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Immunotherapy With or Without Chemo for the First-Line Treatment of NSCLC
Martin J. Edelman, MD, Fox Chase Cancer Center, Philadelphia, PA, discusses the use of immunotherapy with or without chemotherapy in the first-line treatment of patients with NSCLC.
Transcript:
Martin J. Edelman, MD: My name is Martin Edelman. I am Chair of the Department of Hematology/Oncology at Fox Chase Cancer Center in Philadelphia, Pennsylvania. Let's start talking about stage 3 non-small cell lung cancer. This is an important area of disease.
Probably 20 to 30 percent of non-small cell lung cancer patients present with locally advanced disease which is primarily determined by the presence of mediastinal adenopathy but could also be a result of a large tumor, particularly one that extends into a major structure.
Our results for the last 35 years have demonstrated a few key points.
First is that chemotherapy in addition to radiation is potentially curative. A series of trials that began in the late 1980s and has continued to this date has demonstrated that chemotherapy prior to radiation cures more patients than radiation alone.
Chemotherapy combined with radiation incrementally improves that, and most recently that chemotherapy concurrent with radiation followed by immunotherapy improves those results still further.
In this situation, we now know that approximately 25 to 35 percent of patients who present with locally advanced non-small cell lung cancer can potentially be cured with this non-surgical approach.
The questions that we have going forward are, should we utilize immunotherapy earlier in the course specifically concurrent with radiation or chemotherapy or chemo-radiotherapy together? That's one question we still do not completely understand what the role of surgery will be in this situation.
Furthermore, we need to be very cognizant of the potential toxicities both acutely and long term from this approach. However, overall, once again, non-operative therapy for stage 3 disease is potentially curative and that's kind of the key commit take home point.
