David P. Mason, MD, chief of thoracic surgery and lung transplantation, Baylor Scott & White Health System, chief of lung transplantation, head of the Department of Thoracic Surgery, Baylor University Medical Center, discusses the progress that has been made in resectable stage III lung cancer.

Over the past few decades, not much has changed in the treatment of patients with resectable stage III lung cancer from both a surgical and medical perspective, says Mason. However, over the last few years, there has been a lot of progress made in unresectable stage III lung cancer. In that space, there are several therapies on the horizon that have the potential to change things for the better, he adds.

For patients with resectable stage III lung cancer, surgery and chemoradiation remain the standard of care. However, there are associated adverse events (AEs) to be aware of. Patients may experience all of the secondary AEs of chemotherapy, including nausea, vomiting, drop in blood counts, susceptibility to infection, and admission to the hospitals, says Mason. With radiation, patients may experience esophagitis, discomfort, and lung injury; those are all downsides of chemoradiation. When surgery is added on top of that, it can be a particularly challenging regimen for patients, concludes Mason.

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David P. Mason, MD, chief of thoracic surgery and lung transplantation, Baylor Scott & White Health, chief of lung transplantation, head of the Department of Thoracic Surgery, Baylor University Medical Center, discusses the progress that has been made in resectable stage III lung cancer.

Dr. Mason on Progress Made in Resectable Stage III Lung Cancer

David P. Mason, MD, chief of thoracic surgery and lung transplantation, Baylor Scott & White Healthcare System, chief of lung transplantation, Baylor University Medical Center, discusses the role of surgery in stage III non—small cell lung cancer (NSCLC).

A number of factors may prevent patients from seeing a surgeon, even though one-third to one-half of patients with lung cancer require a multimodality approach. For example, a lot of patients present with stage III disease in which the role of surgery is not as well defined as it is in earlier stages.

As far as the conversation between a surgeon and a patient, Mason says he first likes to get a sense of the patient’s overall fitness, motivation, and willingness to undergo an intensive procedure in addition to receiving other medical therapy such as chemoradiation. Additionally, patients have to understand the level of risk associated with surgery, Mason adds.

David P. Mason, MD, chief of thoracic surgery and lung transplantation, Baylor Scott & White Healthcare System, chief of lung transplantation, Baylor University Medical Center, discusses the role of surgery in stage III non–small cell lung cancer.

Dr. Mason on the Role of Surgery in Stage III NSCLC

David P. Mason, MD, chief of thoracic surgery and lung transplantation, Baylor Scott & White Healthcare System, chief of lung transplantation, Baylor University Medical Center, discusses standard treatment approaches available for patients with stage III non—small cell lung cancer (NSCLC).

There are 2 treatment approaches for patients with stage III NSCLC, explains Mason: one is chemotherapy and radiation and the other is chemotherapy and radiation with the addition of surgery. It's hard to compare the 2 approaches because the patients who are selected for each approach often have different clinical characteristics, says Mason. Typically, the patients who are selected for surgery are more fit and may have more localized disease; they may also be more motivated to have surgery, he adds.

There have been few randomized trials comparing the 2 treatment interventions, and the few that have been done have not shown a big difference in the overall outcomes. However, in selected patients, surgery may confer a survival advantage, Mason concludes.

David P. Mason, MD, chief of thoracic surgery and lung transplantation, Baylor Scott & White Healthcare System, chief of lung transplantation, Baylor University Medical Center, discusses standard treatment approaches available for patients with stage III non–small cell lung cancer (NSCLC).

Dr. Mason on Standard Treatment Approaches in Stage III NSCLC

David P. Mason, MD, chief, Thoracic Surgery and Lung Transplantation, Baylor Scott & White Center for Thoracic Surgery, discusses the reliability of the PD-L1 biomarker in non—small cell lung cancer (NSCLC) and its potential applications in surgical approaches.

PD-L1 seems to be a reliable biomarker. There is value in its use in the adjuvant setting, and that may be in a larger subpopulation of patients receiving treatments in addition to surgery. This is done to try and improve long-term outcomes and diminish the likelihood of occurrence.

There are some very interesting studies coming out now that show the use of induction therapy in other settings, not necessarily in a surgical setting, but nonetheless show high efficacy. In patients with locally advanced tumors, particularly stage III disease who don’t undergo surgery upfront, physicians can note the effectiveness of those treatments and bring that into the surgical arena to improve patient outcomes.

David P. Mason, MD, chief, Thoracic Surgery and Lung Transplantation, Baylor Scott & White Center for Thoracic Surgery, discusses the reliability of the PD-L1 biomarker in non–small cell lung cancer (NSCLC) and its potential applications in surgical approaches.

Dr. Mason on the Reliability of the PD-L1 Biomarker

David P. Mason, MD, Baylor Scott & White Center for Thoracic Surgery, discusses a case that demonstrates the evolution of lung cancer surgery in a biomarker-driven era.

Mason recalls a setting of oligometastatic disease in which biomarker-driven therapy was used based on the findings that the patient was PD-L1 high. The patient was relatively young, in her 50s, who presented with a tumor that was metastatic to the brain. She was treated on trial with a PD-L1 inhibitor that controlled her disease for 2 years. At the end of that therapy, she had a single residual area of tumor in her lung, which was in her right upper lobe. The decision was to go ahead and remove it considering she had progressed nowhere else, and that may have been her only site of disease.

In surgical resection, her lung demonstrated no evidence of residual disease.

David P. Mason, MD

Articles

Dr. Mason on Progress Made in Resectable Stage III Lung Cancer

Dr. Mason on the Role of Surgery in Stage III NSCLC

Dr. Mason on Standard Treatment Approaches in Stage III NSCLC

Dr. Mason on the Reliability of the PD-L1 Biomarker

Dr. Mason on the Intersection of Surgery and Biomarkers in NSCLC