Tumor Size as a Critical Factor in Weighing Value of Adjuvant Chemo

   While there are good reasons to not pursue chemo after surgery for stage I NSCLC, there are several factors that argue at least for strong consideration of adjuvant chemotherapy for higher risk patients.  Because stage IB generally has a less favorable prognosis than stage IA, it’s not suprising that the debate about which patients […]

The Case Against Post-Operative Chemotherapy for Stage I NSCLC

   Over the last several years, chemo for resected early stage NSCLC has become a standard of care, but while it’s pretty widely accepted for stage II and IIIA patients after surgery, the role for chemo is much more debatable for stage I patients.  I’ll try to explain why, starting with the downside, and then […]

How Should We Treat Frail Patients with Locally Advanced NSCLC?

   Despite the fact that a very significant proportion of the “real world” patients have considerable medical problems such as markedly decreased lung function (pretty common with many years of smoking), weight loss (5 or 10% of body weight is usually considered a problem), or otherwise are not able to be very active.  The vast majority of clinical […]

Comparison of Iressa to Single Agent Chemo in First Line treatment for Elderly Advanced NSCLC Patients: The INVITE Trial

   In addition to a direct comparison of iressa to chemo in the second line setting for advanced NSCLC (see recent post on INTEREST trial), as conducted with the INTEREST trial I described in a recent post, a very similar comparison of Iressa to chemo was also performed in another setting where single-agent chemo is […]

The INTEREST Trial of Chemo vs. Iressa as Second Line Treatment for Advanced NSCLC

   In a post several months ago, I described the results of a trial from Japan, designated V-15-32, that directly compared Iressa to Taxotere as a second line therapy. Although overall comparable, the study showed that Japanese patients receiving Iressa had a higher response rate, but despite that had a lower median and one year […]

Making Sense of the “JMDB” Trial

   In my recent post on the JMDB trial that randomized patients between cisplatin/alimta and cisplatin gemcitabine in first line treatment of advanced NSCLC, the take home conclusions were that overall efficacy was very similar, with the cis/alimta arm looking a little better in several side effect parameters, most notably a less significant decline in […]

“JMDB” Trial Indicates Tailored Chemo Approach for Different NSCLC Subtypes May Improve Survival

Erbitux in Context: BMS 099 and other Trials Before FLEX

   In my last post, I noted that the FLEX trial of cisplatin/navelbine with or without the EGFR monoclonal antibody erbitux was reported to be positive, demonstrating a significant survival benefit.  That’s definitely going to have major implications, since our track record for phase III trials of chemo with or without new drug X was […]

FLEX Trial of Chemo +/- Erbitux Shows Survival Benefit

  Merck KgAA, the company developing cetuximab/Erbitux, the monoclonal antibody against EGFR, reviewed here) outside of the US, has announced that their pivotal FLEX trial (for First-Line Trial for patients with EGFR-Expressing Advanced NSCLC) is positive, demonstrating a signficant improvement in overall survival, as indicated here.  I mentioned it as an important study to define any role for Erbitux in NSCLC, […]

Calcitriol in Lung Cancer

   My presentation at the World Conference on Lung Cancer last week was on a trial I led for patients with previously treated advanced NSCLC, who received a combination of taxotere every three weeks along with a new drug called DN-101, or Asentar.  It’s actually a new formulation of calcitriol, which stimulates the vitamin D receptor […]