Dr. Eric Vallieres explains why a molecular measure of tumor aggressiveness is needed.
5-Year Mortality Rates by Stage
Identification of patients that are at higher risk of cancer-specific mortality is a current unmet clinical need for patients with early stage lung cancer.
Utilizing myPlan Lung Cancer, the physician and patient can make informed treatment decisions based on the aggressiveness of the patient’s disease.
Treatment options for early stage patients
NCCN guidelines recommend complete resection for all surgical candidates with stage I or II non-small cell lung cancer (NCCN guidelines). CT observation is recommended for patients with stage IA disease, while adjuvant chemotherapy is recommend for stage II patients with nodal involvement. For patients with stage IB or II with no nodal involvement, treatment decision between CT observation and adjuvant chemotherapy is determined by the presences or absences of various high risk features.
Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumors. J Thorac Oncol 2007; 2:706–714
National Comprehensive Cancer Centers. NCCN clinical practice guidelines in oncology (NCCN Guidelines): Non-small cell lung cancer v3.2014.
NCCN high risk features in early stage lung cancer
|HIGH RISK FACTOR||CHALLENGES|
|Tumor Size||Limited evidence suggests patients with stage I disease and tumors >3.2cm1 or >4cm2 may benefit from systemic treatment.|
|Tumor Grade||No clear standards distinguish different levels of tumor cell different levels of tumor cell differentiation and associate risk.3|
|Lymphovascular Invasion||T1 (smaller) cancers with vascular invasion have a worse outcome than T2 (larger) cancers that don't have vascular invasion. However, diagnosis is binary and reliability varies from clinic to clinic.4|
|Wedge Resection||Sublobar resections have a worse prognosis.5|
|Visceral Pleural Involvement||Conflicting evidence supporting its value as a prognostic indicator.1,7,8|
|Nodal Evaluation||Subjective depending on surgeon and perceived patient risk.6|
*No high risk feature is validated in a prospective randomized clinical trial
- Park SY et al. Efficacy of platinum-based adjuvant chemotherapy in T2aN0 stage IB non-small cell lung cancer. J Cardiothorac Surg 2013; 8:151.
- Strauss GM et al. Adjuvant paclitaxel plus carboplatin compared with observation in stage IB non-small-cell lung cancer: CALGB 9633 with the Cancer and Leukemia Group B, Radiation Therapy Oncology Group, and North Central Cancer Treatment Group Study Groups. J Clin Oncol. 2008 26:5043-51
- Ou SH et al. Prognostic factors for survival of stage I non-small cell lung cancer patients : a population-based analysis of 19,702 stage I patients in the California Cancer Registry from 1989 to 2003. Cancer. 2007; 110:1532-41.
- Mollberg NM et al. Lymphovascular Invasion as a Prognostic Indicator in Stage I Non-Small Cell Lung Cancer: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2014; 97:965–72.
- Zhang Y et al. Meta-analysis of lobectomy, segmentectomy, and wedge resection for stage I non-small cell lung cancer. J Surg Oncol. 2015; 111: 334-40.
- Ludwig MS et al. Postoperative Survival and the Number of Lymph Nodes Sampled During Resection of Node-Negative Non-Small Cell Lung Cancer. Chest. 2005; 128:1545-1550
- Shimizu K et al. Visceral pleural invasion is an invasive and aggressive indicator of non-small cell lung cancer. J Thorac Cardiovasc Surg. 2005; 130: 160-5.
- Kawase A et al. Visceral pleural invasion classification in non-small-cell lung cancer in the 7th edition of the tumor, node, metastasis classification for lung cancer: validation analysis based on a large-scale nationwide database. J Thorac Oncol. 2013; 8: 606-11
- National Comprehensive Cancer Centers. NCCN clinical practice guidelines in oncology (NCCN Guidelines): Non-small cell lung cancer v3.2014.