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early stage NSCLC


ECOG 1505 Study: No Benefit of Post-Operative Avastin in Early Stage Lung Cancer Patients




Drs. Ben Solomon, Leora Horn, & Jack West review trial result and implications of ECOG 1505 trial that showed no benefit to addition of Avastin (bevacizumab) to adjuvant chemotherapy for early stage NSCLC.

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Dr. West:  So, we just finished the presidential symposium at the World Conference on Lung Cancer, here in Denver. There were a few high-profile presentations there, including one that was anxiously anticipated, that was presented by Heather Wakelee, a colleague of ours, who presented the ECOG 1505 trial of chemotherapy with or without Avastin (bevacizumab), the anti-angiogenic agent, as post-operative therapy for patients with a resected lung cancer. Unfortunately, a totally negative trial, I’d say. Do you think there was anything to be gleaned from that, or do you think it even might have some negative effects on its use outside of that setting, like metastatic disease, Leora?

Dr. Horn:  So, I don’t think I was surprised by the results, I think I was disappointed, but I don’t think it’s going to really change how Avastin is used outside of — in metastatic disease, outside of the adjuvant setting. I think there’ll be some interesting subset analysis to come out — so things like, is there a difference between the different chemotherapy regimens that were used? Because, I know, in places like the U.S., we extrapolate the metastatic data to the adjuvant setting, and some of the biomarker data.

Dr. West:  Ben, what did you think?

Dr. Solomon:  Yeah, I’d agree completely with Leora, I mean, it was a big study, 1,500 patients enrolled, and I think it gives us a definitive answer about bevacizumab in the adjuvant setting — there was no difference in outcomes whether you had bevacizumab or not. But it is a different situation to the metastatic setting, these patients had no residual disease, and even pre-clinically, we know that the efficacy of bevacizumab may be different in primaries versus metastases. So, I think, in this situation, we maybe need to take a little bit of care from extrapolating from the adjuvant to the metastatic setting.

Dr. West:  What’s the pattern in Australia, in terms of how widely used bevacizumab, or Avastin, is in metastatic disease? I would say it’s certainly used as a standard of care in the U.S., and I think in various parts of the world, but it’s not something that is, certainly, uniformly used in every possibly eligible patient.

Dr. Solomon:  Yes — so, in Australia, I think our sort of usage pattern is a bit closer to the European usage — so, bevacizumab is very rarely used, and partly this reflects the fact that it’s not reimbursed. And I think we’re influenced by the AVAiL data, which didn’t show an improvement in survival, in contrast to the ECOG study which did. So, bevacizumab can only be used in the setting where patients pay for it, and as a consequence, isn’t really a part of common practice.


Do You Seek and Do You Use Molecular Marker Information in Patients with Early Stage NSCLC?


Dr. Karen Kelly of University of California, Davis, presents her current view on using molecular markers in early stage non-small cell lung cancer and explains the RADIANT study that she leads.


Dr. Heather Wakelee: How Should We Use Molecular Marker Information for Management of Earlier Stage Non-Small Cell Lung Cancer?


Dr. Heather Wakelee from Stanford University discusses the open question of whether patients with resectable or locally advanced NSCLC should have testing for molecular markers, as well as how we might use this information in clinical practice.

Dr West

Case in Point: Recommending Post-Operative Chemo for a Patient with a Smaller NSCLC Tumor but High-Risk Features


This is the first in a series of “uncut” videos that I’m starting that will focus on illustrative cases from my clinic that highlight some broader teaching points.  This particular video is on the decision-making process that led me to recommend adjuvant chemotherapy for a patient who underwent surgery for a 3.5 cm lung adenocarcinoma without lymph node involvement. Though this size is under the threshold we often use for recommending post-operative chemo, which is 4 cm, her particular cancer had some other features that made me concerned it may represent a high enough risk to favor additional treatment, in combination with her overall good health and desire to pursue a more aggressive approach if there is a good rationale for it.

As always, I’d welcome your thoughts, questions, objections, etc., as well as any feedback you want to offer about the format of using clinical cases to review broader concepts.  And any ideas for topics are also welcome.

Dr West

Webinar on Refining Prognosis of Early Stage Lung Cancer by Molecular Features, with Dr. Johannes Kratz


The next live webinar to be done through the partnership of GRACE and LUNGevity Foundation will be on the timely subject of using molecular features of a resected non-small cell lung cancer in order to better understand the probability of the cancer recurring. This will be on November 14th, 7 PM Eastern/4 PM Pacific, and will hope to answer the question, “Could these molecular features improve upon current staging efforts to help us refine our recommendations of which patients should receive post-operative chemotherapy in order to reduce the chance of recurrence?”

To help us answer that question, we’ll be joined by Dr. Johannes Kratz, surgeon at Massachusetts General Hospital in Boston, who participated in important research while previously at the University of California in San Francisco on a molecular profile that can be performed on archived tissue (stored in wax after completion of the surgery) and has demonstrated an ability to discriminate between patients with a better or worse prognosis after surgery. This research was published in the prestigious journal The Lancet (with Dr. Kratz as lead author), was highlighted in one of my posts at the beginning of this year as an exciting new development, and this testing platform has recently become commercially available.

Dr. Kratz will review various efforts pursued to use tumor biology to refine treatment recommendations in patients with early stage NSCLC, including the benefits and limitations of different strategies. He will discuss ongoing research and current standards of care in this clinical setting.

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