"Why do I still need to take targeted drugs after surgery when I have early-stage lung cancer?" This is a common confusion among many patients with early-stage (1A stage) lung cancer.
According to the guidelines for the diagnosis and treatment of lung cancer, patients in stage 1A usually do not require postoperative adjuvant therapy. However, in clinical practice, some early-stage patients need to start targeted drugs. What is the diagnostic and therapeutic logic behind this?
Professor Yang Nong, a specially-appointed expert at Hainan Cancer Hospital, dispelled the confusion regarding individualized treatment for early-stage lung cancer patients by analyzing typical cases.
Question: Patients with stage 1A lung cancer usually do not need adjuvant chemotherapy or targeted therapy after surgery. But why do some early-stage lung cancer patients still need to take targeted drugs in clinical practice?
Professor Yang Nong cited a case he had treated as an example: A middle-aged female patient underwent lung cancer surgery two years ago, and the postoperative pathological stage was 1A. However, the disease recurred recently. Reviewing her case, it was found that although the tumor was small and the stage was early, the proportion of micropapillary components in the pathological type exceeded 30%.
Therefore, for stage 1A patients with postoperative pathology indicating high-risk factors (such as micropapillary components, low differentiation, vascular/lymphatic/neural invasion), it is recommended to conduct genetic testing and tumor minimal residual disease (MRD) monitoring. The genetic testing of the tissue biopsy after the recurrence of this patient showed the presence of EGFR mutations, which is precisely the key basis for initiating targeted therapy.
Professor Yang Nong pointed out that whether patients with stage 1A lung cancer need postoperative targeted adjuvant therapy mainly depends on two key factors:
Whether there are high-risk features in the postoperative pathology
The high-risk factors for recurrence after surgery for stage 1A lung cancer need to be accurately identified through pathological reports. There are mainly four types: micropapillary type, poorly differentiated carcinoma, vascular tumor thrombus, and airway dissemination, all of which are high-risk characteristics.
Whether the monitoring of tumor micro-residuals is positive or not.
If tumor micro-residual lesions are detected through tests, it indicates that the surgery may not have completely removed the hidden cancer cells. Even if the tumor is at stage 1A, there is still a risk of recurrence and metastasis.
Note
In either of the above two situations, targeted drug therapy is recommended. By precisely inhibiting the mutated genes (such as EGFR, ALK, etc.), it can eliminate residual cancer cells, reduce the risk of recurrence, and protect health.
Expert introduction
Consultation Information
[Consultation Time] July 6th, morning, Sixth Consultation Area, Hainan Cancer Hospital
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