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Interview with Dr. Tony Mok, Part 2
Continued from part 1
Dr. West: You have a huge portion of your patients who have an EGFR mutation and we know that over time patients develop acquired resistance. So how do you approach the patients who have a great response initially, have a known EGFR mutation, and then you see that slipping away at slow progression? Do you continue the EGFR inhibitor? Do you add something to it? Do you change the dose? How do you approach that?
Dr. Mok: I think this is one area where we still have a lot to learn. First of all, let’s define resistance, or progression. If you use the Jackman criteria (Jackman, J Clin Oncol 2010), that still incorporates the RECIST criteria, which mean if the lesion that has increased by about 30%, then it’s progression. But then one factor we didn’t look into was in the rate of progression within this definition. The second concern is about the occurrence of a new lesion that’s also progression. Now, whether this is directly applicable to a targeted like Tarceva or another EGFR TKI or not, I have some doubts, because simply from your experience and my experience, some of these patients get a new nodule, but they can take a long time to grow and the patient lives a normal life. And we also know the fact that if we take them off the TKI, the disease can progress rapidly. So some of these are slow progressors, then we just keep them on a TKI. Continue reading
Interview with IPASS Trial & Leading Lung Cancer Researcher Tony Mok
A few weeks ago I had the chance to speak with Dr. Tony Mok, who is a professor in the Department of Clinical Oncology at the Prince of Wales Hospital in Hong Kong and the Chairman of the Hong Kong Cancer Therapy Society.
He is also the principal investigator and lead author for the pivotal Iressa Pan ASian Study (IPASS), which was published in the New England Journal of Medicine in the fall of 2009. I started by telling him that I consider that study to be arguably the most influential over the last 5-10 years in the field of lung cancer, because it highlighted that molecular predictive factors trump clinical markers in determining who is likely to do best with a targeted therapy, specifically an EGFR tyrosine kinase inhibitor like Iressa (gefitinib) or Tarceva (erlotinib). Here’s the first part of our conversation about what we’ve learned about how best to use these EGFR inhibitors and the potential differences in practice between Asia and the US.
Q&A With Dr. Sequist
The third and last podcast from our discussions with Dr. Lecia Sequist, of Massachusetts General Hospital and Harvard Medical School, covers the question & answer session that followed her excellent webinar on acquired resistance to EGFR tyrosine kinase inhibitors, as well as the update I did with her on the latest information from their experience of re-biopsying lung tumors over the course of treatment.
Here are the audio and video versions of the podcast, as well as the transcript.
sequist-qa-session-audio-podcast
Podcast: Play in new window | Download (35.1MB) | Embed
Fibroblast growth factor—the next molecular target in lung cancer?
What is FGF?
FGF is a type of receptor tyrosine kinase. What, you might ask, is a receptor tyrosine kinase? Well, since you were so kind as to ask, and since I’m a bit of a nerd at heart, I’ll tell you. Receptor tyrosine kinases are a part of the machinery of a cell; they have a role in signaling to the rest of the cell what it should do.
(click on image to enlarge)
Dr. Lecia Sequist on the Value of Repeat Biopsies with Ongoing Treatment of Lung Cancer
Here’s a continuation of the webinar content by Dr. Lecia Sequist, who is an Assistant Professor of Medicine at Harvard Medical School and Massachusetts General Hospital (MGH). At the time of her live presentation, she was unable to discuss some very new work that was about to be published on their experience at MGH in repeating biopsies on patients over the course of their ongoing treatment, and the interesting and sometimes treatment-changing results they found.
This second podcast includes her presentation on this very timely information that was, frankly, surprising to many in the lung cancer community, as well as to the investigators themselves. The presentation is in video and audio podcast forms, along with the associated transcript and figures.
sequist-on-lessons-learned-from-serial-biopsies-audio-podcast
sequist-on-lessons-learned-from-serial-biopsies-transcript
sequist-on-lessons-learned-from-serial-biopsies-figures
Podcast: Play in new window | Download (27.1MB) | Embed
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