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Chemotherapy in Advanced Bronchioloalveolar Carcinoma (BAC)
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 of NSCLC, as is widely perceived, or if chemo is similarly helpful for BAC as for NSCLC in general. Some of these studies suggest a similar response rate in BAC compared to other types of NSCLC, while others suggest that patients with BAC are less likely to respond. Making conclusions has also been a problem because of the difficulty in measuring response of BAC lesions, which are often poorly circumscribed on CT scans that are generally used for response assessment. Continue reading
Avastin with Chemo: Standard of Care for a Subset with Advanced NSCLC
Avastin (bevacizumab), an antiangiogenic agent that works by blocking the blood vessel stimulating factor vascular endothelial growth factor (VEGF), has already been FDA approved and commercially available for colon cancer, but it has now been approved by the FDA for first-line treatment of non-squamous NSCLC in combination with standard chemo of carboplatin and paclitaxel (taxol). This is because the combination of chemo and Avastin was found in a large randomized trial publsihed in the New England Journal of Medicine (abstract here) that the combination improved survival when combined with chemo alone for patients with advanced/metastatic NSCLC who hadn’t received chemo before. This trial, with nearly 900 patients, compared carboplatin and paclitaxel (Carbo/Taxol) alone to the same two-drug chemo with Avastin every three weeks, and people who went through six cycles of chemo and Avastin without having progression of disease went on to receive Avastin alone as maintenance therapy until their cancer showed progression:
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