Expert Case Discussion with Drs. Hensing and Jackman, Molecular Markers and Sequencing Therapy for Advanced Squamous Cell NSCLC

Posted by Dr West on August 20, 2010 at 2:47 pm

Several weeks ago, my colleagues Dr. Tom Hensing from North Shore Health System in Chicago, affiliated with the University of Chicago, and Dr. David Jackman from Dana Farber Cancer Institute in Boston, were kind enough to take the time to go over a series of cases in a webinar format.  We reviewed the time line of several patients with advanced NSCLC, focusing on two central questions:

1) For various clinical situations, which molecular markers would you be inclined to recommend?

2) How would you be most inclined to have a patient approach an end to first line therapy and either continue ongoing maintenance therapy (continuation maintenance), transition to a new maintenance therapy (switch maintenance), or just hold off on treatment until there is evidence of progression and a clear reason to restart treatment.

The first case we covered is an elderly gentleman with a good performance status and an advanced squamous cell NSCLC.  Here is the audio and video versions of the podcast, as well as the accompanying transcript and figures.

drs-hensing-and-jackman-molec-testing-sequence-of-rx-case-1-audio-podcast

drs-hensing-and-jackman-molec-testing-sequence-of-rx-case-1-transcript

drs-hensing-and-jackman-molec-testing-sequence-of-rx-case-1-figures

This program was sponsored by OSI Pharmaceuticals, who had no input in its content.  We appreciate their support in making this activity possible.

Podcast: Play in new window | Download

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Posted in: Chemotherapy, Clinical Cases, EGFR mutations and other molecular markers, First-line treatment, GRACEcast, Maintenance Therapy after First Line, Maintenance therapy, Metastatic/Recurrent NSCLC, First Line, Metastatic/Recurrent NSCLC, Second Line and Later, Pathology/Lung Cancer Subtypes, Second-line treatment, Stage IV/Advanced/Metastatic NSCLC, Treatment, Webinars

2 Comments  

Dragonfruit
 Posted on August 23, 2010 at 12:50 pm

Thanks for the useful discussion.

This makes me wonder whether squamous tumors seem to be low-yield for specific markers because they are more often associated with significant smoke exposure and therefore are more genetically chaotic than adenocarcinomas? Might there be a higher yield in testing squamous tumors from never-smokers for specific mutations? Has this been done?

Thanks so much.
Anna
Dr West
 Posted on August 23, 2010 at 1:00 pm

The lung cancers in never-smokers are so frequently adenocarcinomas that I don’t think I’ve seen any real series that describes molecular findings in never-smokers who have a squamous or other non-adenocarcinoma NSCLC. I would consider any never-smoker lung cancer to be more likely to be genetically simpler, driven by one or a few key mutations, compared to a lung cancer that developed in a smoker. There are certainly studies that show that the lung cancers in never-smokers are less genetically complex than those that arise in smokers, but I’ve never seen any of this kind of work that looked specifically at never-smokers with a non-adenocarcinoma NSCLC histology.

Posted In

Chemotherapy • Clinical Cases • EGFR mutations and other molecular markers • First-line treatment • GRACEcast • Maintenance Therapy after First Line • Maintenance therapy • Metastatic/Recurrent NSCLC, First Line • Metastatic/Recurrent NSCLC, Second Line and Later • Pathology/Lung Cancer Subtypes • Second-line treatment • Stage IV/Advanced/Metastatic NSCLC • Treatment • Webinars