Case Discussion with Experts, Drs. Julie Brahmer & Greg Riely, Part 1

Here’s a webinar case discussion I did with Drs. Julie Brahmer from Johns Hopkins in Baltime, and Greg Riely from Memorial Sloan Kettering Cancer Center in New York.  They’re great thoracic oncologists as wellas friends, and they were kind enough to join me for discussion of several complex cases that don’t have clear answers and [...]

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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, [...]

Debating maintenance therapy for advanced NSCLC: Not accepted as the standard of care

This past weekend, I had the unenviable task of debating my friend Dr. Nasser Hanna, from Indiana University and a highly respected leader in lung cancer, about maintenance therapy.  He had been the expert discussant of the three key trials on maintenance therapy presented at ASCO this year (the JMEN trial of Alimta (pemetrexed) and [...]

ATLAS Trial Falls Short of Overall Survival Benefit

On October 15th there was a press release that, as far as I can tell, went almost entirely unnoticed. News outlets reported that Roche (owner of Genentech, the maker of Avastin (bevacizumab)) reported to OSI Pharmaceuticals (the maker of Tarceva (erlotinib)) the final overall survival results from the ATLAS trial.
There have been a number of [...]

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 [...]

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 [...]

Beyond the SWOG 0023 Trial: Are Iressa and/or Tarceva Harmful after Definitive Concurrent Chemoradiation (CRT)?

In 2008 the SWOG 0023 trial was published, which looked at the question of maintenance Iressa (gefitinib) after definitive chemoradiation in patients with locally advanced (Stage III) NSCLC. The trial randomized patients who had not progressed after completing CRT with concurrent cisplatin and etoposide chemotherapy followed by consolidation Taxotere (docetaxel) to either Iressa or placebo. [...]

SATURN Survival Results: What Can We Say About “Maintenance” Tarceva?

Shortly after ASCO 2009, Dr. Pennell provided the highlights of the early report of the SATURN trial, conducted primarily in Europe, that randomized patients to maintenance tarceva (erlotinib) or placebo after four cycles of first line chemotherapy.   The early report described a modest but statistically significant improvement in progression-free survival (PFS), but overall survival [...]

More is better than nothing: another look at duration of therapy in NSCLC

Patients often ask me, “Why are we only doing four cycles of chemotherapy for my lung cancer?”  This is a great question and one for which the answer is a moving target, based on recent data incorporating maintenance therapies.  A recently published meta-analysis took another look at this question in NSCLC. The study authors searched [...]

Avastin Alone or with Alimta Following First-Line Chemotherapy: A Tale of 3 Trials

   For many years, chemotherapy for advanced or metastatic NSCLC had been limited to the use of “doublet” (two-drug) therapy using different combination regimens that were overall found to have very similar outcomes, but with different toxicity (side effect) profiles.  Attempts to add a third chemotherapy agent for a triplet regimen, and numerous attempts to add [...]