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Podcast by Dr. Camidge on ALK Rearrangements and a New Era of Molecular Oncology
Last week, Dr. Ross Camidge from the University of Colorado joined me on a webinar entitled “One Size Does Not Fit All” in which he discussed the early work on ALK rearrangements and the novel agent PF-02341066 (now known as crizotinib) in particular, and the new era of molecularly defined practice of oncology in particular. This story has been widely considered to be among the most important in the field of lung cancer over the last few years, and Dr. Camidge did not disappoint.
Not only did many of the participants in the live program write comments here expressing their positive feedback on the great energy and overall quality of the program, but both our transcriber and the editor of our podcasts independently commented to me that they thought it was a terrific podcast and that they learned a lot (and they don’t have a special, vested interest in lung cancer issues).
Here’s the audio and video podcast links, as well as the transcript and the figures from the webinar:
dr-camidge-on-alk-inhibitors-and-molecular-oncology-audio-podcast
dr-camidge-on-alk-inhibitors-and-molecular-oncology-transcript
dr-camidge-on-alk-inhibitors-and-molecular-oncology-figures
Finally, I’d like to personalize this a bit, because one of the people who was mentioned in the podcast, Andy Hill, has also been featured in the local news in both Seattle (link to news report here) and Denver (link here) as a remarkable example of the promise of molecular oncology. He’s also been a dedicated and extremely helpful supporter of GRACE in terms of both financial support and participating in our recent programs and some meetings as we work on the future directions for our organization. So I’d like to dedicate the program to Andy and hope he continues to redefine the great success of this work in how well he does.
Speaking of which, we could really benefit from your support for these programs. This webinar wasn’t from a grant but rather from your contributions. I hope you find these activities helpful and will support them. I’d also encourage people to tell others, provide the link, if you know of anyone else who might benefit from learning the material in our educational programs. We’d hate to think of the Andy Hills out there who may miss a chance for a very helpful treatment because they simply didn’t know such a possibility might exist. And unfortunately, many oncologists are still not aware of these developments: the field is simply moving too quickly.
Podcast: Play in new window | Download (85.7MB) | Embed
Round Table Discussion with Experts: Indolent BAC in an Elderly Man
This is the first part of a case presentation I did with two great colleagues: Dr. Anne Tsao, who is a medical oncologist and lung cancer expert at MD Anderson Cancer Center in Houston, and Dr. Alex Farivar, who is a terrific thoracic surgeon at my own institution, Swedish Cancer Institute in Seattle.
This case is an elderly gentleman who has a very indolent but growing lung lesion. His story brings up questions of how concerned to be in following a nodule in a patient of advanced age and with competing medical issues, whether surgery that is less than a lobectomy might be considered, as well as the systemic therapy options for bronchioloalveolar carcinoma.
Here are the audio and video versions of the podcast, along with the transcript and figures.
expert-round-table-tsao-and-farivar-pt-1-bac-audio-podcast
expert-round-table-tsao-and-farivar-pt-1-bac-figures
expert-round-table-tsao-and-farivar-pt-1-bac-transcript
Podcast: Play in new window | Download (46.2MB) | Embed
Loading the Dice: Comparative Trials of EGFR Inhibitors in Patients with EGFR Mutations (or, When Bad Trials Happen to Good People)
The IPASS trial that randomized Asian never-smoking or light previously smoking patients with previously untreated advanced NSCLC to either standard chemo or the epidermal growth factor receptor tyrosine kinase inhibitor (EGFR TKI) inhibitor Iressa (gefitinib) is widely considered among the most important and standard-changing trials of the last few years in the field of lung cancer. Nevertheless, it’s important to bear in mind that patients were identified for enrollment on that trial based on clinical factors, with about a third of the 1217 enrolled patients having their tumors analyzed for EGFR mutation status. The post-hoc results for that molecularly defined subset was the most interesting component of the trial, demonstrating that the patients with an EGFR mutation had a very significantly longer progression-free survival (PFS) with Iressa than with the standard chemo combination of carbo/taxol (paclitaxel). In contrast, the exact opposite was true for patients who were Asian never-smokers with an adenocarcinoma but didn’t have an EGFR mutation.
That comparison of chemo vs. an EGFR inhibitor in a clinically selected population was a perfectly appropriate question when the study was designed and enrolled, since we didn’t have evidence that one approach was superior to another in clinically or molecularly selected populations. This line of inquiry has been taken one step further by work from the North East Japan Gefitinib Study Group from Kobayashi and colleagues that tested Iressa against chemo in 200 previously untreated patients with advanced NSCLC who were prospectively selected for having an EGFR mutation. It was designed to enroll 160 patients per arm, but an interim analysis showed that the results were so overwhelmingly more favorable for recipients of Iressa that the trial was closed early because it was felt to be unethical to continue to randomize patients if the answer to the question was already clear. Although overall survival was not mature and wasn’t shown, preliminary results of this trial presented at ASCO 2009 revealed that the patients on the Iressa arm had a far superior response rate (74.5% vs 29%, p < 0.001) as well as PFS (10.4 vs. 5.4 months, p < 0.001). The curves for the latter are shown below.
(click on image to enlarge)
Along with this trial, a remarkably similar European trial is being completed that randomizes a population of previously untreated patients with an EGFR mutation to either erlotinib or cisplatin/docetaxel.
Molecular Markers from the INTEREST Trial: Chemo and EGFR Inhibitor Therapy Still Remarkably Equivalent
Oncologists often have their own ideas about how effective or ineffective a targeted therapy like an EGFR tyrosine kinase inhibitor (TKI) (Tarceva (erlotinib) or Iressa (gefitinib)) is compared with standard chemotherapy options. We’ve seen a lot of new information emerge in the field over the last few years, and we now have evidence that patients with an EGFR mutation generally have excellent outcomes with an EGFR TKI, but many physicians believe that patients who don’t have an EGFR mutation don’t get any benefit from this class of agents, or certainly far less than they get with a standard chemo agent.
The INTEREST trial directly compared Iressa with the standard chemo agent Taxotere (docetaxel), which was the first agent proven to improve survival for previously treated patients with advanced NSCLC. As I described in a post when the INTEREST trial was initially reported, this was a worldwide trial of 1466 previously treated patients with advanced NSCLC who were randomized to one treatment or the other, and I previously reported the results showing that Iressa and Taxotere led to an identical survival:
(click on image to enlarge)
Dr. Kristin Manning: Introduction to Imaging for Lung Cancer
A radiologist, the person who specializes in reviewing imaging studies in medicine, is often someone you notice if they’re unusually bad or unusually good. They perform a service and you presume that they’re good at it, but a few are so sharp that the other doctors they work with notice it at every tumor board discussion or one on one exchange.
Dr. Manning is one of those special radiologists. She had trained at the University of Washington while I was completing my medical oncology training there, and when she left to join Seattle Radiology, a private group based at Swedish Hospital in Seattle, I was among the many doctors who felt the body blow of losing her talent. On the other hand, when I later joined the medical oncology group at Swedish, I was very happy to have the opportunity to be reunited with her.
But talk is cheap, so I’ll also add that when I developed a cough that lasted for months a few years ago, and one of the thoracic surgeons I work with said I needed to get a chest CT to check it out (as I joked that his practice was slow and that he was trying to drum up business), it was Dr. Manning who read my own scans for me (and fortunately, they were OK).
She remains a terrific resource, and one too valuable to not share with others. She was kind enough to sit down with me for a discussion of current issues in imaging, with a particular focus on issues related to lung cancer. Here’s the first part of our discussion, which covers a bit on screening, the issues related to assessing and following lung nodules, and some basics of the work-up and ongoing follow-up of patients with lung cancer. Below you’ll find the audio and video versions of the podcast, the transcript, and a copy of the very few figures associated with the audio component:
dr-manning-imaging-intro-part-1-audio-podcast
dr-manning-imaging-intro-part-1-transcript
dr-manning-imaging-intro-part-1-figures
Podcast: Play in new window | Download (0.3KB) | Embed
Dr. Horton Interview on Pathology, Part 3: Transitioning to Molecular Pathology
This is the last part of my discussion with Dr. Matthew Horton, a pathologist with a special training and a great expertise in lung pathology who works here in Seattle at a company called CellNetix.
We focus in this last one on the increasing focus on molecular markers in making clinical decisions and how this is changing the relationship of pathologists with oncologists, as well as the need for pathologists to provide this information in a timely way.
dr-horton-pt-3-transition-to-molecular-pathology-audio-podcast
dr-horton-pt-3-transition-to-molecular-pathology-transcript
dr-horton-pt-3-transition-to-molecular-pathology-figures
Podcast: Play in new window | Download (20.6MB) | Embed
Dr. Pennell on Emerging Molecular Markers in NSCLC Management: Podcast Now Available
We know that many people interested in the topics we discuss in our webinars may not be able to attend the live programs, but we’re committed to offering our content to people as easily as possible. Accordingly, here is the podcast version of Dr. Pennell’s very well received presentation on a range of molecular markers currently being used and others emerging in clinical trials as potential tools for the coming years.
Below you’ll find the audio and video versions of the presentation, along with a transcript and a pdf file of the figures that go with the transcript.
dr-pennell-webinar-molecular-markers-audio-podcast
dr-pennell-webinar-molecular-markers-transcript
dr-pennell-webinar-molecular-markers-figures
Podcast: Play in new window | Download (114.0MB) | Embed
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