Stage two lung cancer treatment
- Stage 2 lung cancer is an early form of lung cancer and is curable.
- Surgery is the standard of care for stage 2 lung cancer and has the highest chance of cure.
- Sometimes following surgery additional therapies such as chemotherapy or targeted agents are needed.
Like stage 1 lung cancer (where no lymph nodes are involved), stage 2 lung cancer is considered a localized disease that is treated primarily with surgery. Although stage 2 lung cancer can involve a lymph node these lymph nodes are close to the involved lung and are called hilar lymph nodes making them removable with surgery. In certain circumstances chemotherapy, targeted agents, or immunotherapy may be used before (neoadjuvant) or after (adjuvant) the tumor is removed with surgery.
How is Stage 2 Lung Cancer Treated?
Read MoreDr. Geoffrey Oxnard tells Survivornet -Surgery to remove a lobe of the lung (a lobectomy) and the affected lymph node(s) is the first-line treatment for stage 2 lung cancer.In some patients who achieve a negative margin resection (no tumor left after surgery) and who have no lymph nodes involved with cancer, surgery is curative and no additional therapy or treatment is needed. This group of patients will be monitored for cancer recurrence by their oncologists but do not require additional treatment with chemotherapy, targeted agents, or immunotherapy.
When are additional treatments needed?
In some cases, chemotherapy may be recommended after surgery to lower the risk of cancer coming back or spreading. Chemotherapy given in this manner is called adjuvant and when treating lung cancer is typically a platinum agent like cisplatin. Chemotherapy is often recommended in patients with high-risk features such as tumors > 4cm or in poorly differentiated tumors. There are other factors your clinical team will also consider when deciding on whether chemotherapy is right for you.
In addition to chemotherapy, some patients may also be considered for other therapies including the targeted agent osimertinib and the immunotherapy drug called atezolizumab. These drugs are very different from chemotherapy and are often much better tolerated. However, to receive these drugs the tumor must test positive for certain biomarkers that allow these drugs to be effective.
When are targeted therapies or immunotherapy used?
To know if a targeted therapy or immunotherapy would be beneficial doctors, known as pathologists, will examine the lung tissue after surgery and perform advanced analysis to look for biomarkers and other factors present in the cancer cells. Specifically, the presence of an EGFR exon 19 deletion will be checked to see if a person is a candidate for osimertinib and PD-L1 will be checked to determine if the immunotherapy agent atezolizumab will be beneficial. Other factors are also taken into consideration when deciding on adjuvant therapy after lung surgery including what prior systemic treatments a patient has received, the patient’s performance status, and the patient’s overall goals. When deciding on adjuvant therapy you should have a detailed discussion with your treating team to understand what options are right for you.
The take-home message.
Treatment for lung cancer has changed rapidly over the last 5 years. Surgical resection remains the most important step in treating and curing stage 2 lung cancer. Some patients may benefit from additional treatment after surgery including chemotherapy, the targeted agent osimertinib, or an immunotherapy drug called atezolizumab. What is right for you is dependent on multiple factors and we recommend you discuss your options with your treating physicians.
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