Dr. Novello on the Gray Areas in Lung Cancer Care

Silvia Novello, MD, PhD, assistant professor, Thoracic Oncology Unit, University of Turin, San Luigi Hospital, Orbassano, Italy, discusses some of the “gray areas” that require more research for the treatment of patients with lung cancer.

Chemotherapy is effective for patients with stage II or IIIA lung cancer but little is known about how best to treat early-stage disease, Novello says. Ongoing trials are investigating this setting further.

If chemotherapy is indicated, physicians will generally add a platinum compound to a cytotoxicagent. However, whether bevacizumab or pemetrexed is superior remains unclear. Until trials are completed, physicians should use the chemotherapy combination they are the most comfortable with.

In addition to chemotherapy, physicians are unsure how to utilize targeted therapies in the adjuvant setting, Novello says. There is currently insufficient data on EGFR and ALK inhibitors following a complete resection. As a result, many nonacademic physicians administer adjuvant chemotherapy, even when an EGFR or ALK alteration is identified.