Surgery vs Radiation for Patients With Stage 3 Non-Small Cell Lung Cancer
Jamie Chaft, MD, Memorial Sloan Kettering Cancer Center, New York, New York, highlights the role preoperative chemoimmunotherapy and surgical resection plays in the treatment of patients with stage 3 non-small cell lung cancer (NSCLC).
Dr Sameera Kumar makes the opposing argument here.
Transcript:
I’m Jamie Chaft, a thoracic medical oncologist from Memorial Sloan Kettering Cancer Center, and I'm at Great Debates in Solid Tumors. Today I debated my opponent, Dr Kumar, on the topic of surgery versus radiation for stage 3 non-small cell lung cancer– specifically focusing on patients who are appropriate for immunotherapy, and I'll say, frankly, it was not a fair debate.
Stage 3 is a very heterogeneous disease and there is certainly a role of each modality for this patient population, but I absolutely won this debate because surgery has a role. For patients who are medically operable, and clearly, technically resectable as determined by the thoracic surgeon, preoperative chemoimmunotherapy followed by surgery has shown both improvements in event-free survival and overall survival leading to increased cure rates. Patients need evaluation by a multidisciplinary team, but N2 disease is no longer a disease for radiation oncology.
I think what we've seen fall out from the data, and of course, cross-trial comparisons, is that universally preoperative chemoimmunotherapy in an appropriately selected patient population leads to improvements in outcomes. The hazard ratios have been largely beneficial in every study. And this is different than the adjuvant setting where doing upfront surgery and then chemotherapy and immunotherapy. Our results have been very heterogeneous, some studies purely negative, others positive, but only in a subset.
There's a biological advantage to giving that chemoimmunotherapy, or particularly the immunotherapy, with the tumor in the body. Preoperative therapy should be considered for anyone of a stage appropriate for systemic therapy with a technically resectable tumor and known biomarkers.
Source:
Chaft J. Optimizing therapeutic outcomes in stage 3 lung cancer: Surgery. Presented at Great Debates in Solid Tumors. March 22-23, 2025; New York, NY.
