Chemotherapy before or after surgery

sandwich2000
sandwich2000 Member Posts: 7 Member
in Lung Cancer #1

Hi, I am new here. My father was recently diagnosed with NSCLC. It’s at least stage 2b. We have seen two oncologists in Northern Virginia. One suggested to have surgery now and do systemic treatment after. The other oncologist suggested chemo and immunotherapy before the surgery. Given my dad is 80 and qualify of life is most important factor to concern, I am thinking to go with surgery first. I am scared that I will lose him and also scared that I am making wrong decision for him. Any help please? Thank you!

Comments

  • eDivebuddy
    eDivebuddy Member Posts: 57 Member
    edited November 2024 #2

    Not to muddy the waters more but I would discuss neoadjuvant or adjuvant immunotherapy with stereotactic body radiotherapy instead of surgery. Not quite as effective as surgery but a heck of a lot easier.

  • sandwich2000
    sandwich2000 Member Posts: 7 Member
    #3

    Thank you so much for the reply! We did talk to radiologist about SBRT and Proton therapy. Unfortunately my dad has one positive lymph node near the mass, so any radiation therapy need to combine with Chemotherapy. Doctors said immunotherapy need to go with chemo too, and no target therapy for him. I researched and found even among healthy young patients, the rate to have grade 3 or above chemo related adverse effects will be 40-50%. That’s really high in my opinion. It seems no guidance of systematic treatment for older patients yet. Hope his surgery goes well!

  • eDivebuddy
    eDivebuddy Member Posts: 57 Member
    #4

    Do you know his PD-L1 or tumor mutation burden numbers?

  • sandwich2000
    sandwich2000 Member Posts: 7 Member
    #5
    https://csn.cancer.org/discussion/comment/1718953#Comment_1718953

    For some reason, his biopsy results do not show PD-L1 level. I asked his surgeon and I was told that particular result takes time. I am wondering maybe doctor didn’t order this test when doing his biopsy. His surgeon promised PD-L1 will be analyzed from his surgery results.

  • eDivebuddy
    eDivebuddy Member Posts: 57 Member
    #6

    Yeah that should be know before doing anything. If he had 100% PD-L1 he could quite easily get away with immunotherapy only which I've done over 4 years for stage 4b

  • sandwich2000
    sandwich2000 Member Posts: 7 Member
    #7

    Wow! That’s very encouraging! Thanks for sharing the information. I guess it’s too late to ask his pulmonologist to order PD-L1 test now since the biopsy was done almost 3 weeks ago. Just hope his surgeon won’t miss this important test. Where can I find survivors network who are treated by the same doctors/facilities to share experiences? I feel that would be very helpful.

  • eDivebuddy
    eDivebuddy Member Posts: 57 Member
    #8

    It can takesl about 4 weeks for all the genetic testing to come back. Check with the cancer center for local support groups.

    https://forums.lungevity.org/

    https://www.inspire.com

    https://m.facebook.com/groups/986284055480932/

  • sandwich2000
    sandwich2000 Member Posts: 7 Member
    #9
    https://csn.cancer.org/discussion/comment/1718964#Comment_1718964

    Thank you so much!

  • BrendaHenry
    BrendaHenry Member Posts: 22 Member
    #10
    https://csn.cancer.org/discussion/328678/chemotherapy-before-or-after-surgery

    How much do you know about the side effects of immunotherapy? I began my lung treatments with chemo immunotherapy in October of 2023. In May of 2024, I was hospitalized with pneumonia. I am 68 years old and I had much difficulty overcoming the pneumonia. Prior to pneumonia and other complications from it, I had never been on oxygen. After pneumonia and as of this date, I began and am still using oxygen. After pneumonia, I had to regain strength for walking and to learn to use a walker. After my bout with pneumonia, I learned that immunotherapy can and does cause pneumonia in some cases. As I said, I am 68. You said your father is 80. Make sure that you know everything there is to know about immunotherapy and how it may affect your father's quality of life if this is the route that you choose to go for him.

  • sandwich2000
    sandwich2000 Member Posts: 7 Member
    #11
    https://csn.cancer.org/discussion/comment/1719162#Comment_1719162

    Many thanks for sharing your experience with chemo immunotherapy. I hope you are recovered from pneumonia and no longer need to use walker or oxygen. My father had the surgery on December. Chemotherapy plus immunotherapy is a standard treatment for NSCLC after surgery. But we are thinking not doing any further treatment. His PD-L1 level is low, 1%, so immunotherapy may not work well on his case. Considering all the side effects, I think it’s not worth it to using chemo immunotherapy on him. Good luck on yours everything! Wishing you a healthy, happy new year!

  • eDivebuddy
    eDivebuddy Member Posts: 57 Member
    edited January 10 #12

    Hopefully your dad is recovering well. Does he have a palliative or geriatric specialist as part of his cancer team? Do they offer integrative oncology at his center? Some centers offer it as part of their standard treatments for cancer. Unfortunately It's not generally covered by Medicare though. But again many parts are covered for free at major treatment centers.


    Good luck to you guys.

  • sandwich2000
    sandwich2000 Member Posts: 7 Member
    #13
    https://csn.cancer.org/discussion/comment/1720164#Comment_1720164

    I have never heard or think about the palliative care. Now after you mentioned it, I googled and found his cancer center does provide this service. I will ask his care team next time. Thank you so much for the information! Yes, my dad is recovered very well. Not having further treatment is the idea from his medical oncologist, I am still debating whether to take this suggestion. I am changing mind every day.

Discussion Boards