Does it Matter Which Chemo Agent You Get with Your Platinum? Maybe it does…

For years it has been generally accepted that the choices for the second drug in a platinum doublet for treating metastatic non-small cell lung cancer (NSCLC) were pretty much interchangeable. The question of whether cisplatin is better than carboplatin is a separate question, one which GRACE’s own Dr. Sanborn recently reviewed quite nicely. For the [...]

A Case of a 36 Year-Old Never-Smoking Woman with Metastatic Adenocarcinoma of the lung

   With all this recent talk about never-smokers with lung cancer, and the interest in stories of patients with so-called “oligometastatic” cancer (minimal metastatic burden to perhaps a single site), I thought I would describe a recent case in my clinic as an illustration of how I use this information in everyday decision making.
   Mrs. [...]

The Subtleties of Progressive Disease: Why Some Oncologists Continue EGFR Inhibitors (or Other Agents) after Progression

   One of the basic concepts of oncology is that you treat patients with different drugs once they’ve shown progression on a treatment, rather than continue that a patient has presumably become resistant to.  However, there are some exceptions to this: many or most women with breast cancer continue the antibody herceptin (trastuzumab) even after progression, adding [...]

A New Look at Maintenance Treatment after First-Line Chemotherapy in NSCLC

  With the recent publication of the Eli Lilly-sponsored phase III trial of immediate versus delayed Taxotere (docetaxel) after the completion of first-line chemotherapy in patients with advanced NSCLC (abstract of paper by Fidias and colleagues here), I think the time has come to critically evaluate this as a potentially practice-changing concept. Call it whatever [...]

Tarceva Dose Escalation in Current Smokers: Could Higher Doses Improve Results?

   We have long noted that there is a clear association of smoking history with effectiveness of oral EGFR tyrosine kinase inhibitors (TKIs).   Part of this is because never-smokers have a high incidence of carrying activating EGFR mutations, but also potentially because current smokers actually metabolize EGFR TKIs faster (see prior post).   We’ve seen a [...]

ATLAS: Another Trial Shows Benefit for “Maintenance”/Early Second Line Therapy

    A press release today informs us that the ATLAS trial of maintenance avastin (bevacizumab)  combined with tarceva (erlotinib) vs. avastin with placebo was positive for a significant improvement in progression-free survival (PFS).  We had already learned that the very similar SATURN, of maintenance tarceva vs. placebo in patients who weren’t on avastin was also positive [...]

Angiogenesis in First Line Advanced NSCLC: Focus on Avastin (Bevacizumab)

   Video presentation describing the concept behind angiogenesis and the evidence on the anti-angiogenic agent avastin (bevacizumab) in NSCLC.  
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Or access via web link here. 
Slide/figure images from the video presentation are available as a pdf here: Angiogenesis FL Adv NSCLC Vodcast images
Transcript is here: Angiogenesis FL Adv NSCLC Vodcast Transcript

Podcast: Play in new window | Download

The Amazing Case of Rob F: Oligo-Metastatic NSCLC as a Truly Chronic Disease

   One of the issues that we’ve commonly discussed and debated here is the question of when a local approach like surgery and/or radaition may be appropriate for I recently saw a patient of mine who I first met more than four years ago. At that time, he was only 37 years old and had [...]

Differences in Never-Smoker vs. Current/Ex-Smokers Receiving Chemo

A quick point on the importance of biology over treatment. Years ago, I highlighted the results in the TRIBUTE trial of chemo with placebo or combined with erlotinib (tarceva) at the same time (biomarker study abstract here), which showed that patients with EGFR mutations had a much better survival whether they received an EGFR inhibitor [...]

Can Development of a Rash on Erbitux Predict Who Will Benefit?

   The improvement in median survival of 1.2 months with the monoclonal antibody to EGFR erbitux (cetuximab) in the FLEX trial that I’ve previously described was statistically significant, but there’s plenty of room to debate whether it’s really clinically significant (see prior post).  What If we could add some way to refine our predictions of who [...]