Understanding NSCLC and Traditional Treatment
Non–Small Cell Lung Cancer (NSCLC) is the most common type of lung cancer, making up about 85% of all cases. When this cancer is caught early, surgery to remove the tumor offers the best chance for cure. However, even after a successful operation, there’s always a risk that some cancer cells remain, which can later cause the cancer to come back.
Traditionally, doctors have used chemotherapy after surgery (called adjuvant therapy) to help kill any leftover cancer cells. In some cases, chemotherapy is given before surgery (neoadjuvant therapy) to shrink the tumor and make it easier to remove. But despite these efforts, many patients still faced relapses.
The Challenge: Why Just Surgery or Chemotherapy Isn’t Enough
Microscopic cancer cells can remain: These are too small to be seen or removed during surgery.
Chemotherapy side effects : While helpful, chemotherapy can be tough on the body and isn’t always effective in preventing relapse.
Risk for patients with lymph node involvement (N2 disease) : These patients have a higher risk of cancer coming back, so more effective treatments are needed.
The Breakthrough: Adding Immunotherapy to the Mix
Recent research has shown that combining immunotherapy (which helps the body’s own immune system fight cancer) with surgery and chemotherapy can make a big difference, especially for early-stage and locally advanced NSCLC.
What’s New?
Traditionally, doctors have used chemotherapy after surgery (called adjuvant therapy) to help kill any leftover cancer cells. In some cases, chemotherapy is given before surgery (neoadjuvant therapy) to shrink the tumor and make it easier to remove. But despite these efforts, many patients still faced relapses.
Perioperative therapy : This means giving treatment both before and after surgery. The goal is to attack the cancer from all sides—shrink it before surgery and wipe out any stray cells afterward.
Tailored approaches : Ongoing research is exploring how to personalize treatment based on how well the cancer responds and on special blood tests like circulating tumor DNA (ctDNA), which can help detect leftover cancer cells.
The Game-Changing Trials: CheckMate 816 and CheckMate 77T CheckMate 816
What did it test? Giving patients a combination of immunotherapy (nivolumab) and chemotherapy before surgery.
Who was included? Patients with resectable (operable) NSCLC.
What did it find? After five years, patients who got immunotherapy plus chemotherapy before surgery lived longer and had fewer cancer recurrences compared to those who got chemotherapy alone. In fact, those who had a complete response to treatment (no cancer found at surgery) had a 90% reduced risk of dying over five years .
CheckMate 77T
What did it test? Giving immunotherapy (nivolumab) plus chemotherapy before surgery, followed by more immunotherapy after surgery (perioperative approach), versus just chemotherapy and surgery.
What did it show? Patients receiving the full perioperative approach had much longer periods without their cancer returning (event-free survival: 46.6 months vs 16.9 months). The benefit was seen regardless of cancer type or stage, and the treatment was well tolerated .
Why Is This Important?
Improved Survival : More patients are alive and disease-free years after treatment.
Durable Results : The benefits last, with some patients remaining cancer-free for five years or more.
Biomarker Clues : Special blood tests (ctDNA) may help predict who will benefit most, paving the way for personalized care.
What Does This Mean for Patients?
A better chance at cure : Especially for those with higher-risk disease (like N2 lymph node involvement).
Shorter, more effective treatments : Some regimens involve just a few cycles of therapy before surgery.
Hope for long-term survival : With new therapies, the outlook for lung cancer patients is better than ever.
Considerations and Ongoing Research
Side Effects : Immunotherapy can cause immune-related side effects, but most are manageable with proper care.
Access and cost : As with all new treatments, affordability and availability can be barriers.
Personalization : Research is ongoing to fine-tune who gets which treatment, and for how long, based on individual risk and response.
The MACS Clinic Approach: Teamwork for the Best Outcomes
At MACS Clinic, Bangalore, Dr. Sandeep Nayak (surgical oncologist) and Dr. Suresh Babu (medical oncologist) work together to design the best treatment plans for each patient. By combining state-of-the-art surgery with advanced immunotherapy and chemotherapy, they are at the forefront of cancer care in India.
Looking Forward: A Brighter Future for Lung Cancer Patients
If you or a loved one is facing NSCLC, ask your doctor about the latest combined treatment options. With innovation and teamwork, there’s more reason than ever to believe in a cure.
This article is for educational purposes and reflects the patient-focused approach of Dr. Sandeep Nayak and Dr. Suresh Babu at MACS Clinic, Bangalore. Always consult your healthcare provider for advice tailored to your unique situation.