Evolution of Adjuvant, Neoadjuvant Therapy with Jonathan Spicer, MD, PhD

In the February 2024 Lungcast episode segment, a discussion was held on lung cancer’s continued impact on aging populations in North America, as well as efforts to tailor care to individual needs at the right time.

The importance of neoadjuvant, adjuvant, and perioperative therapies is evident for lung cancer treatment. The same could be said of precision medicine as it is designed for patients based on clinical and demographic elements, and it is gaining traction as researchers find out more.

Jonathan Spicer, MD, PhD, a prominent expert in lung cancer intervention from the McGill Thoracic Oncology Program, spoke in this Lungcast with host Albert Rizzo, MD, chief medical officer of the American Lung Association (ALA), on CT screening and neoadjuvant and adjuvant lung cancer research.

Spicer was initially asked by Rizzo to describe current experience in Canada with low dose CT screening, drawing the comparison that in the United States, rates continue to be lower than they should be.

“We have some provinces that are further down the road of having formally established screening programs,” Spicer explained. “Ontario was the first to get that afoot. Now, we have one that is on the verge of being deployed here in Quebec, and there's several other provinces that are moving in that direction. We definitely see those patients coming through, but because we're still so early in the deployment…There's no doubt that getting patient engagement for these types of efforts continues to be a challenge, we see that.”

Later, Spicer was asked to speak to the evolution of adjuvant and neoadjuvant therapy when it comes to lung cancer and surgical therapy, explaining perceived benefits. Spicer noted that such efforts had been longstanding.

“In the early 90s, one (study) was out of the Spanish cooperative group led by Rafael Rosell, and the other one was led by the Anderson group with Jack Roth,” Spicer said. “Those two studies were published in 1994, and showed that any added chemotherapy to surgery for stage 3 disease just had a very dramatic impact in terms of survival. And both of those trials actually had to be stopped halfway through because of the benefits of adding a systemic treatment to a local modality. Then, really 30 years have gone by of trying to pair all of the different options, surgery, chemo, radiation, and then an introduction of new treatments into that mix. But it's been sort of rearranging chairs for 30 years.”

Spicer also noted that until recently, only incremental steps in this direction have been made.

Lungcast is a monthly respiratory health podcast series from the ALA produced by HCPLive.

Subscribe to Lungcast on Spotify here or listen to the latest episode below: