinum-based for 3 to 4 cycles, followed by surgical resection.