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Understanding Non-metastatic Non-small Cell Lung Cancer (NSCLC)
Information for the Newly Diagnosed Patient
Funding & Support Provided By
This video was created by JADPRO in collaboration with Bristol Myers Squibb. Health information provided in the video is for educational purposes only and not intended to replace discussions with your doctor or care team.
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Disclaimer
Moderator: Beth Sandy, MSN, CRNP, FAPO Ms. Sandy is on the Speakers Bureau for AstraZeneca, Amgen, Jazz Pharmaceuticals, Takeda Oncology, Eli Lilly and Company, and Merck & Co., Inc., and she is on the Advisory Board for Janssen Pharmaceutical Companies of Johnson & Johnson. She is a consultant for Abbvie Inc. Terri Conneran Ms. Conneran is a consultant for Janssen Pharmaceutical Companies of Johnson & Johnson, Loxo Oncology, Amgen, Revolution Medicines, AstraZeneca, Novartis Pharmaceuticals, Sanofi, Mirati Therapeutics, Bayer, Genentech, La Roche-Posay, Verastem Oncology, Bristol-Myers Squibb, Merck & Co., Inc., and Labcorp. She is on the Advisory Board for Mirati Therapeutics and La Roche-Posay and on the Speakers Bureau for KRAS Kickers. Susan Knippel, DNP, APRN, FNP-C Dr. Knippel has no financial interest to report. Karen Reckamp, MD Dr. Reckamp receives research funding to her institution from Genentech, Blueprint Medicines, Calithera Biosciences, Inc., Daiichi Sankyo, Inc., Elevation Oncology, and Janssen Pharmaceutical Companies of Johnson & Johnson. She is a consultant for Amgen, AstraZeneca, Blueprint Medicines, Daiichi Sankyo, Inc., EMD Sereno Inc., Genentech, GSK, Janssen Pharmaceutical Companies of Johnson & Johnson, Eli Lilly and Company, and Mirati Therapeutics.
Disclosures
Understanding Non-metastatic NSCLC | Table of Contents
What to Expect During Diagnosis, Staging, & Biomarker Testing
Key Terms & Phrases in Lung Cancer Therapy
Treatment Options
The Rapid Pace of Therapeutic Development
Patient Concerns & Empowering Steps
Biomarker Testing: Putting It All Together
Chapter 5
Chapter 4
Chapter 3
Chapter 2
CHAPTER 1
Chapter 1 | What to Expect During Diagnosis, Staging, & Biomarker Testing
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Biomarker testing can be performed different ways.
Chapter 1 | Test Your Knowledge
Biomarker testing can be performed through a surgical biopsy, during which a piece of the tumor or cancerous tissue is taken for study, or through a liquid biopsy, which is a blood test.
Explanation
Biomarker testing is only performed once.
Biomarkertesting can be performed before or after surgery, or even both. As cancer can change over time and new mutations can develop, biomarker testing may be performed multiple times.
The staging system used in lung cancer is called the:
ABC System
123 System
TNM System
XYZ System
The TNM Staging System describes the primary Tumor, whether the cancer has spread to any nearby lymph Nodes, and whether the cancer has spread to more distant parts of the body, known as Metastasis.
CHAPTER 2
Chapter 2 | Key Terms & Phrases in Lung Cancer Therapy
Neoadjuvant
Adjuvant
Perioperative
Surveillance
Survivorship
Survivorship, or living with cancer, begins the moment of diagnosis and continues for the duration of life. Regardless of disease status, patients who are living with lung cancer may lead active, hopeful lives during and after treatment, depending on the treatment goals they discuss with their care team.
Surveillance is an ongoing process of collecting information about a person's cancer through laboratory tests and/or scans. A surveillance timeline will look different for each patient. Some patients may get scans every 3 months, and some patients may get scans every 6 months. The purpose of the repeat scans is to look for changes, no matter how small, over time. Surveillance is also referred to as "monitoring" or "follow up."
A perioperative treatment regimen combines neoadjuvant and adjuvant treatment.
Perioperative Treatment
An adjuvant treatment is a treatment given after the main treatment, like surgery. Adjuvant treatment is given to try to decrease the chance the cancer will come back. When cancer comes back, it is called a recurrence.
Adjuvant Treatment
Neoadjuvant treatment is given before the main treatment, like surgery. Some patients may receive chemotherapy or immunotherapy before surgery - in other words, neoadjuvant chemotherapy or neoadjuvant immunotherapy. The goals of neoadjuvant treatment are to treat any signs of disease at the earliest opportunity and to prevent the cancer from returning at a later point.
Neoadjuvant Treatment
CHAPTER 3
Chapter 3 | Treatment Options For Non-Metastatic NSCLC
Decisions about surgery and other possible medical treatments are made by just the surgical oncologist.
Chapter 3 | Test Your Knowledge
Although the first person you meet after diagnosis might be a surgical oncologist, they will work with medical oncologists and potentially radiation oncologists to assess if additional treatments before (neoadjuvant) or after (adjuvant) surgery will be beneficial for you to help control the cancer.
To prepare for surgery, you should do which of the following:
Stop smoking at least 2 weeks before surgery
Notify your advanced practitioner about what other medications you are taking
Get a pulmonary function test.
All of the above.
Smoking cessation is important to helping you achieve the best possible outcomes throughout recovery from surgery and beyond. Some medications may be unsafe to take during surgery, such as those for heart disease, so you may have to stop taking some medications prior to surgery. Finally, knowing your pulmonary function test results help surgeons predict your lung function after surgery. A personal care team made up of family, friends, and community members is helpful, not only during recovery from surgery, but throughout your lung cancer journey.
Enlist help from family, friends, neighbors and community members for your recovery period.
Everyone with lung cancer must get surgery to control the cancer.
Patients with larger tumors or tumors that are in harder-to-reach areas of the body, such as on the outer rim of the lung, may be better suited to radiation therapy. In addition, those patients who have poor lung function or other health problems may be better treated with radiation therapy. Some patients feel uncomfortable with the idea of surgery or are unable to take time away from work for recovery; other patients might have had other surgeries that could have a negative impact on a surgery for lung cancer. In both of these situations, radiation therapy would be a therapeutic option in place of surgery.
The Rapid Pace Of Lung Cancer Therapy Development
CHAPTER 4
Chapter 4 | The Rapid Pace Of Lung Cancer Therapy Development
Targeted therapy, chemotherapy, immunotherapy, and combination therapy
Surgery, radiation, chemotherapy, and combination therapy
The four types of systemic (whole-body) therapies are:
Chapter 4 | Test Your Knowledge
Although surgery and radiation are potential treatments for non-metastatic NSCLC, they are localized therapies that do not involve the entire body. Targeted therapies are used for those patients that have certain biomarkers in their DNA or in their tumors. Chemotherapy is not as specific as targeted therapies but does target cancer cells. Immunotherapy helps a patient’s immune system recognize the cancer as a threat. Combination therapy simply combines two or more of these whole-body treatments.
Clinical trials are only for people who have no other treatment options.
Answer 3
Answer 4
Clinical trials may offer opportunities or other treatment options for patients that are not available through the current standard of care. Clinical trials have helped improve surgical and radiation techniques, creating wider windows of availability of surgery to more patients. In addition, the rapid advances in immunotherapies for NSCLC are because of clinical trials. Your advanced practitioner can provide information about which trials are available to you.
Patient Concerns And Empowering Steps
CHAPTER 5
Chapter 5 | Patient Concerns And Empowering Steps
Chapter 5 | Questions to Ask Your Care Team
What does each treatment option look like realistically for me based on my life and goals?
What are the possible side effects and which ones might affect me more than others based on my medical history?
How likely is each treatment to work for me based on my test results?
What treatment do you suggest for me and why?
How long does each treatment take each day? How long of a duration will treatment last in terms of weeks or years? Are there breaks?
How will we manage side effects? Will I need to ask for help from my support network?
Advocacy Organizations
Cancer.Net American Cancer Society Lung Cancer Research Foundation Independent biomarker-specific patient advocacy groups are present on social media.
For Information About Lung Cancer
Chapter 5 | Patient Resources
Cancer.Net
American Cancer Society
Lung Cancer Research Foundation
LVNG With Lung Cancer
LUNGevity Foundation
GO2 Foundation for Lung Cancer
American Lung Association
Beth Sandy, MSN, CRNP, FAPO Terri Conneran Susan Knippel, DNP, APRN,FNP-C Karen Reckamp, MD
Many Thanks to Our Contributors
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Thank you for taking the time to view this educational resource. We hope it was helpful in empowering you to have important discussions about non-metastatic non-small cell lung cancer (NSCLC) with your treatment team.
Chapter 4 | Learning More About the Testing Process
What is comprehensive biomarker testing?
Testing for a large number of biomarkers at the same time
Testing for biomarkers one at a time until you have a comprehensive report
Testing for 5-10 biomarkers at a time until you find one that is positive
Using multiple tumor samples to test for biomarkers
Chapter 2 | Test Your Knowledge
Comprehensive biomarker testing is testing for a large number of biomarkers at the same time. Most of the time this means “next-generation or high-throughput sequencing”. This is a process where the DNA sequence (partial or complete) of a large number of cancer-related genes in a biopsy sample are examined.
Next-generation sequencing involves processing a biopsy for DNA sequencing, followed by computer processing of the results, then the pathologist’s interpretation of findings. How long does this process take?
Approximately 24-28 hours
Approximately 5-7 days
Approximately 2 weeks
Approximately 1 month
Next-generation sequencing takes up to a couple of weeks to complete. This is because it takes several days to process patient biopsies and to perform the actual DNA sequencing, and then it takes additional days for computers to process the large amount of data generated, and then for pathologists to review and interpret the results when they are ready.
Chapter 3 | How Do Biomarker Test Results Help Plan Treatment?
Picture cancer like a lock that needs to be opened, and treatment like a key. Each person's cancer is unique, like the key for each lock. Having the right key for your lock may help your treatment team choose the best treatment for your particular cancer.
Chapter 3 | Thinking About Biomarkers in a Different Way
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Treatment
Cancer
Biomarker testing can give the team the information to choose the best treatment for you, for the best chance of success.
Chapter 4 | Finding Support and Guidance
Which resources may exist to help oncology patients if their treatment plan requires frequent travel?
Some private insurance plans offer travel/lodging benefits for patients
Cancer centers may have relationships with hotels to provide rooms at reduced costs.
Cancer centers at times have funds to assist patients with travel costs.
All of the above
Multiple options may exist for cancer patients needing to travel for their treatment. There may be a travel/lodging benefit available through private insurance companies, some cancer centers have relationships with local hotels to provide reduced costs, or the cancer center may have funding available to help patients with travel costs. Patients and their caregivers should talk to the cancer center social worker or nurse navigator to get more information.
What kind of support can a patient navigator provide for patients?
Making connections with a social worker or psychologist
Finding a support group
Clarifying insurance and financial issues
A patient navigator can support patients and their families in many ways: they can coordinate contact with a social worker or psychologist, help locate a support group, clarify the financial and insurance implications of treatment, and assist with other aspects of the cancer journey.
Chapter 5 | Biomarker Testing: Putting It All Together
Chapter 5 | The Team Approach
We have discussed what biomarker testing is, how each member of the clinical care team is involved in your biomarker testing, how your results are interpreted, and how these results influence treatment decisions. Biomarker testing is an important part of precision medicine, and new progress in research will continue to identify even more biomarkers that will help guide decision-making in cancer care.
Pfizer Inc. does not control or endorse third-party organizations. The content provided by Pfizer Inc. or these organizations is meant for informational purposes only. It is not meant to replace your doctor’s medical advice.
