Mark G. Kris, MD, discusses neoadjuvant therapy for patients with locally advanced lung cancers.
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A huge question has come up. I just came from a meeting of lung cancer experts asking what to do if you have a patient with a small tumor, for example, a 3-cm tumor. Do you recommend immediate surgery followed by adjuvant therapy, chemotherapy, and then a checkpoint inhibitor if appropriate? Or do you proceed with neoadjuvant therapy if appropriate? The truth is that it's a very difficult decision.
Well, I think that the first reason is that it is probably a better regimen. I think many of you saw the. It was an interesting trial. They gave a checkpoint inhibitor for 18 doses after surgery for melanoma vs three doses of checkpoint inhibitor, surgery, and then 15 doses of the checkpoint inhibitor.
There are other advantages to it as well. I think a big one is that all the information shows that it's better tolerated, so you're more likely to give all the drug. You can see if the drug isn't working, and you can stop the drug. Also, if the drug is causing a side effect, you can see whether it's working or not and use that decision to stop.
The way to handle it today, though, is to convene your multidisciplinary panel about every patient other than those with the tiniest of lung cancers and put your heads together to see what the best treatment is for that patient.
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