| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 2000;69:886
© 2000 The Society of Thoracic Surgeons
Discussion
DR CLINTON E. BAISDEN (Temple, TX): Is it possible for us to get molecular biologic substaging on our patients at this point? If it is, how much does it cost and does insurance pay for it?
DR D’AMICO: The mechanism that this can be arranged without any payment is through CALGB 9633, which is a prospective randomized trial of patients with T2N0 disease. These patients are randomized after surgery to receive either chemotherapy or observation, but all the patients are stratified according to their histologic factors. So you will have four groups of patients, a group of patients with low risk markers and a group of patients with high risk markers who receive chemotherapy, as well as low risk and high risk who are observed. That is currently the only study that we are looking at the panel of tumor markers. There is a second study, CALGB 9761, that is looking at tumor and lymph nodes and bone marrow.
So the answer is, I would like to get a prospective study of more patients that is actually a phase II treatment trial rather than a phase III treatment vs observation. Within pathology departments, all these markers are known to them, and you can get markers analyzed in most pathology departments. We do it ourselves in our lab, but it is not recognized yet as a treatment strategy, and like I said, I am writing a Phase II trial to evaluate that in our own institution.
DR BAISDEN: It seems that this clearly is a stronger prognostic indicator than lymph node status. This is something that we certainly need to be able to have for our patients.
DR D’AMICO: I think it is the way to go.
DR JOSHUA R. SONETT (Baltimore, MD): I enjoyed your presentation, which was excellent and comprehensive. It was also an insightful view of the future treatment of lung cancer using molecular markers to prognosticate and, more importantly, as direct therapy. What I am wondering about is how you think primary tumor subtyping will be used as compared with nodal status in the future.
As we know, nodal status presently carries the greatest weight in terms of prognosis. Will primary tissue subtyping usurp nodal status as the primary prognosticator, or will we need to use other molecular markers within the nodes themselves to detect micrometastases? And if so, will we need to routinely identify a sentinel lymph node to direct complex molecular and histologic evaluation?
DR D’AMICO: I think that is a great question and that is why I think that CALGB 9761 is so important. Just in terms of taking a patient that has a T1 or T2 tumor up front, if you knew they were N0, these factors could predict survival that would be less than the average patient who is T1N1. It does not mean there is no value in substaging the stage II patient as well, but I think that applying this strategy to the group of patients that has the least risk, the stage Ia and Ib patient, and finding results that predict the value of therapy, could then be translated into treating more patients. And I believe that this is a more rational strategy than treating everybody up front with chemotherapy. That may be the way we go. If we find chemotherapy is effective against lung cancer with no cost and no morbidity, then that would be a rational strategy. Thank you.
| ||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
