Information needed on Stage 1A

[Eileen]

Does anyone have any recent info on the reoccurence rate of stage 1A nsclc after a lobectomy either with or without chemo?

-I have searched the Internet and I cannot seem to find anything ---I do find some info regarding chemo after a lobectomy, but it does not seem to differentiate between stages 1A & 1B---I have also seen that chemo increases survival rate for stage 1, but again I cannot seem to find the breakdown between 1A & 1B.

I also see a survival rate of about 85-90% for stage 1A, which I guess means that it reoccurs in 5% of the people?---but I am not sure how accurate this is. Nor am I able to find out how many years after the intial diagnosis does it reoccur.

Thanks

regards

[gail]

I have grilled my onc on this and honey, I think you are at a good place. What he told me was that most recurrences happen within 2 years, and the longer you go the better. This is unlike breast cancer which could reoccur any time.

I was 1A with no chemo, and asked him about that too. After my surgery they started preventive chemo. I looked at my records again and told me if I entered his office today with the same tumor I would still not get chemo.

Aren't we just special?

We got the "good" cancer.

gail

[Donna G]

Chemotherapy improves lung cancer survival

By DANIEL Q. HANEY

Associated Press

NEW ORLEANS - Two landmark studies convincingly show that standard chemotherapy markedly improves survival in victims of early stage lung cancer, a discovery that should quickly change the way the common disease is treated.

Doctors typically cut out lung tumors that have not noticeably spread, but they do not routinely put patients through the rigors of chemotherapy, because there has been no clear evidence it improves their chances.

Experts believe that dogma will change as a result of the data released Saturday. The studies show chemotherapy indeed can make a substantial difference in lung cancer, just as it does in breast and colon cancer.

"This will translate into thousands of lives saved every year," predicted Dr. Bruce Johnson, a lung cancer expert at Boston's Dana-Farber Cancer Institute.

The two studies involved patients with what's called non-small lung cancer. Lung cancer is the world's most common malignancy, and about 80 percent of cases are this type.

The new data were presented at the annual scientific meeting in New Orleans of the American Society of Clinical Oncology. At the same meeting last year, an international study offered the first hint of a small benefit to adding chemo to surgery for this kind of cancer.

Nevertheless, many doctors wondered afterward whether the payoff was big enough to change the way they treat lung cancer. The latest studies, which show an even bigger benefit, should tip the profession toward making chemotherapy a standard part of treatment, experts say.

"This will convince even the most skeptical," predicted Dr. David Johnson of Vanderbilt University.

At the same meeting Saturday, other teams reported encouraging data on two newer, so-called targeted drugs that jam up cancer's internal signaling circuits without producing major side effects. These are OSI Pharmaceuticals' Tarceva and ImClone system's Erbitux, the drug that enmeshed Martha Stewart in an insider trading scandal.

Last year's lung cancer study involved somewhat more advanced cases and showed a 5 percentage point improvement in survival after five years in those getting chemo. The latest studies were carefully confined to the patients with the best chances - those with relatively small tumors and no sign of cancer in lymph nodes beyond the lung - and found a larger benefit, roughly 15 percentage points.

"These are paradigm-shifting studies," said Dr. Frances Shepherd of the National Cancer Institute of Canada.

The two studies were financed by the government cancer institutes of the United States and Canada and involved different drug regimens, but they had remarkably similar outcomes:

The U.S. study enrolled 344 patients who were randomly given either surgery alone or surgery plus Taxol and carboplatin. After four years, 71 percent getting chemo were still alive, compared with 59 percent getting only surgery.

The Canadian-sponsored study involved 482 patients and used the drugs vinorelbine and cisplatin. After five years, 69 percent getting chemo were still alive, compared with 54 percent receiving surgery alone.

After these results, "I would have difficulty not offering chemotherapy to my patients," said Dr. Gary Strauss of Rhode Island Hospital, who headed the U.S. study.

In the United States and Canada alone, about 200,000 new cases of lung cancer are diagnosed annually, and 80 percent are non-small cell. Of these, about 30 percent are the same early stage that can be removed surgically.

Another Canadian cancer institute study showed that Tarceva, which has not yet been approved for routine use, can slightly improve survival in people with advanced non-small lung cancer who do not respond to other treatments. In testing on 731 patients, survival increased by two months. Doctors hope results will be better if the drug is started earlier.

Both Tarceva and Erbitux work by blocking epidermal growth factor, one of the errant stimulants that keeps cancer alive. Erbitux was approved in February for use in colon cancer, and Saturday's study shows remarkable benefit against tumors of the tongue, tonsils and voice box.

Dr. James Bonner of the University of Alabama headed a company-sponsored study of 424 patients with cancer that had not spread beyond the neck. The treatment doubled median survival from 28 months to 54 months.

"Nobody anticipated this degree of positive outcome," said Dr. Robert Mayer of Dana-Farber.

The drug was central to Martha Stewart's conviction by a federal jury in March for lying to investigators about why she sold ImClone stock on Dec. 27, 2001. That was the day before the company received a setback from regulators in its eventually successful quest to market Erbitux.

On the Web:

http://www.asco.org/

Sorry , does'nt differenciate between I A and I B

[gail]

Bad day for my typing. A day of rain with children.

I had no chemo for the lung cancer--and the onc told me if I presented today he would still not recommend chemo.

I was told several times early on that I had a 90% cure rate. But before anyone says great, let me tell you

After the first cancer they told me I had a 94% cure rate. What they didn't tell me was that 7-10% of women get a new cancer in the same breast . . .

and I did just that 4 1/2 years later.

So, statistics tell me nothing. Every day I am here is a blessing

gail

[Marie]

I didn't have chemo either and haven't had a recurrence, however I may have a new cancer in the other lung. I agree with Gail, forget the statistics. There are no hard and fast rules for this thing.

[chloesmom]

Eileen,

I think that at 4+ years of no recurrence, you're doing great! I thought I read someplace once that for 1A people chemo didn't really show a significant benefit, but that for 1B there was a real increase in the chances of not having a recurrence.

Here's what I know for sure--my surgeon said that once I go for two years with follow-ups every 3 months (including a chest x-ray), we can go to an annual follow-up and chest x-ray. That should certainly underline the 2 year mark being important.

Although of course no one is ever going to tell someone it can never come back, I think you're in really good shape. I know there are a lot of people who don't get good results, but there are also a lot who do. I personally know two people who are long term survivors, one is 11 years (and she wouldn't let anyone take that mass out of her lung for 5 years!!!!) and one is 20 years. So, cures do happen all the time......

Cindy

Cindy

[MurielK]

I was 1B - a 3.1 cm tumor in the upper lobe of my right lung. Had a lobectomy at the end of June 03. The surgeon said it was gone. No more treatment needed. The pulmonary specialist said the same, but also said I could see on Onc. The Onc recommended Carbo & Taxol - 4 cycles, 3 weeks apart. I did that and had good CTs in Aug (before chemo) and after chemo in Jan, April, and Aug. The Aug one, however, showed something suspicious in the left upper lobe (5 mm) that should be watched. My Nov CT found the "something" to be 1.8 x .8 cm. A PET scan the following week indicated cancer in that spot, but no other place. A new primary? I see the Onc on Mon. Anyway, whatever it is has come back 15 mo. following surgery. My situation my be similar to Marie's.

MurielK

[Gina D.]

I was told everything that Gail was told.

I am quickly aproaching the 2 year mark.. I am going to throw a party and maybe even start up my retirement fund again.

I think at 4 years, you should throw an even bigger party and start to breath (Excuse the pun) easier again.

[Debi]

Hey Eileen,

I have never been able to find anything regarding the benefits on Stage 1A either, it seems that the studies lump the early stages together. There were 2 sites that I had found that said that it appeared that adjuvent chemo didn't make a difference in Stage 1A but of course, when I need them, now I can't find them.

I did find the following article that I found interesting, I had never seen this one before: http://www.healthscout.com/news/1/518476/main.html This is actually a study done in Japan with drugs that are not available here but the one line below pretty much has the same figures that you have quoted as far as Stage 1a.

Patients with the earliest stage of lung cancer, T1 disease, had a survival rate of 89 percent in the drug group and 90 percent in the control group.

I'll keep trying to find those other articles I had when I have some more time. I know when I was trying to make up my mind which way I was going to go with treatment, I had to really look hard to find even them...

And let me tell you all.. I know its all just statistics..but I still can't wait till June of 2005 gets here...

[Kaffie]

Eileen,

I am stage 1AT0M0 and had a lower left lobectomy, my tumor size was 1.3.

Every doctor I ask has a different answer. My surgeon says I have an 80& chance of being cured, my primary physician says it depends on they type of cancer, squmas cell having the highest cure rate and my onco has such a low answer I won't repeat it.

I am taking Taxol and Carboplantin. I was not offered chemo but read that it is just now starting to be given to early stage lc. I have been told that chemo ups the survival rate by 5 - 10% by all of my doctors but it only helps if you start it shortly after surgery.

I have a lingering fear that stays with me every day, I hope one day that will ease as I don't have much of a life right now, just worry, worry, worry, maybe that will lessen when I hit my 2 year mark which is considered "cure" for early stage.

Kathy

[richinsdakota]

Yea; I read similar things about the recent studies and Onc. suggested adjuvant chemo...even tho he said there's only about a 4 percent chance it will save me. (Im a Stage1T2M0). I tried it, expecting to get carbo/taxol ....but he hit me with a full treatment of taxotere ...still dont know why...and it gave me pneumonia like infection in remaining lung...sheesh. Dont want to scare anyone off from adjuvant chemo, tho, remember this was taxotere, and just hit me wrong, I guess. Anyway, Onc. has lost my trust and confidence...figure I better stay away from there before he crosses me up worse, even. So, cancelling any further treatment. And I had so many xrays and CTscans the last few months, dont wanna even screen for 6 mos. , If I can help it.

You want to give yourself every possible chance, however small, but only if you can tolerate the treatment. If there are serious reactions to the drugs....just not worth the small chance to me. Important to clarify and confirm what chemo regimen/drug youre getting, and what side effects to expect....if its well tolerated, fine....

Dunno if I might seek advice from a different Onc. yet....

Meanwhile...i did survive one powerful treatment of taxotere....can only hope it got any stray cells and knocked em dead. Rich B.

[chloesmom]

I have some information on this from my surgeon's visit yesterday. He said that 90% of the recurrences happen in the first two years. That's why the extensive every three month visits for two years and then annually from then on and forever.

EILEEN---Good news for you!!!!!!

I told him I will be so happy to hit the two year mark because of the anxiety that happens with these visits every three months, particulary as the time compresses down to the two year mark. He said, "You should be optimistic." Now I know that wasn't a prediction, but I'm taking that quote with me to bed every night to try to keep the monsters away.

[mayos]

I'm also a stage IB........T2N0M0.... because my tumor was over 2cm. I received Navelbine/Cisplatin for 3/4 rounds. I had problems with side effects too....fever, flu, anemia,etc... My onco cut back the cisplatin and my treatments went back on schedule. Large amounts of fluid must be added to our chemo IVs when cisplatin is given....and the extra fluid contradicted my H20 restrictions for another serious medical disease I'm stuck with...Primary Pulmonary Hypertension. The first 8 hr session with cisplatin almost put me down....by the 5th hr of infusion I was grabbing for my portable oxygen tank. I'm still happy I was offered chemo due to the larger size of my tumor...It was rough but I feel safer now.

The research I've done has indicated my own personal cure rate as a IB adeno w/adjuvent chemo is slightly lower than the IAs......Statistically standing at a level slightly under 65%.

I'll add a URL to a site with medical trial results for us...There are also links at the bottom of the page to abstracts with some other views....I hope you can see all these for free....http://ejcts.ctsnetjournals.org/cgi/content/abstract/20/2/378

[mayos]

Here's another link to the full text of a study on implications of size differences in IA tumors...I hope you can get through to this...

http://www.chestjournal.org/cgi/content/full/124/5/1828

[Eileen]

Thank you, that helps

regards,

[Snowflake]

Eileen,

I was IIIa, not early stage, not late stage, but smack-dab in the middle, according to my oncologist. My "measurements" were T2N2M0. I was not offered chemo as he said in my case the side effects didn't balance the slim margin it added to survival. He suggested radiation as it was less evasive and sent me for a second opinion at MD Anderson. THE cancer center wouldn't even suggest radiation in my case, and knocked down chemo...suggested a double-blind Iressa trial.

I flew back home and told my oncologist that a double-blind trial was a big no, he put me on Iressa as "suppressive therapy" - another trial that AstraZeneca was working on. Pulled off that after two months due to nasty side effects.

Been scanned and monitored pretty closely, monthly for the first six months with the Iressa trial and all, then every other month for the rest of that first year. After that year, it was every three months....

In eight days, I will hit the mark of two years from diagnosis. In 21 days, I will mark two years from surgery. Does the fear and anxiety ever go away? I don't think so.

There is a denial over the facts that you do have cancer when diagnosis is made, but there also seems to be denial when told it's all gone - an "Are you SURE?" and "HOW do you know that?". Funny, same questions ya have on diagnosis, ya know?

Congrats on still being clear. That's the important thing, after all.

[john]

One thing to ask also for resected lung cancer is:

1) Was there a complete mediastinal lymph node dissection or a sampling?

http://www.jco.org/cgi/content/full/21/6/1029

The two other trials with which this has been compared are ECOG 3590 and ALPI. In ECOG 3590, patients were stratified based upon the type of surgery that they had, and the type of lymph node dissection -- sampling of the mediastinal lymph nodes vs a complete lymph node dissection. If you look at the survival of those patients who had a complete mediastinal lymph node dissection, it was dramatically better than those patients who had just sampling. It didn't detect any more N2 disease, but it detected more multi-level N2 disease. The survival time was significantly longer if you had a complete mediastinal lymph node dissection. The question of complete dissection vs sampling is now being addressed prospectively by ACOSOG, and we hope we'll get the answer of whether you actually cure more people if you do complete dissection.

Where we're at now, 8 years after the meta-analysis, is that we have a 4.1% difference at 5 years, and we sort of think that there are some patients who benefit from chemotherapy, but we don't know who, we don't know what drugs to give them, and we don't know what dose to give them -- we haven't answered any of our questions. All we have done is to confirm our suspicions that there are some patients who might benefit. (from adjuvant chemo)

[Eileen]

John, thanks-, I have not seen this before----I am not sure I am reading this right, but it appears that when you sample less lymph nodes, in fact the staging of 1A based on this, may not truly be 1A, thus the lower survival rate?

Is that correct?

thanks

[john]

Yes I believe that is correct. Plus a positive lymph node may not be removed and so there are cancer cells in the body instead of out.

[Kaffie]

When I was going over my last CT scan with my doctor he pointed out the the surgeon had done complete lymph node dissection so I'm thinking there is something to that.

I also wonder why the insurance companies would pay for chemo if there is no proof of it helping. Insurance companies are so cheap they don't want to pay for anything, it seems to me that they would be fighting paying for it since it wouldn't be considered necessary.

That part is confusing to me.

Kathy

[Katester]

I always respond that I am a candidate for whatever my insurance will pay for.

My surgeon told me that my cancer was limited to the surface cells with no evidence of anything anywhere else after sampling of lymph nodes and

several of the scattered nodules throughout my lung. I have asked and I am asked by others on a regular basis why not chemo and my team of doctors insist I don't need it and the purpose of the surgery was to remove the cancer. So, I'm going to run with that for now, however I would only be foolish to belive that cancer could never return no matter how early it was discovered.

Kate