GRACE :: Lung Cancer




Dr. William Pao on “How Concerned Should We Be About Different Testing Methods, as well as the Heterogeneity of Different Biopsy Results from the Same Patient?”


Dr. William Pao explains the caveats of molecular testing in terms of differences in testing methods through different laboratories and the heterogeneity of molecular findings in different biopsies even within the same individual with lung cancer.

Radiation to Address Cells with Resistance to Targeted Therapies



Thank you to member Craig for asking some excellent questions in response to my Highlights of 2011 webinar ( ).  Thank you also to Dr. West, who emailed me to comment more on the idea of radiation for cells with acquired resistance.

We’ve spoken at length about EGFR and related mutations such as EML4/ALK and ROS1 on GRACE.  For those who are not familiar with these subjects, I will refer you to my webinar for a summary on the most recent data on EGFR, EML4/ALK and ROS1:

(Parenthetically, we did also cover CT screening and optimal management of elderly patients at )

In the Q&A for this webinar that covered some of the existing approaches to resistance, Dr. West pushed me and asked if there was one that was particularly promising.  Well, I’ve spent a ton of time thinking about this problem and have written a trial to attempt to address it.  I couldn’t resist the bait and mentioned my trial.  In this post, I’d like to review the rationale for the approach that I described and address Craig (and Dr. West’s) question about how appropriate this approach will be to new mutations, such as EML4/ALK and ROS1.

The Approach:

(click on image to enlarge)

The basic idea is to take patient whose cancer has grown on tarceva, do cyberknife to the spots that have grown to eliminate the resistant clones, then continue using tarceva for the rest of the cancer that has shown evidence for ongoing sensitivity to tarceva.

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Dr West

Refining CT based lung cancer screening with a blood test?


Many people in the lung cancer world consider the National Lung Screening Trial (NLST) that demonstrated a 20% improvement in survival from CT-screening higher risk people for lung cancer as a major advance in the field, befitting coverage in Dr. Weiss’s summary of lung cancer highlights from 2011, but this hasn’t yet led to wholesale adoption of the practice.  Why not? Some people say that it’s just one study and that we need more evidence, but it’s hard not to believe that implications for health care resource utilization (i.e., cost and practical implementation) aren’t a big part of the challenge.  Annual CT scans will/would add a lot of cost when applied for the millions of people just in the US who would be appropriate candidates by the definition of the study (age 55-75 and with a 30 pack-year smoking history).  In addition, we know that CT screening detects a lot of nodules that require plenty of follow-up scans and cause significant anxiety but ultimately prove to not be cancer.  What if we could add another factor that could raise or lower our suspicion and potentially enable us to modify the frequency of scanning and/or our enthusiasm for escalating the workup?

I’ve covered one such approach in a prior post describing a test analyzing chemical compounds in the exhaled breath of patients, and this research is ongoing.  But another strategy is to analyze the blood of patients in search of preliminary evidence of cancer that might be detectable at the time of or even before the earliest imaging findings suggestive of cancer.  The EarlyCDT-Lung test is designed to do this by looking for immuno-biomarkers (“auto-antibodies” created by the body in reaction to a protein detected within), any of a panel of 6-7 that could signify early cancer if one or more of these is elevated.   

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