Underutilization of Systemic Therapy in Patients with NSCLC Undergoing Pneumonectomy: A Missed Opportunity for Survival

This large-scale analysis of the National Cancer Database (NCDB) highlights some interesting trends in the current use of systemic therapy in patients with NSCLC who undergo pneumonectomy. Current practice patterns show only 12 percent of patients undergoing pneumonectomy for pathologic stage IB to IIIA received neoadjuvant therapy, 43 percent received adjuvant therapy, and 45 percent underwent surgery alone. Although this retrospective study is subject to limitations of large database analysis, including selection bias reporting only patients who received a particular therapy without reasons identified, this large difference in treatment patterns is certainly an area of potential research. In an era of rapid oncological advances with targeted therapy and immunotherapy, there seems to be a role for further systemic therapy in patients who require pneumonectomy, as the authors highlight survival benefits and downstaging of tumors to perhaps allow a lesser resection to be performed.