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Managing Unresectable Locally Advanced NSCLC


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Managing Unresectable Locally Advanced NSCLC: Consolidation Therapy or No?

http://blog.lungevity.org/2011/09/01/ma ... apy-or-no/

September 1st, 2011 - by Dr. Jack West

The podcast featured in today’s post is from the conversation I had with Drs. Jyoti Patel, of Northwestern University, and Bob Doebele, of the University of Colorado. That discussion comprised a series of challenging cases in lung cancer management, then combining their comments with the responses from several other excellent experts (Drs. Suresh Ramalingam, Jonathan Goldman, Julie Brahmer, Heather Wakelee, and Karen Reckamp) about the same case. Together from these discussions, you can perceive how, even working from the same core set of studies and information, different very good clinicians have their own interpretation and style for cases where there are significant gaps in what the data tell us.

This particular case is one we struggle with all the time: if someone with unresectable stage III NSCLC has completed initial chemo/radiation, typically over an approximately seven week period, should we recommend any additional treatment after that? We are generally tempted to do so, in hopes of providing better results than what we might expect without it, but we don’t have evidence that it helps. I think you’ll get a clear sense of the uncertainty (at least mine), but several of the speakers also note their different mindset for those patients treated with weekly carbo/Taxol (paclitaxel) (which we believe doesn’t give meaningful systemic dosing to eradicate micrometastatic disease, but it can help make the radiation given concurrently more effective) versus “full dose” cisplatin/etoposide (which we feel does treat possible distant disease in addition to helping make the radiation more effective where it is directed).

Click the blog link above to get the audio and video versions of the podcast, along with the transcript and figures from the presentation.

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