Round Table Discussion with Experts: Indolent BAC in an Elderly Man

This is the first part of a case presentation I did with two great colleagues: Dr. Anne Tsao, who is a medical oncologist and lung cancer expert at MD Anderson Cancer Center in Houston, and Dr. Alex Farivar, who is a terrific thoracic surgeon at my own institution, Swedish Cancer Institute in Seattle.
This case is [...]

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Clinical Factors of Prognosis in Surgical Series: A Focus on Smoking Status

   In my last post I wrote about the prognostic value of molecular markers like EGFR and K-Ras that have generally been studied in patients with advanced NSCLC and treated with EGFR inhibitors, but these studies looked at prognosis in patients with early stage NSCLC who underwent surgery.  These studies also provided some interesting results [...]

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 [...]

Tales from the Clinic: Surgery after Chemo/Radiation

   In prior posts I’ve described the special circumstance of a Pancoast tumor, which is a tumor at the top of the lung that tends to grow into the spine, ribs, and sometimes the nerves going to the arm. These cases are a major challenge because surgery is often something to consider, because they often [...]

Incidental N2 Nodal Disease and the Heterogeneity of Stage IIIA N2 NSCLC

   Probably the most contentious areas of lung cancer management is stage IIIA NSCLC, with N2 nodal involvement, the nodes outside of the lungs, toward the middle of the chest but on the same side as the main tumor.  One of the key issues is that the staging is the same whether there’s a single [...]

What I Really Do: Adjuvant (Post-Operative) Chemotherapy

    To begin with, my overall impression is that the preponderance of evidence on adjuvant (post-operative) chemotherapy supports that it can reduce the recurrence risk and improve the survival at five years, which I’d presume to be pretty close to the “cure rate”.   The benefit isn’t uniformly distributed for all patients: higher risk patients, [...]

Gene Signatures to Predict Benefit from Adjuvant Chemo

  I had described earlier this week (prior post here) how the long-term follow up of one of the more important adjuvant chemotherapy trials for early stage resected NSCLC patients showed that there may be long-term adverse effects of chemotherapy.  My last post also suggested that the benefit of pre-operative chemotherapy in another trial appeared [...]

More Work with Neoadjuvant (Pre-Op) Chemotherapy: The SWOG Experience

   In my last post I described the results of the ChEST trial that showed a borderline statistically significant improvement in survival of patients who received cisplatin/gemcitabine chemotherapy for stage IB to IIIA NSCLC prior to surgery.  This study was very similar to another neoadjuvant chemotherapy trial, known as SWOG 9900, which also randomized patients [...]

Pre-Operative Chemotherapy as an Alternative to Post-Operative Chemo: Evidence of Stage-Dependent Survival Benefit

  In contrast with post-operative chemotherapy, which has become a standard treatment approach to reduce the probability of recurrence of resected stage II and IIIA NSCLC (still pretty controversial for stage IB), pre-operative chemotherapy (also known as neoadjuvant, or induction chemotherapy) is less well studied and isn’t a typical approach.  However, a recent study called ChEST, the [...]

Long-Term Risk with Adjuvant Chemo

   Over the past few years, the role of post-operative, also known as adjuvant, chemo has become increasingly accepted as a standard of care.  Several trials have shown an improvement in survival at about 5 years that is in the 5-15% range for recipients of chemo.  However, the evidence indicates that the people at higher [...]