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Actions Speak Louder than Words: When Pathology and the Clinical Picture Don’t Fit

August 13, 2008 - 7:54 pm

   I’ve been involved in a wide range of discussions, both here and in my own clinical, about the fairly common situation of how to approach a situation in which the story on paper and what you see actually happening are incompatible.  For instance, last week I and several of my colleagues participated in a […]

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Biomarkers Predicting Clinical Benefits for BAC Patients Receiving Tarceva

April 30, 2008 - 9:35 pm

   Continuing with the analysis of a publication about tarceva (erlotinib) for patients with advanced BAC that I introduced in the last post, we’ll turn now to the analysis that Dr. Vince Miller and colleagues did on the biomarkers that might predict more or less clinical benefit with an EGFR inhibitor like tarceva (abstract here).   The trial looked at three […]

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Surgery for BAC: Special Considerations

December 10, 2007 - 11:08 pm

   While there is a lot of variability in the clinical behavior of bronchioloalveolar carcinoma (BAC), there are some commonly observed findings that are now leading lung cancer experts to consider it as a distinct clinical entity worthy of special consideration for management.  Among the important areas for potentially special clinical management is in surgical management of […]

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Noguchi Classification of Bronchioloalveolar Carcinoma (BAC)

December 8, 2007 - 10:55 pm

   I had previously written about a spectrum from pure bronchioloalveolar carcinoma (BAC) to invasive adenocarcinoma in one of my first posts here, but the real credit for this concept goes back to Dr. Masayuki Noguchi from the National Cancer Center Hospital in Tokyo, Japan, who characterized a classification system for peripheral lung adenocarcinomas back […]

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Beyond Stage & Tumor Size: More Pathology Variables Associated with Risk of Recurrence after Surgery

October 2, 2007 - 12:56 pm

   The decision about pursuing post-operative treatment is often difficult and requires carefully weighing the risks of treatment with potentially challenging and even dangerous chemotherapy against the potential to eradicate micrometastases and actually lead some people to be cured who otherwise wouldn’t be.  It’s important to remember that some people are already cured, while others won’t be […]

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The Variability of Bronchioloalveolar Carcinoma (BAC): Non-Mucinous and Mucinous BAC

May 14, 2007 - 4:14 pm

  One of the themes that we’ve covered in some of the posts introducing the clinical entity of BAC is the variability in its natural history.  In fact, much of what we’ve been learning about BAC has been in the last several years, and we’re still learning more about it all the time.  One of […]

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Limited Resections for Very Small NSCLC Tumors and BAC

February 11, 2007 - 5:34 pm

  While lobectomy or pneumonectomy may be the surgical treatment of choice for most NSCLC tumors in younger, fit patients, a limited resection may be an ideal choice in certain settings.  In my previous post I discussed the data supporting a limited resection in older patients, who are likely to have competing health risks that […]

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The Risk of Overtreating Indolent Bronchioloalveolar Carcinoma

December 6, 2006 - 12:15 am

   Bronchioloalveolar carcinoma, or BAC, is a subtype of lung adenocarcinoma that has a tendency to progress more slowly, stage for stage, than other types of lung cancer.  There are many patients who experience symptomatic and significant progression over months, and rarely patients have a very aggressive and fulminant form of the disease.  However, many […]

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EGFR Tyrosine Kinase Inhibitors in Advanced BAC

November 5, 2006 - 4:53 pm

As we established several years ago that it is indeed possible to do clinical trials with more than 50 or even 100 patients with advanced BAC, we were also seeing that those first forays into advanced BAC with standard chemotherapy were somewhat disappoingting (described further in another post). Fortunately, as it became clearer that we […]

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Chemotherapy in Advanced Bronchioloalveolar Carcinoma (BAC)

November 5, 2006 - 4:24 pm

   Up until very recently, conclusions about the usefulness of chemotherapy among patients with advanced, diffuse BAC had generally been based on retrospective experiences with chemotherapy at a single center with a very limited number of patients.  From such limited subsets, it is difficult to tell whether BAC is less responsive to standard chemotherapy than other forms […]

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