Dr. Langer on the Treatment of Early Stage Lung Cancer

Corey J. Langer, MD, professor of medicine, hematology/oncology division, University of Pennsylvania, Abramson Cancer Center, discusses the treatment of patients with early stage lung cancer.

Early stage disease is different from advanced disease. The major concerns in early stage disease include proper surgical resection and clean proximal nodes. It is difficult to know the stage of many patients, Langer says, though this is important to make treatment decisions. Although stage can be surmised with a PET scan, CAT scan, and other methods, Langer says that a definitive conclusion is ideal.

Today, in patients with N1 or N2 involvement or stage 1 patients with tumors larger than 4 centimeters, standard postoperative care is adjuvant platinum-based chemotherapy for 4 cycles. Langer says that there is no proven role for a targeted agent in this setting, though this certainly remains a research question.

From a practical standpoint, Langer says that he requests that pathologists perform reflex testing on surgical specimens. Though this test is not immediately actionable in the adjuvant setting, the information on marker status can be used later. Langer says that half of this group of patients will relapse, furthering the need for information rather than test and wait for results later on.