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CD 2, Track 2

DR LOVE: Tom, how did you answer the question, do you think adjuvant chemotherapy should be discussed and presented as a treatment option to most patients with Stage IA NSCLC and a performance status of zero?

DR LYNCH: I answered “in between” because I do see the occasional patient with Stage IA disease that I talk to about adjuvant chemotherapy.

DR LOVE: What if a patient with Stage IA disease asks, “I understand there are side effects, but will adjuvant chemotherapy lower my already modest or low risk for recurrence?”

DR LYNCH: I tell them I expect it probably will, to the best of our ability to estimate.

DR EDELMAN: If you had asked me six months or one year ago, I would have probably agreed with Tom. The occasional patient appeared with Stage IA disease with whom I would discuss this.

But we’ve learned from the CALGB-9633 update that smaller tumors generally didn’t benefit (Strauss 2006). So now I’m a lot more conservative.

CD 2, Tracks 4-6

DR LOVE: Ed, what chemotherapeutic regimen do you use in the adjuvant setting?

DR KIM: I will talk to patients and tell them, “If you go by the data, it is cisplatin/vinorelbine.” I also tell them that I’ll use cisplatin/docetaxel based on the study by Frank Fossella.

In the metastatic setting, it was similar in efficacy but had a better side-effect and quality-of-life profile (Fossella 2003). I usually go with docetaxel. Vinorelbine requires a central line for administration because it’s a vesicant.

DR LOVE: Rogerio, how do you approach patients with Stage IB disease?

DR LILENBAUM: CALGB-9633 had a great impact on my practice.

Up until ASCO 2006, I discussed with patients and colleagues the initial analysis of CALGB-9633, which I considered Level 1 evidence, and, in patients with Stage IB disease, I felt comfortable using carboplatin/paclitaxel. However, that has changed since the updated analysis of CALGB-9633 (Strauss 2006).

I still recommend that most patients with Stage IB disease receive adjuvant chemotherapy, but whenever possible I use a cisplatin-based regimen, usually docetaxel. I’ve used gemcitabine once in a while, despite the absence of data.

If I see a patient who is clearly not a good candidate for cisplatin, I will use carboplatin but with a much lower level of confidence than I had before ASCO.

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