Hypertrophic Pulmonary Osteoarthropathy (HPOA): An Unusual But Distinctive Complication of Lung Cancer

Although it’s uncommon, hypertrophic osteoarthropahy, or HPOA, is an odd and therefore memorable syndrome that can be a side effect of lung cancer. It features an abnormal proliferation of skin and bone tissue, primarily in the hands and feet. Patients can develop clubbing, which is most commonly associated with NSCLC (up to 1/3 of patients) [...]

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

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Potentially Life-Threatening Hypersensitivity Reaction with Erbitux: A Region-Specific Side Effect

   Erbitux (cetuximab) is a monoclonal antibody to EGFR, and it’s actually made from a protein that is part mouse and part human (called a chimeric protein, named for the mythologic creature chimera that was composed of multiple parts from different animals). It’s uncommon but not rare for patients to have an allergic reaction to [...]

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 [...]

Tales from the Clinic: Mucinous BAC

   In my last post I outlined the typical clinical scenario for pneumonic bronchioloalveolar carcinoma (BAC), which is typically the mucinous subtype of this unusual disease.  In fact, we are still actively learning a great deal about BAC, enough for the lung cancer experts to begin to develop a more sophisticated view that the mucinous and non-mucinous subtypes have [...]

The MARVEL Trial: Will It Live Up to Its Name?

   There’s a national trial that is just kicking off throughout North America, called the MARVEL trial, which stands for Marker Validation of Erlotinib in Lung Cancer.  The lead investigator is Dr. Alex Adjei, now at Roswell Park Cancer Center in Buffalo and previously of Mayo Clinic, which leads the North Central Cancer Cooperative Group, [...]

Is it Time for EGFR Mutation Testing? Confessions of a Newly Convinced, Former Clinical Selector

   Those who have followed my writings over time will know that I haven’t been inclined to adopt a reflexive strategy of ordering molecular testing without good evidence that having this information will improve outcomes.  Testing tumors for EGFR mutations is advocated by a vocal minority of lung cancer experts in Boston and New York [...]

What I Really Do: EGFR Inhibitor Rashes

   Though EGFR inhibitors like tarceva can produce some terrific and long-lasting results in many patients, they aren’t toxicity-free.  The “targeted therapies” we use just have a very different side effect profile from standard chemo, and the EGFR inhibitors are well known to have skin-related side effects as the leading problem, with loose stools/diarrhea as [...]

Longterm Survival with Iressa in BAC

One of my earliest posts when I started OncTalk was on the use of oral inhibitors of the epidermal growth factor receptor (EGFR), one of the growth signals that is often over-active in cancer cells, against advanced bronchioloalveolar carcinoma (BAC), a unique subtype of lung cancer that tends to grow within the [...]

Refining the Treatment Populations for Erbitux in Lung Cancer: Can We Make the Juice Worth the Squeeze?

    The FLEX trial raises a number of additional points as we struggle to determine how to integrate Erbitux (cetuximab) into the current standards of care.  One question is whether we can refine how well we do with Erbitux by using clinical or molecular variables to select better or worse candidates for it.  I already [...]