Expert Round Table with Drs. Hensing & Jackman: Molecular Markers & Sequence of Therapy for An Asian Never-Smoker with Advanced Lung Adenocarcinoma

Posted by Dr West on September 9, 2010 at 8:18 pm

   The third and final part of my conversation with Drs. Tom Hensing from North Shore Health System in Chicago and David Jackman from Dana Farber Cancer Institute in Boston covered a presentation of an Asian never-smoking woman with an advanced lung adenocarcinoma, the demographic picture most closely associated with potentially but not necessarily having an EGFR mutation or ALK rearrangement.

   We cover the question of whether, in someone with a significant probability of one of these particular molecular markers, it’s worth obtaining tissue and delaying treatment to tailor treatment on the basis of these results.  We also discuss the range of options for maintenance therapy in someone who has many alternatives for continuing one or more agents from the first line setting or switching to a new treatment.  Finally, we turn to the question of managing treatment for a patient who has a prolonged response to an EGFR inhibitor and then develops an acquired resistance to that therapy.

   Here’s the audio and video podcasts of the discussion, along with the transcript and figures.

drs-hensing-and-jackman-molec-testing-sequence-of-rx-case-3-audio-podcast

drs-hensing-and-jackman-molec-testing-sequence-of-rx-case-3-transcript

drs-hensing-and-jackman-molec-testing-sequence-of-rx-case-3-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: Clinical Cases, Clinical variables in EGFR therapy, EGFR mutations and other molecular markers, Epidermal growth factor receptor (EGFR)-based therapies, First-line treatment, Lung Cancer, Maintenance Therapy after First Line, Maintenance therapy, Never-Smokers with Lung Cancer, Never-smokers with lung cancer, Stage IV/Advanced/Metastatic NSCLC, Targeted therapies, Webinars, never-smoker NSCLC

2 Comments  

Jazz
 Posted on January 13, 2011 at 10:49 pm

Terrific discussion, bringing together all the key points for those (like me) currently progressing after extended good response on TKI’s. I doubt a request to be biopsied again for the cause of resistance will meet with agreement (HMO health insurance—Kaiser—they don’t do anything beyond the basic), as helpful as it would be to determine what course to follow next.

I see Avastin as a single agent mentioned often as maintenance therapy, and am curious as to what a typical length of response is. It failed for me after 4 months.

Jasmin
Dr West
 Posted on January 14, 2011 at 2:59 pm

Thanks for your comments. I believe the median in the ECOG 4599 trial, which established Avastin as a standard maintenance therapy after completion of 4-6 cycles of first line chemo with Avastin, was just 3 treatments after completion of chemo. There was certainly a tail on the curve with a minority of patients going several months on Avastin alone, after discontinuing chemotherapy, but we typically expect to see some suggestion of enough progression to warrant initiating the next line of treatment within 1-2 scans on Avastin alone.

Posted In

Clinical Cases • Clinical variables in EGFR therapy • EGFR mutations and other molecular markers • Epidermal growth factor receptor (EGFR)-based therapies • First-line treatment • Lung Cancer • Maintenance Therapy after First Line • Maintenance therapy • Never-Smokers with Lung Cancer • Never-smokers with lung cancer • Stage IV/Advanced/Metastatic NSCLC • Targeted therapies • Webinars • never-smoker NSCLC