From the Guidelines
For this patient with stage IIA (pT2bN0M0) peripheral destructive left lower lobe lung cancer, adjuvant chemotherapy should be considered to improve overall survival. The patient's diagnosis of Ca lobi inf. pulmonis sin. peripherica destructyva, St.IIA pT2bN0M0 G2/PD-L1<1%/LVI3/PL1/R0, indicates a high-risk feature with lymphovascular invasion and pleural invasion, despite the N0 status. According to the most recent and highest quality study 1, adjuvant platinum-doublet chemotherapy is recommended for patients with completely resected stage II NSCLC. The recommended regimen is cisplatin-based doublet chemotherapy, typically cisplatin 75 mg/m² plus vinorelbine 25-30 mg/m² every 3 weeks for 4 cycles. Alternative regimens include cisplatin with gemcitabine, pemetrexed (for non-squamous histology), or docetaxel. Some key points to consider when deciding on adjuvant chemotherapy include:
- The patient's performance status (ECOG 0-1) and recovery from surgery
- The presence of high-risk features like lymphovascular invasion and pleural invasion
- The potential benefits and risks of adjuvant chemotherapy, including the approximately 5% absolute improvement in 5-year survival for completely resected stage II NSCLC
- The potential toxicities of cisplatin, including ototoxicity, nephrotoxicity, and neurotoxicity, which may limit its use, especially in older patients Treatment should begin within 6-8 weeks post-surgery if the patient has adequate performance status and has recovered from surgery. Immunotherapy is not indicated in the adjuvant setting for this patient given the PD-L1<1%. Regular follow-up with CT scans every 3-6 months for the first 2 years is recommended. It is essential to weigh the benefits and risks of adjuvant chemotherapy and consider the patient's individual circumstances, including their overall health, preferences, and values. In this case, the evidence supports the use of adjuvant chemotherapy to improve overall survival, and it should be considered as part of the patient's treatment plan.
From the Research
Lung Cancer Adjuvant Therapy
The patient's lung diagnosis is Ca lobi inf. pulmonis sin. peripherica destructyva, with a staging of pT2bN0M0 G2/PD-L1<1%/LVI3/PL1/R0, and a clinical classification of Cat.cl.2.
Adjuvant Therapy Options
- The study 2 suggests that cisplatin plus vinorelbine adjuvant chemotherapy is a standard of care for non-small cell lung cancer (NSCLC) and has sufficient tolerability, safety, and efficacy.
- Another study 3 compared pemetrexed plus cisplatin with vinorelbine plus cisplatin as postoperative adjuvant chemotherapy in patients with pathologic stage II-IIIA nonsquamous NSCLC, and found that pemetrexed plus cisplatin showed better tolerability.
- Cisplatin is a widely used chemotherapy agent in the treatment of various forms of carcinomas and sarcomas, and its effectiveness in delaying negative outcome in cancer patients has been documented 4.
Considerations for Adjuvant Therapy
- The patient's PD-L1 expression is less than 1%, which may influence the choice of adjuvant therapy.
- The study 5 discusses treatment considerations for patients with advanced squamous cell carcinoma of the lung, but does not provide direct guidance for adjuvant therapy in this patient's case.
- The study 6 found that the addition of radiation to adjuvant therapy does not appear to significantly improve survival in patients with resected duodenal adenocarcinoma, but this may not be directly applicable to lung cancer.