Watching Small Lung Lesions Do Nothing: “Ground Glass Opacities” Don’t Progress Over Years If They’re Watched, Not Resected

In one of my earliest posts about bronchioloalveolar carcinoma (BAC) (in the dark ages, pre-Twitter), I wrote on the subject of managing small BAC-type lesions, which tend to appear as small hazy areas called “ground glass opacities” (GGOs) and suggested that some of these cancers may be so indolent that they don’t need to be [...]

Round Table Discussion with Experts: Indolent BAC in an Elderly Man

This is the first part of a case presentation I did with two great colleagues: Dr. Anne Tsao, who is a medical oncologist and lung cancer expert at MD Anderson Cancer Center in Houston, and Dr. Alex Farivar, who is a terrific thoracic surgeon at my own institution, Swedish Cancer Institute in Seattle.
This case is [...]

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An Uplifting Case: Tarceva after Iressa Led to a Great Response

   I just wanted to tell people about a remarkable patient I just saw who is delighted to have had a remarkable response to Tarceva a few years after responding to Iressa.  She made my day.
   In truth, her case was remarkably long before this.  She was diagnosed with bronchioloalveolar carcinoma (BAC) all the way [...]

New Podcast on the ABCs of BAC

   Here’s a video slide presentation that provides a basic introduction to bronchioloalveolar carcinoma (BAC), including the demographics, natural history, imaging appearance, and patterns of response that make it a unique subpopulation within lung cancer.   The audio only version is below the video. 
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  In addition, we’ve got the final slides in pdf form, so people [...]

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Tales from the Clinic: Mucinous BAC

   In my last post I outlined the typical clinical scenario for pneumonic bronchioloalveolar carcinoma (BAC), which is typically the mucinous subtype of this unusual disease.  In fact, we are still actively learning a great deal about BAC, enough for the lung cancer experts to begin to develop a more sophisticated view that the mucinous and non-mucinous subtypes have [...]

Pneumonic BAC: The Subtype Very Unlike Other Forms of BAC

   One of the issues with BAC is that I’ve referred to it as potentially very indolent, but as we’ve learned more about BAC, it’s become clear that there is a great degree of heterogeneity in BAC cases.  We’re learning that the cases that are more often slowly progressing and sometimes exceptionally responsive to EGFR [...]

The Troubling Symptom of Bronchorrhea in BAC

Warning: this symptom can be a little gross, so the delicate flowers out there should skip this post.
One of the more unusual but quite vexxing symptoms we sometimes see in lung cancer is called bronchorrhea, which is the copious production of watery sputum, specifically at least 100 ml per day. [...]

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

   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 [...]

Biomarkers Predicting Clinical Benefits for BAC Patients Receiving Tarceva

   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 [...]

Trial of Tarceva in BAC: New Info on Who Benefits with Tarceva

   In a recent issue of the Journal of Clinical Oncology, Dr. Vince Miller and colleagues published the results of an important trial of the EGFR inhibitor tarceva (erlotinib) in the unusual NSCLC subtype bronchioloalveolar carcinoma, or BAC (abstract here).   This work was predicated on the observation, also by Dr. Miller and his colleagues at Memorial [...]