Molecular Markers from the INTEREST Trial: Chemo and EGFR Inhibitor Therapy Still Remarkably Equivalent

Oncologists often have their own ideas about how effective or ineffective a targeted therapy like an EGFR tyrosine kinase inhibitor (TKI) (Tarceva (erlotinib) or Iressa (gefitinib)) is compared with standard chemotherapy options.   We’ve seen a lot of new information emerge in the field over the last few years, and we now have evidence that [...]

Round Table Case-Based Discussion — Drs. Laskin and Sandler on Molecular Testing in a Never-Smoker

Here is the first podcast of what we plan will be an ongoing series of round table discussions with cancer experts about real case scenarios and how we make decisions in practice.  My guests for the discussion are Drs. Janessa Laskin, medical oncologist from British Columbia Cancer Agency in Vancouver, BC, and Alan Sandler, medical [...]

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NCCN Guidelines for NSCLC Now Include Reference to Maintenance Therapy

   Just a few days ago, I described my humbling experience of trying to argue in favor of making a standard of patients with advanced NSCLC who hadn’t progressed after four cycles of chemo-based first line treatment being started on maintenance therapy.   That didn’t work, and it’s clear both from the outcome of the debate, [...]

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 [...]

Consolidation Tarceva after Chemo/Radiation for Locally Advanced NSCLC: At Least It Isn’t Significantly Harmful

Perhaps the most unexpected clinical trial result in lung cancer over the past 5 years was the finding in the large Southwest Oncology Group (SWOG) 0023 trial that randomized several hundred patients to maintenance therapy with either the oral EGFR inhibitor  Iressa (gefitinib) or a placebo after chemo/radiation concurrently and then consolidation taxotere (docetaxel).  While [...]

EGFR Inhibitors: Personalization by “Snips”

What we are striving for in cancer care today is personalized medicine. So, if a patient with newly diagnosed NSCLC has an activating epidermal growth factor receptor (EGFR) mutation, we give that patient Tarceva (erlotinib), a tyrosine kinase inhibitor (TKI).  Right?  Well, yes — but it doesn’t always work (the response rate is in the [...]

Tarceva for Advanced Squamous NSCLC: Recalibrating Expectations

When most oncologists think about the EGFR inhibitor tarceva (erlotinib), they think of the uncommon but very memorable patient who has a spectacular response within a few weeks of starting it, then continues to do well on it for a year or more.   These patients are most commonly never-smokers, often Asian, and almost invariably [...]

More Evidence from Asia on Where EGFR TKIs Fit into NSCLC Treatment

As more and more oncologists become aware of the importance of testing for at least the EGFR mutation in tumor, and soon, perhaps, in blood, it seems likely that more patients will have their first systemic treatment for advanced non-small cell lung cancer (NSCLC) be an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), [...]

Integrating EGFR Inhibitor Therapy with Chemotherapy: Should We Treat Advanced NSCLC Like a Sprint and Not a Marathon?

Dr. Tony Mok, a friend who lives and works in Hong Kong and is an international leader in lung cancer, has just published not only the IPASS trial in the New England Journal of Medicine but also another trial called FAST-ACT (for First Line Asian Sequential Tarceva and Chemotherapy trial) in the Journal of Clinical [...]

Broad Screening for EGFR Mutations: The Spanish Lung Cancer Group Experience

 
   In the same issue of the New England Journal of Medicine that contained the IPASS trial results, Dr. Rosell and colleagues reported results of their effort to institute large-scale EGFR mutation testing in lung cancer patients in Spain, who then received erlotinib (Tarceva).
  Patients with non-small lung cancer were recruited from selected public hospitals [...]