What is the current level of evidence on the subject? Thanks
It may happen for resectable stage IIIA. The pCR rates are quite high with neoadjuvant IO + chemotherapy.Medoncs trying to take away lung from us now?
We don't typically operate on Stage III anyways (unless incidental pN2 disease found after surgery) and I wasn't keen on pre-op in those patients to begin with.It may happen for resectable stage IIIA. The pCR rates are quite high with neoadjuvant IO + chemotherapy.
Adjuvant IO is also going to become s.o.c. likely within the next couple of years for patients with resected stage II-IIIA (on top or without adjuvant chemotherapy), so medoncs are likely to extrapolate that if it works in the adjuvant setting it is going to work in the neoadjuvant setting too.
Our thoracic surgeon was going off on some phase 2 trial at mskcc and how he sees it opening up more stage 3 to surg. He also thinks he will be giving the io. On a separately depressing note, the company making nav bronch is trialing an attachment for ablating tumors. Our guys can already deploy sbrt fiducials in very peripheral tumors.We don't typically operate on Stage III anyways (unless incidental pN2 disease found after surgery) and I wasn't keen on pre-op in those patients to begin with.
Wasn’t IO recently approved w/postop chemo? Up until then, only chance for stage 3 pt to get IO was with pacific.With PACIFIC, it’s gonna be pretty hard for surgery to break out of single station N2… especially in the absence of pCR. Data will need to be VERY compelling.
pCR is something med oncs love. Look at breast cancer, for instance, and how they are pushing for it there. The same goes for TNT in rectal cancer (soon without RT, likely).With PACIFIC, it’s gonna be pretty hard for surgery to break out of single station N2… especially in the absence of pCR. Data will need to be VERY compelling.
You must not have a med onc who tries to refer N3 disease to thoracic surgery for "curative" intent in an 'academic" practice. - Sigh... Its probably just me that I have to try to stop this every time.Medoncs trying to take away lung from us now?
Increased the pCR ten-fold? Whoa.Neoadjuvant Opdivo (nivolumab) Plus Chemotherapy Significantly Improves Event-Free Survival in Patients with Resectable Non-Small Cell Lung Cancer in Phase 3 CheckMate -816 Trial
CheckMate -816 is the first Phase 3 trial with an immunotherapy-based combination to demonstrate improved event-free survival and pathologic complete response in the neoadjuvant setting of non-small cell lung cancer Positive results reinforce the improved efficacy seen with Opdivo-based...bit.ly
pCR is something med oncs love. Look at breast cancer, for instance, and how they are pushing for it there. The same goes for TNT in rectal cancer (soon without RT, likely).
Give the med oncs data on good pCR rates and they will push for that kind of treatment.
Absolutely. The IO is having a systemic effect as well. It also seems to work if pdl< 1%Increased the pCR ten-fold? Whoa.
These pCR rates are not that different than the below, but I would chose the IO versus the below personally.
Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas: long-term results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160) - PubMed
This combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.pubmed.ncbi.nlm.nih.gov
Or any different that this one:Increased the pCR ten-fold? Whoa.
These pCR rates are not that different than the below, but I would chose the IO versus the below personally.
Induction chemoradiation and surgical resection for superior sulcus non-small-cell lung carcinomas: long-term results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160) - PubMed
This combined-modality approach is feasible and is associated with high rates of complete resection and pathologic CR in both T3 and T4 tumors. Local control and overall survival seem markedly improved relative to previous studies of radiation plus resection.pubmed.ncbi.nlm.nih.gov