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Podcast on Current Questions, Clinical Trials in Adjuvant Therapy for Resected NSCLC
GRACE is very happy to have the opportunity to present this podcast by Dr. Heather Wakelee, medical oncologist at renowned lung cancer expert at Stanford University Cancer Center. The focus of this particular program, supported by an educational grant from GlaxoSmithKline, is on the most important research questions and clinical trials in the field of post-operative therapy for resected NSCLC.
Here is the video version along with the audio (mp3) version and the accompanying figures and transcript. We’ll try to get Dr. Wakelee back for future programs, so if you want to leave questions or comments to her, please do.
wakelee-on-adjuv-nsclc-clin-qs-trials-figures
wakelee-on-adjuv-nsclc-clin-qs-trials-transcript
wakelee-on-adjuv-nsclc-clin-qs-trials-audio-podcast
Podcast: Play in new window | Download (38.8MB) | Embed
4 Responses to Podcast on Current Questions, Clinical Trials in Adjuvant Therapy for Resected NSCLC
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I listened, with great interest, to this overview of the state-of-the-art in adjuvant chemotherapy. The presenter certainly has a command over the information and a rapid-fire technique. It revealed the intricate granularity of the subject of cancer, and how difficult a challenge curing lung cancer is.
Is there any way to parse the information presented here with other clinical trials or research in adjuvant/maintenance chemotherapy which may exist, in order to get a better view of the landscape for patients with a RAS-positive mutation?
Thanks,
-Roger
Dr. Wakelee is a leading expert in this field, and part of the rapid fire was an effort, per my instruction, to try to keep it brief (hoping to keep it under the time limit imposed by YouTube, which is very challenging for complex subjects).
One of the many challenges with adjuvant therapy trials is that we’re very limited in the number of trials we can actually run and questions we can answer. This is because adjuvant trials really need large numbers to see the effects, since perhaps half of the patients are already cured and will therefore not be able to show any effect of the post-operative treatment (you can’t become more cured). Consequently, there are only a very limited number of higher profile trials in this setting, and she covered them; these are all multi-center efforts. And unfortunately, though RAS mutations are an important subject, none of the trials of which I’m aware at this time are focusing on this. There is simply no way to cover all of the important questions we’d like to address, so we need to pick the most relevant ones. We may still find out more about RAS mutations in the post-operative setting, but I think that for the near future this will come from a retrospective analysis of tissue from other trials that aren’t specifically focusing on RAS mutations are a primary question.
-Dr. West
What I’m taking home from this is that predictive markers–either proteins or gene signatures–are part of studies today. Soon patients will be given a standard screen for markers at the time of staging, and then treated–or better–entered into trials accordingly. Given the opportunity to collect so much new data, everyone should be in a trial. Trials should be combined into a single data collection scheme, instead of separate trials with separate administration. I get the impression that this is better organized in Europe today.
I was not aware that retrospective studies showed all these predictive markers.
I was not aware of all these studies either. Listing them all in one place was helpful.
• PREDICTIVE markers in advanced NSCLC
• In general low levels = sensitivity
– ERCC1 – platinum
– Thymidylate Synthase (TS) – pemetrexed
– RRM1 – Gemcitabine
– BRCA 1 – low platinum, but HIGH for taxanes
– EGFR mutation – EGFR-TKIs – Erlotinib
MAGE-A3 antigen – MAGE-A3 vaccine
Having been diagnosed long ago, I have not been tested for any marker. There seems no urgency to include me in this. I find it irresistible to get included in this research, even if only retrospectively.
David
You provide a good summary of the data we have, though I would say that this many elements are not well established enough to be incorporated in routine practice. Much of this work is based on a limited number of studies and is nearly all retrospective work. For it to become standard, we’d really need to see evidence that patients have better outcomes when these markers are obtained prospectively and used for clinical decision making to do better than we do with our current methods.
-Dr. West