Dr. Stiles on Treatment Advances Made in Early-Stage Lung Cancer

Brendon Stiles, MD, thoracic surgeon and associate attending cardiothoracic surgeon at New York-Presbyterian Hospital, and associate professor of cardiothoracic surgery at Weill Cornell Medicine, of Cornell University, discusses the roles of surgery, radiation, and chemotherapy in treatment for early-stage lung cancer.

Although surgery has been the mainstay treatment for patients with early-stage lung cancer, multimodality therapy should now be considered, particularly for those with stage 2 or stage 3 disease, Stiles says. Although chemotherapy continues to be the standard approach in the adjuvant or neoadjuvant settings, increasing trials are examining neoadjuvant and adjuvant immunotherapy approaches. The key challenge faced with immunotherapy, is identifying which patients would be eligible for that approach, explains Stiles.

Additionally, in December 2020, the FDA approved the EGFR-targeted therapy osimertinib (Tagrisso) for use in the adjuvant space, adds Stiles. This regulatory decision underscores the importance of developing a better understanding of the molecular disease characteristics of those with early-stage disease, according to Stiles.

Radiation also retains a role in the treatment of this population, says Stiles. For example, stereotactic radiation therapy may be a strong choice for patients with very early-stage disease, particularly those with limited pulmonary function, concludes Stiles.