Dr West

Dr. West attended Princeton University before heading to the University of Cambridge on a Fulbright Scholarship. He then returned to the US to attend Harvard Medical School, where he was honored as a Howard Hughes Medical Institute Research Fellow. He did his internship and residency training at Brigham & Women’s Hospital in Boston before moving to Seattle for his specialty training at the Fred Hutchinson Cancer Research Center/University of Washington, where he served on faculty after completing his fellowship in medical oncology. Since that time, he has fused his commitment to patient care at Swedish Cancer Institute in Seattle, focusing on thoracic and genitourinary oncology with a commitment to clinical research as well as entrepreneurial ventures. While overseeing a cancer clinic that draws patients from all over the world, he offers a wife array of clinical trials and leads several, including serving as Principal Investigator of several phase II national trials with the Southwest Oncology Group. He has emerged as a very rare oncologist based in a private practice setting yet remains a nationally to internationally recognized expert, thought leader, speaker and writer. Dr. West has also pioneered many new ventures that exercise his interests in social media, new educational platforms, and even marketing. He founded Go West Health Care Consulting in 2004, which has flourished into a very successful company that enabled him to pursue roles in developing of a wide range of oncology products, lead dozens of pharmaceutical advisory boards, speak and write for professional and patient oriented audiences, help in developing educational and marketing materials, serve as a medical director for a CME company, and even work as the dedicated oncology consultant to a large marketing agency. He is widely recognized as an oncologist who understands the complex market forces from scientific background to commercial development strategies to current and future practical market forces within the oncology space –the only oncologist who has delivered a TEDx presentation and attends not only ASCO but TEDMED, South by SouthWest interactive, and the American Telemedicine Association’s annual conference Finally, recognizing that patients and caregivers are a remarkably underutilized resource and critical voice in medical decision-making, Dr. West developed OncTalk.com in 2006 as a mechanism to provide very timely, specialized free information about cancer directly to a global patient community. This effort transitioned to become the nonprofit Global Resource for Advancing Cancer Education (GRACE) (www.cancerGRACE.org) in 2007, which has continued to grow rapidly, now integrating participation from many expert physicians and other health care specialists and reaching tens of thousands of people in over 130 countries each month. His efforts have provided expert content in a wide range of formats, including blog posts, audio and video podcasts, and an interactive discussion forum that have led to his being recognized as an international leader in the growing role of the educated patient as a means of shaping medical care and ultimately improving patient outcomes. “You are truly a Godsend -- I am thankful for the support and compassion you offer people throughout the world. I appreciate it more than words can convey.” GRACE Member Linda P

My Top 5 Notable ASCO 2012 Abstracts in Metastatic NSCLC

Published May 19, 2012 | By Dr West | 4 Comments

The annual conference of the American Society of Clinical Oncology in late spring is the biggest event in the cancer world, where more of the big trials are presented than at any other time all year. In the lung cancer world, it’s looking like this one won’t be a blockbuster but will have some promising and interesting findings to discuss. As a preview, I wanted to offer my top 5 for what I think will emerge as the most important results we’ll see, based on the recently released abstracts of the meeting. Lung cancer is divided into two tracks: today, I’ll cover the metastatic lung cancer track, and then I’ll next offer a top 5 on the track covering stage I-III NSCLC, SCLC, and other less common thoracic cancers

Without further adieu, here are my top 5 in metastatic NSCLC: Continue reading →

Posted in EGFR mutations and other molecular markers, First-line treatment, Immune/Vaccine-based therapies, Lung Cancer, Other targeted therapies, Second-line treatment, Stage IV/Advanced/Metastatic NSCLC, Targeted therapies, Third-line therapy and beyond | Tagged Advanced NSCLC, afatinib, alimta, anti-PD1, ASCO 2012, BMS-936558, EGFR mutation, EGFR wild type, Immunotherapy, Janne, Lung Cancer, MDX-1106, MEK inhibitor, pemetrexed, performance status, Second-line treatment, selumetiinib, SQ-MAP, Squamous Cell Lung Cancer Mutation Analysis Project, squamous cell NSCLC | 4 Comments

Modifying Factors: Should Patients with Smaller Resected Node-Negative NSCLC Tumors Receive Adjuvant Chemo?

Published May 15, 2012 | By Dr West | 2 Comments

While post-operative chemotherapy for early stage NSCLC is a well-established standard for relatively healthy patients with stage II or higher resected cancers, the question of whether adjuvant chemotherapy is more likely to help or hurt a patient remains more a matter of debate. Much of the debate has focused on a threshold of tumor size, with 4 cm emerging as a cutoff, above which chemotherapy appears more likely to be helpful and is often recommended. The general concept is that adjuvant chemotherapy confers a benefit that is proportional to the risk of the cancer recurring — a higher risk cancer is more likely to have the risk reduced by chemo more than enough to counterbalance the acute and chronic side effects of adjuvant chemo. But while tumor size is certainly one of the more readily identifiable factors associated with risk of recurrence and death, it’s not the only relevant factor. The National Comprehensive Cancer Network (NCCN) also includes several other factors in its guidelines for consideration of adjuvant chemotherapy, even for smaller tumors, so let’s review those.

I covered the issues of tumor histology and pleural invasion in a prior post. In addition, vascular invasion, or tumor cells invading into blood vessels, is associated with increased risk. In fact, as shown in the figure to the left, T1 (smaller) cancers with vascular invasion have a worse outcome than T2 (larger) cancers that don’t have vascular invasion.

Continue reading →

Posted in Chemotherapy, Early Stage NSCLC & Surgery, Early Stage NSCLC (Stage I/II), Non-Small Cell Lung Cancer (NSCLC), Pathology/Lung Cancer Subtypes, Treatment | Tagged adjuvant chemotherapy, nodal involvement, nodal yield, pleural invasion, Stage I, sublobal resection, surgery quality, tumor grade, vascular invasion, wedge resection | 2 Comments

Molecular Markers, Part 5: Dr. David Spigel on Integrating Markers into Clinical Trials

Published May 12, 2012 | By Dr West | Leave a comment

Here’s part 5 of our Santa Monica program on Molecular Markers in Advanced NSCLC, closing in on the end of the activity. In this podcast, my friend Dr. David Spigel from Sarah Cannon Cancer Center in Nashville, TN presents on the benefits as well as the challenges of new models of clinical trials in lung cancer that move away from “all comers” to smaller, more limited populations defined by molecular markers. Following his presentation, we continued our panel discussion, covering how much the transition into molecular oncology has disrupted how we do clinical research, as well as how our growing experience with molecular testing is leading us to question some of our previously held beliefs.

Below are the audio and video versions of this podcast, along with the transcript and figures for it.

Molecular Markers SM Pt 5 Spigel on Markers in Clinical Trials Audio Podcast

Molecular Markers SM Pt 5 Spigel on Markers in Clinical Trials Transcript

Molecular Markers SM Pt 5 Spigel on Markers in Clinical Trials Figs

Continue reading →

Podcast: Play in new window | Download (Duration: 24:30 — 57.3MB) | Embed

Posted in ALK Inhibitors, Current Clinical Trials, EGFR mutations and other molecular markers, GRACEcast, Pathology/Lung Cancer Subtypes, Targeted therapies, Treatment, Webinars | Tagged ALK Rearrangement, clinical trial design, EGFR mutation, FGFR, KRAS mutation, molecular marker, Molecular Oncology, NSCLC, NSCLC histology, patient characteristics | Leave a comment

It’s ASCO Season: Join Us to Discuss Lung Cancer Highlights on June 28th

Published May 8, 2012 | By Dr West | 1 Comment

We’re heading into the season where much of the biggest news in the cancer world for the year is about to be released, in press releases and full presentations at our annual conference of the American Society for Clinical Oncology (ASCO). The meeting is June 1-5, in Chicago, and I’ll be presenting some of my own work and chairing an educational session on the changing relationships between patients and doctors from the growing knowledge base of patients from online sources. There will be several other presentations that may well have implications that can change how we practice and offer new treatment options.

Dr. Joel Neal

Dr. Mark Socinski

On June 28th, at 7 PM Eastern/4 PM Pacific, we’re going to have two terrific guest faculty members leading us through the most interesting and important work: Dr. Joel Neal, Assistant Professor in Medical Oncology at Stanford, and Dr. Mark Socinski, Professor and Director of the Lung Cancer Program at the University of Pittsburgh. Rather than divide by cancer type, we’ll see what the most relevant ASCO presentations are and then divide them between our two great speakers. Each will speak for about 30 minutes, followed by time for a question and answer session with our live audience.

Registration is free: all you need to do to join our ASCO Lung Cancer Highlight webinar is to sign up through this link. We’ll be editing the content of the program to make it available in free podcasts, but you’ll want to be there for the live event!

Posted in Lung Cancer, Webinars | Tagged ASCO, ASCO highlights, Lung Cancer, lung cancer highlights, Webinar | 1 Comment

Webinar on Pulmonary Complications in Lung Cancer, with Pulmonologist Gerard Silvestri

Published May 3, 2012 | By Dr West | 1 Comment

Our next webinar will be with Dr. Gerard Silvestri, Professor of Pulmonology and Critical Care Medicine at Medical University of South Carolina in Charleston. Dr. Silvestri is amazingly dynamic and gave one of my favorite talks that was turned into a podcast, on the workup of lung cancer. He’s terrific with patients and can cover difficult concepts very accessibly, really connecting with his audience.

GRACE and LUNGevity Foundation will be partnering to feature him in an upcoming webinar on Wednesday, May 30th, at 7 PM Eastern, 4 PM Pacific, where he will cover topics of pulmonary complications like pleural effusions, obstructed airways and collapsed lung lobes, and coughing up blood, and of course how these can be managed.

Continue reading →

Posted in GRACEcast, Management of Pleural Effusions, Miscellaneous Other Problems from Lung Cancer, Webinars | Tagged hemoptysis, obstructive pneumonia, pleural effusion, stent | 1 Comment

Ongoing Great Panel Discussion from the Santa Monica Molecular Markers Webinar: Part 4

Published May 1, 2012 | By Dr West | 2 Comments

Here’s the next installment of the panel discussion on molecular markers from the webinar in Santa Monica with Drs. Charlie Rudin, Alice Shaw, David Spigel, and Glen Goss. We continued our animated discussion on the promise as well as the pitfalls of broadening the use of molecular markers in routine practice of managing patients with advanced NSCLC.

Below you’ll find the audio and video versions of the podcast, along with the transcript (no real figures to go with this one).

Molecular Markers SM Pt 4 Panel Discussion Audio Podcast

Molecular Markers SM Pt 4 Panel Discussion Transcript

We’ll continue with a presentation by Dr. Spigel on the value and challenges of incorporating molecular markers into the design of clinical trials in lung cancer.

Podcast: Play in new window | Download (Duration: 16:57 — 32.1MB) | Embed

Posted in ALK Inhibitors, EGFR mutations and other molecular markers, Epidermal growth factor receptor (EGFR)-based therapies, Evaluation and Work-Up, Gene Profiles/Molecular Signatures, GRACEcast, Pathology/Lung Cancer Subtypes, Targeted therapies, Treatment, Webinars | Tagged ALK Rearrangement, EGFR mutation, FGFR, KRAS mutation, molecular marker, Molecular Oncology, NSCLC, NSCLC histology, patient characteristics, smoking status | 2 Comments

Questions about Benefit from Avastin in Older Patients

Published April 26, 2012 | By Dr West | 3 Comments

A group of investigators at Dana Farber Cancer Institute in Boston, MA recently published a very newsworthy article in the Journal of the American Medical Association (JAMA) that argues that patients with advanced non-small cell lung cancer (NSCLC) who are over 65 don’t appear to benefit from the addition of Avastin (bevacizumab) to standard chemotherapy with carboplatin/Taxol (paclitaxel). Several years ago, Avastin was demonstrated in the ECOG 4599 trial to lead to a survival benefit when it was added to carbo/Taxol in Avastin-eligible patients, who are a pretty limited subgroup with a good performance status, no brain metastases (a requirement since relaxed with more experience), no significant hemoptysis, and non-squamous NSCLC histology. However, there have always been elements of the story that have cast some doubt as to how much benefit it really offers, particularly in older patients. A subset analysis of the ECOG 4599 trial showed that patients over 70 experience disproportionately greater side effects and complications from Avastin and no survival benefit. Meanwhile, another large randomized phase III trial called AVAiL (AVAstin in Lung cancer) that was conducted in Europe showed a statistically significant but overall very unimpressive improvement in response rate and progression-free survival when Avastin was added to a different standard chemotherapy backbone of cisplatin and gemcitabine, and this study demonstrated no benefit at all in survival.

Since Avastin was approved by the US FDA in October of 2006, it has been considered a standard of care but not clearly the standard of care, and only about 20-25% of patients in real world clinics actually get it. The reason it ends up being given to only a minority of patients is a somewhat open question, but in truth, I think that when you disqualify patients with many of the clearer contraindications and then also factor in some relative contraindications such as a cancer next to major blood vessels or a poorly differentiated cancer that is suspected may be of squamous histology, the actual proportion of patients who are really strong candidates for it is probably below 40%. And then, there is also the question of how much stock clinicians place in the ECOG trial vs. the AVAiL trial that failed to show a benefit…and the fact that the median age of newly diagnosed lung cancer in the US is now around 71 meaning that a very significant fraction of patients with advanced NSCLC are in an age range where the value of Avastin is quite questionable.

Continue reading →

Posted in Anti-angiogenic agents, First-line treatment, Lung Cancer, Metastatic/Recurrent NSCLC, First Line, Non-Small Cell Lung Cancer (NSCLC), Older and/or frail patients with lung cancer, Targeted therapies, Targeted Therapies, Activity and Side Effects, Treatment | Tagged Advanced NSCLC, AVAiL trial, avastin, bevacizumab, ECOG 4599, elderly, SEER database | 3 Comments

Molecular Markers Webinar Part 3: Panel Discussion Debating Who to Test and What to Test For:

Published April 24, 2012 | By Dr West | Leave a comment

Here is the next portion of our special webinar on molecular markers in advanced NSCLC, featuring Drs. Charlie Rudin from Johns Hopkins, Dr. Alice Shaw from Massachusetts General Hospital, Dr. David Spigel from Sarah Cannon Cancer Center, and Dr. Glen Goss from the University of Ottawa and NCI-Canada’s Lung Cancer Committee.

In this continuing portion of the program, we have a debate on the merits of uniform vs. more selective testing of “druggable” mutations and consider whether it is more attractive to test for multiple markers simultaneous or perhaps sequentially, since they are typically mutually exclusive. We also discuss the challenge of the delays in treatment that may become a real clinical problem for some patients if testing may require a few weeks of downtime.

Below you’ll find the audio and video versions of the podcast, along with the transcript and figures for this activity.

Molecular Markers SM Pt 3 Panel Discussion Audio Podcast

Molecular Markers SM Pt 3 Panel Discussion Transcript

Molecular Markers SM Pt 3 Panel Discussion Figs

Continue reading →

Podcast: Play in new window | Download (Duration: 17:28 — 38.3MB) | Embed

Posted in ALK Inhibitors, Clinical variables in EGFR therapy, EGFR mutations and other molecular markers, Epidermal growth factor receptor (EGFR)-based therapies, Evaluation and Work-Up, Gene Profiles/Molecular Signatures, GRACEcast, Never-smokers with lung cancer, Pathology/Lung Cancer Subtypes, Sex-based differences in lung cancer, Targeted therapies, Targeted Therapies, Activity and Side Effects, Webinars | Tagged ALK Rearrangement, EGFR mutation, FGFR, KRAS mutation, molecular marker, Molecular Oncology, NSCLC, NSCLC histology, patient characteristics, smoking status | Leave a comment

What are the Characteristics of the Nodules that are Biopsied but Mistakenly Called Benign?

Published April 22, 2012 | By Dr West | 6 Comments

We know that there is a big difference between a lung (or pulmonary) nodule and having cancer. Formal screening studies or just random CT scans done for other reasons will often show nodules that are of questionable significance, leading us to recommend either follow-up imaging or an immediate biopsy, depending on the level of suspicion. Often, the biopsy gives us an explanation for the nodule: perhaps cancer, but otherwise, perhaps just inflammatory or scar tissue, or else infection. That answer is usually the right answer, but not always. There is a chance that a result that comes back as “not cancer” is actually a false negative result: this happens there is actually cancer, but the correct answer wasn’t detected. What are the features that suggest a greater probability that we can’t necessarily be as confident of a biopsy result that comes back as something other than cancer?

We can get some insight about this question from the published experience from the radiology groups at Cornell University and Mt. Sinai Medical Centers in New York City, who just published on their results of the clinical and imaging features of their false negative CT-guided biopsy results over a three-year period from the beginning of 2002 to the end of 2004 (Dr. Yankelevitz, who has great experience as an expert in CT screening and biopsies and who did a terrific webinar for us on detecting and evaluating lung nodules last year, is the senior author of this paper). To do this, they reviewed the results from 170 patients in that interval who had an initial biopsy that was reported as negative initially who were then either found to:

have a lung cancer later diagnosed
have a subsequent procedure (such as a surgery) that confirmed a benign cause, or
showed resolution of the questionable nodule, or
showed stable findings over at least two years of follow-up that would be considered very consistent with a benign nodule

Continue reading →

Posted in Evaluation and Work-Up, Imaging and Response Measurement, Screening Issues and Controversy | Tagged CT-guided Biopsy, false negative, fine needle aspirate, lung nodule, pulmonary nodule | 6 Comments

Dr. Alice Shaw on Clinical Factors Associated with Molecular Markers

Published April 15, 2012 | By Dr West | Leave a comment

I’m happy to bring you now the second part of the Santa Monica webinar, developed with the LUNGevity Foundation, on “Molecular Markers in Advanced NSCLC: Who to Test and What to Test For?“, in which I was joined by Drs. Charles Rudin (Johns Hopkins University in Balimore, MD), Alice Shaw (Massachusetts General Hospital in Boston, MA), David Spigel (Sarah Cannon Cancer Center in Nashville, TN), and Glen Gloss (University of Ottawa in Ontario, Canada).

In this short podcast, Dr. Alice Shaw reviewed the frequencies of different molecular markers in advanced NSCLC as a function of patient sex, smoking status, race, and tumor histology. This work is very interesting, of course, because if we only do molecular marker studies of people with an adenocarcinoma or never-smokers, we not only won’t ever find potentially relevant mutations in people with other histologies and those with a smoking history, but we won’t have any good idea of the probabilities of finding them either.

Here is the podcast in audio and video formats, as well as the transcript and figures.

Molecular Markers SM Pt 2 Shaw on Markers by Clin Factors Audio Podcast

Molecular Markers SM Pt 2 Shaw on Markers by Clin Factors Transcript

Molecular Markers SM Pt 2 Shaw on Markers by Clin Factors Figs

Continue reading →

Podcast: Play in new window | Download (Duration: 10:48 — 24.9MB) | Embed

Posted in ALK Inhibitors, Clinical variables in EGFR therapy, EGFR mutations and other molecular markers, Epidermal growth factor receptor (EGFR)-based therapies, Evaluation and Work-Up, Gene Profiles/Molecular Signatures, GRACEcast, Lung Cancer, never-smoker NSCLC, Never-smokers with lung cancer, Pathology/Lung Cancer Subtypes, Sex-based differences in lung cancer, Special Populations in Lung Cancer, Stage IV/Advanced/Metastatic NSCLC, Targeted therapies, Targeted Therapies, Activity and Side Effects, Webinars | Tagged Alice Shaw, ALK Rearrangement, CancerGRACE, EGFR mutation, FGFR, GRACE, GRACEcast, KRAS mutation, Massachusetts General Hospital, MGH, molecular marker, Molecular Oncology, NSCLC, NSCLC histology, patient characteristics, smoking status | Leave a comment


Follow us on...	Disclaimer	Profile \| GRACEcasts \| DONATE

Copyright ©2012 GRACE

My Top 5 Notable ASCO 2012 Abstracts in Metastatic NSCLC

Modifying Factors: Should Patients with Smaller Resected Node-Negative NSCLC Tumors Receive Adjuvant Chemo?

Molecular Markers, Part 5: Dr. David Spigel on Integrating Markers into Clinical Trials

It’s ASCO Season: Join Us to Discuss Lung Cancer Highlights on June 28th

Webinar on Pulmonary Complications in Lung Cancer, with Pulmonologist Gerard Silvestri

Ongoing Great Panel Discussion from the Santa Monica Molecular Markers Webinar: Part 4

Questions about Benefit from Avastin in Older Patients

Molecular Markers Webinar Part 3: Panel Discussion Debating Who to Test and What to Test For:

What are the Characteristics of the Nodules that are Biopsied but Mistakenly Called Benign?

Dr. Alice Shaw on Clinical Factors Associated with Molecular Markers

Archives

Recent Lung Forum Topics

Recent Lung Blog Posts

Recent Lung Blog Comments

Other Resources