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Dr. Sunil Gandhi

Cancer & Blood Disease

Lung cancer accounts for one-fourth of all cancer deaths in the United States. Lung cancer is the leading cause of cancer death for men and women worldwide.

The earlier we diagnose lung cancer, the higher the chance of cure. Most lung cancers are non-small cell (or NSCLC) and account for almost 85 percent of all lung cancers.

About one-fourth of all patients who are diagnosed with NSCLC have resectable disease. However, from 30 percent to 55 percent of patients who undergo surgery with curative intent ultimately experience recurrence and die from their disease.

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If we diagnose NSCLC early, surgery is the treatment of choice. We commonly give chemotherapy and immunotherapy after surgery to kill microscopic cells and that has shown to improve survival and increase cure rate. Still, cancer can recur and kill the patient.

A landmark study was published in the New England Journal of Medicine (NEJM). In this study, patients with stage 1B to 3A were randomized to be treated with chemotherapy and immunotherapy or chemotherapy alone for two months and then the patient was taken to surgery.

Among 358 patients in the trial, the median event-free survival (EFS) was 31.6 months for patients randomly assigned to the combination of the immune checkpoint inhibitor or immunotherapy nivolumab and chemotherapy, compared with 20.8 months for patients assigned to chemotherapy alone.

This sort of immunotherapy in addition to chemotherapy did not add any significant serious side effects. Immunotherapy boosts the patient’s immune system and then the immune system kills cancer. It does not cause nausea, vomiting, hair loss or low blood count. It is usually better tolerated.

More interesting was at the time of surgery, almost 1 out of 4 (24 percent) of the patients on combined chemotherapy and immunotherapy had no cancer left. This is amazing and unprecedented.

A lot more research is done in this area. At the same time, advances like these really help. After a long time, we have a new and powerful weapon against lung cancer and more people with lung cancers are being cured due to it. This is just the beginning. A lot more new drugs are in the research pipeline that are extremely promising and will likely change the course of cancer treatment.

If somebody is diagnosed with lung cancer, he or she should see a medical oncologist before surgery is done and after surgery to get the best care. New such advances are happening on a regular basis.

Dr. Sunil Gandhi is a hematologist and oncologist. He is the volunteer medical adviser of the Citrus Unit of American Cancer Society. Write to 521 N. Lecanto Highway, Lecanto, FL 34461, email sgandhi@ or call 352-746-0707.

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