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Message from (Bruce u)

Connie B

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The Message from New Member Bruce U was blended in with someone elses thread. I didn't want this to get passed over so I posted it here instead.

Bruce u

Joined: 24 Nov 2007

Posts: 3

Location: Yellowknife, Canada

Posted: Sat Nov 24, 2007 7:20 pm Post subject:

First time viewing this site. I am a 46 year old male that had surgery in September removing the upper lobe of my left lung. Discovered last February in a chest x-ray,the tumour was 2cm and was a stage 1b. Now I have to decide to have 4 rounds of adjuvant chemotherapy or not. There are mixed opinions on this for stage 1b. Would anyone have more information on this or on studies completed ?

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EDMONTON, Alta., June 22-A new adjuvant chemotherapy regimen may shift the standard of care for patients with early-stage non-small cell lung cancer (NSCLC). Action Points

Advise interested patients of increased survival with adjuvant treatment with Navelbine (vinorelbine) plus Platinol (cisplatin) for patients with good performance status after complete resection of stage IB or stage II non-small-cell lung cancer.

Discuss the risk of toxicity verses the benefit of prolonged survival with patients considering this treatment approach.

Compared with observation alone after surgery, the conventional standard of care, adjuvant chemotherapy with Navelbine (vinorelbine) plus Platinol (cisplatin) improved the five-year overall survival rate by 15 percentage points and decreased the risk of death by 31% (P = 0.04).

The five-year survival rates were 69% in the treatment group versus 54% in the observation group (P = 0.03), according to a study published in the June 23 issue of the New England Journal of Medicine.

Although the toxicity of other chemotherapy regimens has been a major concern for doctors and patients, the new regimen had acceptable levels of toxicity, according to Timothy Winton, M.D., of the University of Alberta Hospital and colleagues. The study was supported by the National Cancer Institute of Canada.

Previous studies investigating the use of adjuvant chemotherapy for non-small cell lung cancer showed little benefit and unacceptable toxicity, the authors said. These studies led doctors and patients to eschew adjuvant chemotherapy for early NSCLC.

However, the previous studies used older, more-toxic regimens. This new study is the first to treat all patients with a "third generation" chemotherapy agent, Navelbine, to omit postoperative radiotherapy, and to focus on a narrow subgroup of patients with state IB or II disease, the authors said.

The prospective, phase III study examined 482 patients with stage IB or II cancer and an Eastern Cooperative Oncology Group performance status score of 0 or 1. Half were randomized to the treatment group and half to the observation group. The treatment group included four cycles of adjuvant therapy. All patients began adjuvant therapy within six weeks after surgery. Median follow up, which included regular clinical examinations and chest radiographs, was about five years for both groups.

Fifty-eight percent of patients in the treatment group completed three cycles and 48% completed four cycles of adjuvant therapy.

In addition to improving overall survival, adjuvant chemotherapy significantly improved disease-free survival. Disease recurrence was documented in 36% of the treatment group versus 49.6% of the observation group (P = 0.003).

The most common adverse events from treatment included neutropenia (88%), fatigue (81%), nausea (80%), anorexia (55%), vomiting (48%), neuropathy (48%), and constipation (47%). Toxic effects of grade 3 or higher occurred in less than 10% of patients. Two patients (0.8%) died from toxic effects of treatment.

The results are "astonishing," according to Katherine M.W. Pisters, M.D., of the University of Texas M.D. Anderson Cancer Center in Houston.

"On the basis of the data reported by Winton et al. and the supporting trials, the controversy surrounding adjuvant chemotherapy for resectable non-small-cell lung cancer is over," Dr. Pisters said in an editorial accompanying the study. "Adjuvant platinum-based chemotherapy should be recommended after complete resection of non-small-cell lung cancer in patients with a good performance status."

The study authors agree. "This study indicates that adjuvant treatment with vinorelbine plus cisplatin can be safely administered in the outpatient setting with limited toxicity and is beneficial in non-small-cell lung cancer," they wrote. "We believe that a brief course of such therapy should become the standard of care for patients with good performance status after complete resection of stage IB or stage II non-small-cell lung cancer."

Related article:

Fit Elderly Patients with Limited Stage Small Cell Lung Cancer Can Withstand Radiation

Additional Preventive Care Coverage

Primary source: New England Journal of Medicine

Source reference:

Winton T et al. Vinorelbine plus cisplatin vs. observation in resected non-small-cell lung cancer. New England Journal of Medicine. 2005; 352(25):2589-2597.

View this abstract.

Additional source: New England Journal of Medicine

Source reference:

Pisters KMW. Adjuvant chemotherapy for non-small-cell lung cancer -- the smoke clears. New England Journal of Medicine. 2005; 352(25):2640-2642.

View this extract.

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Thanks Randy.

I am being treated at the Cross Cancer Institute at the University of Alberta in Edmonton. Unfortunately for stage 1b, most people are still undecided. The last study I am aware was released on Oct. 26, 2007 from the Ontario Cancer Clinic. Basically stated that they do not recommend adjuvant chemo for stage 1b on a routine basis but maybe beneficial in specific cases. Difficult for a patient to make a decision when the professionals are undecided.

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You're right that this is a very complex issue, one that is among the most challenging even for experts to discuss. I've participated in many of these discussions and am very aware of the pros and cons of chemo, and I've described several of these issues in detailed posts on my website, OncTalk. Here's a pivotal one if you're interested:

http://onctalk.com/2007/09/28/cons-of-a ... -ia-nsclc/

You can find several more in the subject archives for early stage NSCLC there.

Good luck and take care.

-Dr. West

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