Managing Chemotherapy-Induced Toxicities in Stage II/III Lung Cancers

Although the primary adverse effect (AE) associated with chemotherapy is fatigue, patients may also experience nausea and vomiting, according to Thomas Marron, MD, PhD. Marron is the director of the Early Phase Trials Unit at the Tisch Cancer Institute and a professor of Medicine, as well as Immunology and Immunotherapy at the Icahn School of Medicine at Mount Sinai.

In an interview with CancerNetwork®, Marron discussed the state of treatment for patients with early-stage lung cancers, contextualized by a presentation he gave at the 43rd Annual Chemotherapy Foundation Symposium (CFS) titled, “Stage I-III Is Not What It Used to Be”. He discussed common toxicities associated with chemotherapy for this patient population, as well as common strategies for mitigating or preventing them.

Regarding nausea and vomiting, Marron expressed that his team is well-equipped to handle emergent events, which include the receipt of long-acting premedications and outpatient antiemetics to help mitigate the rate and severity of these AEs.

Furthermore, although he asserted that it may be difficult to reduce the incidence of fatigue, its onset does not typically correlate with delays in surgery, and strategies can be employed to help mitigate it. Furthermore, he expressed that the addition of chemotherapy and corticosteroids to immunotherapy may help to reduce the rate of immunotherapy-related AEs.

Finally, Marron emphasized the importance of proactive disclosure of AEs as they occur, stressing that failing to catch an AE before it escalates to a grade 3 or 4 event may preclude a patient from undergoing surgery for curative intent. Furthermore, he suggested that this risk reemphasizes the need for patient education in identifying and reporting AEs, as well as for families.

Transcript:

Neoadjuvant chemotherapy typically has the same [adverse] effects as chemotherapy in the metastatic setting. The main [adverse] effects of chemotherapy are [primarily] fatigue. Some patients [experience] some nausea and vomiting. We are [quite] good at controlling that. We have great medicines that we give with chemotherapy––[premedications] that are long acting––and we always send patients home with antiemetics to have as needed. We are very good at mitigating that.

Fatigue is probably the most common [adverse] effect, and there is not a whole lot we can do about that, but usually we are able to mitigate it, and it’s not something that in any way would delay surgery. [With] the addition of immunotherapy, there’s always the risk of developing an immunotherapy-related adverse event, especially since we are giving 4 full cycles before surgery. That is always possible. But at this point, we are much better at managing those [adverse] effects. With pembrolizumab, for instance, if you combine it with chemotherapy, the rate of immunotherapy-related adverse events is always lower than it is if you give immunotherapy by itself, which makes sense because you are also giving corticosteroids with the chemotherapy.

It is important in the preoperative setting, though, that we are talking to our patients and we are making sure patients understand the importance of immediately calling us if they are having any sort of new symptoms, because you do not want a patient getting to the point where they have a severe grade 3 or 4 adverse event and are on high-dose immunosuppression, and may all of a sudden have been converted from a curable patient to an incurable patient who cannot undergo surgical resection. It reemphasizes the need for us to educate our patients on what to be on the lookout for, and…to call us if they see [something] in themselves, or if their families notice any differences in how they are acting, or any symptoms that they might be developing.

Reference

Marron TU. Stage I-III is not what it used to be. Presented at: 43rd Annual Chemotherapy Foundation Symposium (CFS); November 12-14, 2025; New York, NY.