Malignant Tumors of the Temporal Bone: Practice Essentials, Etiology, Pathophysiology
Non-Small-Cell Lung Cancer Treatment By Stage
After your lung cancer is diagnosed, the doctor will run tests to find out the size of the tumor and whether the cancer has spread to other parts of the body. This process is called staging. Knowing the stage of your disease is crucial because it will help you and your doctor choose the best course of treatment.
Here's a look at the options for each stage. Keep in mind that no one can say for sure how your cancer will respond. Every person is different, and so is every cancer. Your doctor will make changes along the way to find what works best.
STAGE 0How It's Defined
The cancer is only in the lining of your airways.
Treatments
Surgery: If your health is good overall, surgery is probably all you need. Depending on where the tumor is, your surgeon will suggest one of these procedures:
Photodynamic therapy (PDT): This process uses a drug called a photosensitizer and a certain type of light to create a form of oxygen that kills nearby cells. It can help shrink tumors without the side effects of other drugs.
Brachytherapy: This is a form of internal radiation where radioactive material is put into a tumor or into an airway next to a tumor.
STAGE IHow It's Defined
In stage IA, the tumor is no larger than 3 centimeters (about 1 1/4 inches) across and hasn't spread to any other tissues or lymph nodes. In stage IB, it's no more than 4 centimeters and has spread to the main bronchus of the lung's lining, or both.
Treatments
Surgery: If you're in good health, surgery may be all you need. Based on the tumor's size and placement and how well your lungs work, your surgeon may suggest one of these procedures.
Chemotherapy: With any of these surgeries, nearby lymph nodes are also removed to see if the cancer has spread. If your medical team feels your cancer could come back, they'll probably suggest you get chemo after surgery to destroy any leftover cancer cells. You might hear this called adjuvant chemotherapy. You could take a chemo drug by mouth or get it in a vein.
Radiation: If you're not healthy enough for surgery, your doctor may go with this therapy. It uses powerful X-rays to kill cancer cells. You may hear the doctor call it external radiation.
Radiofrequency ablation (RFA): This is a procedure where heat produced by radio waves kills cancer cells.
STAGE IIHow It's Defined
The tumor is between 3 and 7 centimeters across, or it has spread to your lymph nodes, or both.
Treatments
Chemotherapy: Your doctor may want to do chemo (sometimes paired with radiation) before surgery to shrink the tumor. They might call this neoadjuvant chemotherapy. Even if your doctor doesn't find cancer cells during surgery, they might suggest chemo afterward just in case cancer cells were left behind.
Immunotherapy: An immunotherapeutic drug has now been approved by the FDA to treat some types of stage II NSCLC.
Targeted therapy: These drugs target certain parts of cancer cells. A test can tell if you'll respond to this treatment. They were typically used in NSCLC that had spread, but now there's one targeted therapy that's for use in earlier-stage NSCLC that has certain traits.
Surgery: If you're healthy enough, the doctor will likely recommend one of the following:
After surgery, your doctor will check the tissue they removed to see if cancer cells are at the edges. If so, you may need another operation to remove more cancer cells.
Radiation: If you're not healthy enough for surgery, you may get radiation instead.
STAGE IIIHow It's Defined
Cancer is found in the lung and in the lymph nodes in the middle of the chest. Stage III has three subtypes:
STAGE IIIAHow It's Defined
If the cancer has spread only to lymph nodes on the same side of the chest where it began, it's called stage IIIA.
Treatments
Chemotherapy and radiation: If you can stand the side effects, treatment usually starts with chemo. It might be combined with radiation.
Surgery: If you're healthy enough and your doctor thinks there's a good chance they can remove any cancer that remains, they may suggest surgery. In some cases, it may be his first choice of treatment. It's often followed by chemotherapy and sometimes radiation. The type of surgery depends on the size and location of the tumor, how far the cancer has spread into the lymph nodes, and whether you've had surgery before.
Immunotherapy:There are many immunotherapeutic drug options, depending on the type of lung cancer you have, any mutations or biomarkers that may be present, treatments you've already had, and your overall health. Your doctor can guide you through these choices.
Targeted therapy: These drugs target certain parts of cancer cells. A test can tell if you'll respond to this treatment. They were typically used in NSCLC that had spread, but now there's one targeted therapy that's for use in earlier-stage NSCLC that has certain traits.
STAGES IIIB and IIICHow It's Defined
The cancer has spread to lymph nodes near the opposite lung or in your neck. These cancers can't be completely removed by surgery.
Treatments
Chemotherapy with radiation: Again, treatment depends on your overall health and how you can handle the treatments. If you're in fairly good health, chemo and radiation might improve your condition.
Radiation or chemotherapy: If you can't handle the combo treatment, you'll probably get radiation therapy alone. Chemo by itself is less common.
Clinical trials: These cancers can be difficult to treat, so you may want to think about taking part in a clinical trial of newer treatments.
Immunotherapy: There are many immunotherapeutic drug options, depending on the type of lung cancer you have, any mutations or biomarkers that may be present, treatments you've already had, and your overall health. Your doctor can guide you through these choices.
Targeted therapy: These drugs target certain parts of cancer cells. A test can tell if you'll respond to this treatment. They were typically used in NSCLC that had spread, but now there's one targeted therapy that's for use in earlier-stage NSCLC that has certain traits.
STAGE IVHow It's Defined
The cancer has spread to both lungs, to fluid in the area surrounding the lungs, or to other organs.
Treatments:
Chemotherapy and radiation: A cancer that's spread to distant sites in your body can be hard to cure. As long as you're in fairly good health and can handle the side effects, treatments like chemotherapy and radiation can ease your symptoms and help you live longer.
Immunotherapy: This involves drugs that help your body's own immune system find and destroy cancer cells.
Targeted therapy: These drugs target certain parts of cancer cells. A test can tell if you'll respond to this treatment.
Photodynamic therapy: Doctors use light to kill cancer cells and shrink tumors.
Stent: Lung tumors that have grown into an airway can cause trouble breathing or other problems. Your doctor puts a hard silicone or metal tube called a stent into the airway to hold it open.
FDA Approves Drug For Aggressive Small-Cell Lung Cancer
The FDA has approved the drug durvalumab for adults with limited-stage small-cell lung cancer (LS-SCLC) whose disease hasn't gotten worse after getting platinum-based chemo and radiation at the same time.
LS-SCLC is an aggressive form of small-cell lung cancer that starts in the main airways of the lungs (bronchi) and is generally limited to one lung or one side of the chest. The LS-SCLC cells carry special proteins (PD-L1), which allow them to hide from the immune system, promoting their growth and spread. Often, despite early success with standard chemotherapy and radiotherapy, LS-SCLC often comes back with only about 15% to 30% of people surviving five years after diagnosis. This highlights the need for treatments that can target PD-L1 proteins to improve life expectancy.
Durvalumab, marketed under the brand name Imfinzi, is a human monoclonal antibody, a type of drug that uses your body's immune system to fight cancer. It binds to the PD-L1 protein and prevents tumor cells from evading the immune system, helping it to find and attack cancer cells more effectively.
Imfinzi was first approved by the FDA in 2017 for use against various lung and liver cancers, either alone or along with other treatments. Imfinzi is now the first and only immunotherapy approved for treatment in patients with LS-SCLC, according to a news release from AstraZeneca, the drug's maker.
The effectiveness of Imfinzi was studied in a clinical trial done at 164 centers across 19 countries in North and South America, Europe, and Asia. It included 730 patients with LS-SCLC whose cancer had not worsened after platinum-based chemotherapy and radiation therapy. Patients were randomly selected to receive either Imfinzi alone, Imfinzi along with Imjudo (tremelimumab), or a placebo.
The results showed that the patients on Imfinzi lived longer (nearly 56 months, on average) than those receiving a placebo (33.4 months). Imfinzi also delayed the cancer's progression. The average time before the disease worsened was 16.6 months for those on Imfinzi, compared to 9.2 months for the ones receiving a placebo. The most common side effects were inflamed lungs and tiredness. The treatment's safety profile was the same as seen in previous trials, with no new safety concerns.
Imfinzi Approved For Limited-Stage Small Cell Lung Cancer
The Food and Drug Administration (FDA) has approved Imfinzi® (durvalumab), as a single agent, for the treatment of adult patients with limited-stage small cell lung cancer (LS-SCLC) whose disease has not progressed following concurrent platinum-based chemotherapy and radiation therapy.
The approval was supported by the randomized, double-blind, placebo-controlled phase 3 ADRIATIC study (ClinicalTrials.Gov Identifier: NCT03703297), which evaluated durvalumab, a programmed death-ligand 1 blocking antibody, in 730 patients with histologically or cytologically confirmed LS-SCLC (stage 1 to 3 according to the American Joint Committee on Cancer 8th edition) whose disease had not progressed following concurrent chemoradiation therapy.
Study participants were randomly assigned 1:1:1 to receive intravenous durvalumab as a single agent, durvalumab with tremelimumab, or placebo. The efficacy evaluation for approval was solely based on comparing the single agent arm (n=264) and the placebo arm (n=266). The coprimary endpoints were overall survival (OS) and progression free survival (PFS) assessed by a blinded independent central review according to the Response Evaluation Criteria in Solid Tumors v1.1.
Findings showed treatment with durvalumab reduced the risk of death by 27% compared with placebo. Median OS was 55.9 months (95% CI, 37.3, not reached) with durvalumab compared with 33.4 months (95% CI, 25.5-39.9) with placebo (hazard ratio [HR], 0.73 [95% CI, 0.57-0.93]; P =.0104).
Additionally, durvalumab reduced the risk of disease progression or death by 24% vs placebo. Median PFS was 16.6 months (95% CI, 10.2-28.2) with durvalumab compared with 9.2 months (95% CI, 7.4-12.9) with placebo (HR, 0.76 [95% CI, 0.61-0.95]; P =.0161).
The most common adverse reactions reported during the trial with durvalumab were pneumonitis or radiation pneumonitis and fatigue.
"This approval for Imfinzi marks a breakthrough for patients with limited-stage small cell lung cancer, allowing them to receive immunotherapy for the first time," said Dave Fredrickson, Executive Vice President, Oncology Business Unit, AstraZeneca. "Imfinzi is now the only immunotherapy approved for both limited- and extensive-stage small cell lung cancer, underscoring our commitment to improving survival rates."
This article originally appeared on MPR
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