Preoperative Chemotherapy Holds Promise for Lung Cancer Patients

BUFFALO, NY—Although adjuvant therapies have made important inroads into improving overall survival for many cancer patients, lung cancer patients have not been so fortunate, Robert J. Ginsberg, MD, said at the Roswell Park Surgical Oncology Symposium.

“Previous results of surgery alone or surgery with adjuvant therapies using chemotherapy, radiotherapy, or their combinations have been dismal in patients with locally advanced lung cancers,” said Dr. Ginsberg, chief of the Thoracic Service, Memorial Sloan-Kettering Cancer Center. “However, the use of preoperative or induction chemotherapy, followed by surgery, offers a measure of hope to some lung cancer patients.” In certain instances, he said, when a complete response is noted at surgery, survival of up to 60% has been achieved.

Most trials of such therapy have included patients with N2 disease, but, more recently, trials of preoperative chemotherapy have been reported in patients with earlier stage tumors.

Theoretically, the use of preoperative chemotherapy will decrease the size of the primary lung cancer tumor, affect the number of micrometastases, and decrease the odds of seeding cancer cells throughout the chest cavity during the surgical procedure, Dr. Ginsberg said.

“Preoperative chemotherapy offers us the chance to give patients the potential benefits of such therapy while they are fit to receive it. A major problem with lung cancer surgery is the lengthy recovery time. Because of this, many patients cannot receive adequate adjuvant treatment. Treating with systemic therapy initially seems to make a difference,” he said.

Disadvantages for such induction therapy are the delay of the initial surgery, which may disturb patients, and an increase in surgical morbidity. “Although there are some theoretical disadvantages, it appears that such induction therapy is effective, especially if the tumor can be downstaged. We do not know yet if the optimal preoperative treatment is chemotherapy alone or chemotherapy with radiation therapy,” he said.