Heather Wakelee, MD, assistant professor, Department of Medicine, Division of Oncology, Stanford University, Stanford Clinical Cancer Center, discusses markers currently under investigation that could be used to predict adjuvant chemotherapy benefit in lung cancer patients.

DNA repair enzymes receive the most attention as potential benefit predictors of postoperative therapy. The theory in place is that if these markers are high the tumor will be more likely to build up a resistance to chemotherapy, and contrive less of a benefit.

The most common marker currently being investigated is the ERCC1 DNA repair protein that is encoded by the 

 gene. This marker is still under investigation, but could lead to a clearer understanding of which patients would respond the most to adjuvant cisplatin.

A retrospective examination of a prognostic trial looking at untreated resected non-small cell lung cancer patients showed that ERCC1-positive patients had an increased rate of survival compared to those that are ERCC1-negative. This information suggests that ERCC1-negative patients will benefit the most from cisplatin chemotherapy.

Videos

Dr. Heather Wakelee from Stanford Clinical Cancer Center Discusses Adjuvant Therapy Predictive Markers

Dr. Wakelee on Adjuvant Therapy Predictive Markers

Heather Wakelee, MD, assistant professor, Department of Medicine, Division of Oncology, Stanford University, Stanford Clinical Cancer Center, explains the methods she uses to discuss adjuvant therapy with patients after they receive surgery for lung cancer.

Many factors can influence the effectiveness of adjuvant therapy. Depending on the stage the patients may already be cured from the surgery alone. On average the surgery cure rate is 30-40% for stage III cancer and up to 60-70% for stage I, with many different variables coming into play. Adjuvant therapy provides an additional 5-10% improvement in survival; it is not a guarantee, but does offer significant improvement.

The level of the discussion depends greatly on the sophistication of the patient. Analogies can be a useful tool in some cases, Wakelee commonly uses gambling or two groups of 100 patients, one group will receive adjuvant therapy and the other will not.

Dr. Heather Wakelee from Stanford Clinical Cancer Center on Explaining Adjuvant Therapy to Patients

Dr. Wakelee on Explaining Adjuvant Therapy to Patients

Heather Wakelee, MD, assistant professor, Department of Medicine, Division of Oncology, Stanford University, Stanford Clinical Cancer Center, explains that trials have been completed looking at adjuvant cisplatin given in 4 cycles in multiple age groups that showed an improvement in survival of 5-10%.

Some trials focused on the subset of elderly patients defined as being over 65 years old. These trials found that elderly patients did not tolerate chemotherapy as well but still experience similar survival rates to the broad studies looking at multiple age groups.

When examining patients in their 80's it became clear how important accurate patient selection becomes. It was difficult, but possible, to find patients in their 80's that are fit to receive chemotherapy.

Dr. Heather Wakelee from Stanford Clinical Cancer Center on Adjuvant Therapy in Elderly NSCLC Patients

Heather Wakelee, MD

Articles

Dr. Wakelee on Adjuvant Therapy Predictive Markers

Dr. Wakelee on Explaining Adjuvant Therapy to Patients

Dr. Wakelee on Adjuvant Therapy in Elderly Patients