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Molecular Markers, Part 5: Dr. David Spigel on Integrating Markers into Clinical Trials

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Here’s part 5 of our Santa Monica program on Molecular Markers in Advanced NSCLC, closing in on the end of the activity.  In this podcast, my friend Dr. David Spigel from Sarah Cannon Cancer Center in Nashville, TN presents on the benefits as well as the challenges of new models of clinical trials in lung cancer that move away from “all comers” to smaller, more limited populations defined by molecular markers.   Following his presentation, we continued our panel discussion, covering how much the transition into molecular oncology has disrupted how we do clinical research, as well as how our growing experience with molecular testing is leading us to question some of our previously held beliefs.

 

Below are the audio and video versions of this podcast, along with the transcript and figures for it.

Molecular Markers SM Pt 5 Spigel on Markers in Clinical Trials Audio Podcast

Molecular Markers SM Pt 5 Spigel on Markers in Clinical Trials Transcript

Molecular Markers SM Pt 5 Spigel on Markers in Clinical Trials Figs

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Ongoing Great Panel Discussion from the Santa Monica Molecular Markers Webinar: Part 4

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Here’s the next installment of the panel discussion on molecular markers from the webinar in Santa Monica with Drs. Charlie Rudin, Alice Shaw, David Spigel, and Glen Goss.  We continued our animated discussion on the promise as well as the pitfalls of broadening the use of molecular markers in routine practice of managing patients with advanced NSCLC

Below you’ll find the audio and video versions of the podcast, along with the transcript (no real figures to go with this one).

Molecular Markers SM Pt 4 Panel Discussion Audio Podcast

Molecular Markers SM Pt 4 Panel Discussion Transcript

We’ll continue with a presentation by Dr. Spigel on the value and challenges of incorporating molecular markers into the design of clinical trials in lung cancer.

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Molecular Markers Webinar Part 3: Panel Discussion Debating Who to Test and What to Test For:

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Here is the next portion of our special webinar on molecular markers in advanced NSCLC, featuring Drs. Charlie Rudin from Johns Hopkins,  Dr. Alice Shaw from Massachusetts General Hospital, Dr. David Spigel from Sarah Cannon Cancer Center, and Dr. Glen Goss from the University of Ottawa and NCI-Canada’s Lung Cancer Committee.   

In this continuing portion of the program, we have a debate on the merits of uniform vs. more selective testing of “druggable” mutations and consider whether it is more attractive to test for multiple markers simultaneous or perhaps sequentially, since they are typically mutually exclusive.  We also discuss the challenge of the delays in treatment that may become a real clinical problem for some patients if testing may require a few weeks of downtime.

Below you’ll find the audio and video versions of the podcast, along with the transcript and figures for this activity.

Molecular Markers SM Pt 3 Panel Discussion Audio Podcast

Molecular Markers SM Pt 3 Panel Discussion Transcript

Molecular Markers SM Pt 3 Panel Discussion Figs

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Dr. Alice Shaw on Clinical Factors Associated with Molecular Markers

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I’m happy to bring you now the second part of the Santa Monica webinar, developed with the LUNGevity Foundation, on “Molecular Markers in Advanced NSCLC: Who to Test and What to Test For?“, in which I was joined by Drs. Charles Rudin (Johns Hopkins University in Balimore, MD), Alice Shaw (Massachusetts General Hospital in Boston, MA), David Spigel (Sarah Cannon Cancer Center in Nashville, TN), and Glen Gloss (University of Ottawa in Ontario, Canada).  

In this short podcast, Dr. Alice Shaw reviewed the frequencies of different molecular markers in advanced NSCLC as a function of patient sex, smoking status, race, and tumor histology.  This work is very interesting, of course, because if we only do molecular marker studies of people with an adenocarcinoma or never-smokers, we not only won’t ever find potentially relevant mutations in people with other histologies and those with a smoking history, but we won’t have any good idea of the probabilities of finding them either.

Here is the podcast in audio and video formats, as well as the transcript and figures.

Molecular Markers SM Pt 2 Shaw on Markers by Clin Factors Audio Podcast

Molecular Markers SM Pt 2 Shaw on Markers by Clin Factors Transcript

Molecular Markers SM Pt 2 Shaw on Markers by Clin Factors Figs

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Dr. Weiss’s “Highlights in Lung Cancer, 2011″: CT Screening & Optimal Management of Elderly Patients with Advanced NSCLC

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This is the third and final part of Dr. Weiss’s presentation on “Highlights in Lung Cancer, 2011″.  After focusing on developments in relatively narrow subpopulations with distinct molecular markers in the first two parts of his webinar, Dr. Weiss closed with his coverage of a couple of issues with broader applicability: the new data supporting CT screening for higher risk people with a significant smoking history, and also some new data addressing the question of whether elderly patients are best served by receiving single agent or doublet chemotherapy.

Below you’ll find the podcast of the program in audio and video formats, as well as the transcript and figures for this activity.

Dr. Weiss Highlights in Lung Cancer 2011, Pt. 3 CT Screening and LC in Elderly Audio Podcast

Dr. Weiss Highlights in Lung Cancer 2011, Pt. 3 CT Screening and LC in Elderly Transcript

Dr Weiss Highlights in Lung Cancer 2011, Pt. 3 CT Screening and LC in Elderly Figs

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Lung Cancer Highlights, 2011 by Dr. Weiss, Part 2: ALK and other New Molecular Targets

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Here is the second part of the presentation on “Lung Cancer Highlights, 2011″ by Dr. Jared Weiss.  This section of his talk focuses on the striking story of the identification of the ALK rearrangement as a relevant target in lung cancer, along with an impressive treatment for this subgroup, and other new targets, such as ROS-1.  

Below you’ll find the audio and video versions of the podcast, as well as the transcript and figures.

Dr. Weiss Lung Cancer Highlights 2011, Pt 2 ALK and New Molecular Targets Audio Podcast

Dr. Weiss Lung Cancer  Highlights 2011, Pt 2 ALK and New Molecular Targets Transcript

Dr. Weiss Lung Cancer Highlights 2011 Pt 2 ALK and New Molecular Targets Figs

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Stage IV Non small cell Lung Cancer in the Elderly: Review of Data and update on the Published results of the French IFCT-0501 (Quoix) trial

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Introduction

When I wrote my first review article on the treatment of the elderly, I entitled it, “NSCLC in the elderly—the legacy of therapeutic neglect.” Dr. Corey Langer and I chose the title to directly criticize the major mistake that we perceive in the treatment of the fit elderly—a therapeutic nihilism that leads oncologists to not give sufficiently aggressive treatment to the fit elderly. Lung cancer is a terrible cancer and failure to suppress it with sufficiently active therapy leads to great suffering. This is as true in the older patient as in the younger patient. However, there is great misunderstanding about the efficacy of therapy in the fit elderly patient, the subject of this post. I will seek to summarize coverage of this topic on GRACE previously, highlighting the now published French data on 1st line treatment of the elderly. You may have noted the repeated use of the word, “fit.” Not all elderly patients are as fit as younger patients—aging brings with it more medical problems and more pills; not all elderly patients are as fit as younger patients with lung cancer. I will address this topic in a follow up post dedicated to this important topic.

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Q&A With Dr. Sequist

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qa_01The third and last podcast from our discussions with Dr. Lecia Sequist, of Massachusetts General Hospital and Harvard Medical School, covers the question & answer session that followed her excellent webinar on acquired resistance to EGFR tyrosine kinase inhibitors, as well as the update I did with her on the latest information from their experience of re-biopsying lung tumors over the course of treatment.

Here are the audio and video versions of the podcast, as well as the transcript.

sequist-qa-session-audio-podcast

sequist-qa-session-transcript

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The Evolving Role of Molecular Markers in the Management of Non-Small Cell Lung Cancer

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The Importance of Identifying Molecular Markers in Non-Small Cell Lung Cancer

To understand the importance of molecular markers in the current and future treatment of lung cancer, one should first understand how lung cancer was classified up until the beginning of this decade. Pathologists would look at a sample of a patient’s lung tumor under a microscope, and then make a judgment of whether the cells represented small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC). Although that is an oversimplification, for all practical purposes, that is what oncologists cared about when it came to choosing treatment. If the diagnosis was NSCLC, then oncologists treated the patient with platinum doublet chemotherapy using one of many standard regimens that were felt to be equally effective. Unfortunately we knew that these regimens only worked in a certain proportion of patients, but we had no way to predict ahead of time who would benefit and who would not.

At the same time pathologists and molecular biologists have know for some time that NSCLC is not really just one disease, but rather a constellation of many diseases that all share the distinction of starting in the lung. For example, major subtypes such as adenocarcinoma, squamous cell carcinoma, and large cell carcinoma were often reported in pathology reports but did not influence treatment choice. Since 2004 we have taken this one step farther, asking pathologists to tell us not just that the lung cancer is non-small cell but also that it is non-squamous cell, for purposes of safety with Avastin (bevacizumab) and efficacy with Alimta (pemetrexed), but that is the topic for another chapter.

As our understanding of the molecular basis of cancer has grown, we have developed a number of new molecularly-targeted agents with promise in the treatment of lung cancer. However, targeted drugs tend to have limited or no effect on cancers that lack the “target” of the drug, creating a need for markers to guide us.

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Case Discussion on Stage IIIA N2 NSCLC, with Drs. Blumenschein & Curran

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Several weeks ago I had the opportunity to discuss a series of cases of locally advanced NSCLC with a couple of expert colleagues: Dr. George Blumenschein, medical oncologist in the Division of Thoracic & Head/Neck Oncology at MD Anderson Cancer Center in Houston, TX; and Dr. Walter Curran, radiation oncologist who heads the Division of Radiation Oncology at the Winship Cancer Center at Emory University in Atlanta, GA. Dr. Curran is also the head of the Radiation Therapy Oncology Group, the US-based cooperative oncology group leading important questions about radiation oncology in various cancer types.

The first of the cases we covered is a patient of mine with stage IIIA N2 NSCLC, the most controversial setting in lung cancer management, where many options are all considered as reasonable alternatives throughout the oncology field.

Here’s the audio and video versions of the podcast, along with the transcript and figures.

stage-iiia-n2-nsclc-case-drs-blumenschein-and-curran-audio-podcast

stage-iiia-n2-nsclc-case-drs-blumenschein-and-curran-transcript

stage-iiia-n2-nsclc-case-drs-blumenschein-and-curran-figs

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