Fotolyn (Pralatrexate) Chemotherapy Beats Tarceva on Survival as Second Line Therapy in Smokers

   It’s been two and a half years since I described a phase IIB trial of Fotolyn (pralatrexate), a relatively new chemotherapy agent, being compared to Tarceva (erlotinib) in current or ex-smokers with previously treated advanced NSCLC.  The new drug, Fotolyn, is described in a prior post, and it has since been approved by the FDA [...]

Post-ASCO Discussion of the BR.19 Trial

Here’s the first of a series of posts on key presentations on lung cancer from ASCO 2010, as reviewed by myself and Dr. Nate Pennell of our faculty here several weeks ago.
The first topic we covered was the very interesting if troubling Canadian BR.19 trial of post-operative Iressa (gefitinib) vs. placebo, as summarized by Dr. [...]

Basics of Bronchioloalveolar Carcinoma (BAC)

Bronchioloalveolar carcinoma, or BAC,  is a unique subtype of non-small cell lung cancer (NSCLC) that has unique features in terms of the demographics of who gets it, how it appears on scans, how it often behaves, and potentially in how it responds to treatment.  It is a subset of lung cancer for which most of [...]

Changing Clinical Practice: The Evidence that Convinced Me Many People with Advanced NSCLC Should Have Up Front Molecular Testing

   The question of which patients to test for an EGFR mutation, and when, has become one of the most timely and rapidly changing ones in lung cancer.  The IPASS trial was a landmark study that definitively illustrated that molecular testing overshadows clinical selection for EGFR tyrosine kinase inhibitor (TKI)-based therapy, demonstrating that the 60% of [...]

New Data on Continuation Maintenance Therapy for Advanced NSCLC

A lot of new data have emerged over the last 2-3 years that have addressed the concept of “maintenance therapy” for patients with advanced NSCLC (see Dr. Socinski’s excellent podcast for a general review).  The basic idea is that a patient is treated with first line chemo-based treatment, with or without the angiogenesis in inhibitor [...]

Update on ATLAS: Overall survival

We learned several months ago that the ATLAS trial of maintenance Avastin (bevacizumab) with either Tarceva (erlotinib) or placebo did not demonstrate a significant improvement in overall survival (OS) with Tarceva, despite the fact that it was associated with an improvement in progression-free survival (PFS).  This is in contrast with the similar trial called [...]

Case Discussion with Dr. Hanna: Asian Never-Smoking Woman with Stage IIIA N2 NSCLC

Here is the continuation of my conversation with Dr. Nasser Hanna, lung cancer expert at Indiana University and all-around good guy (not part of his official title).  Here we discuss a patient of mine who combines the challenges of managing stage IIIA N2 NSCLC with the issues of how to potentially integrate an EGFR inhibitor [...]

Can Lower Doses of EGFR Inhibitor Therapy Still be Effective?

   One nagging question that people often ask about, or at least worry about, is whether they are compromising their ability to benefit from an EGFR tyrosine kinase inhibitor (TKI) like Tarceva (erlotinib) or Iressa (gefitinib) if they need to cut down on the dose because of problems with side effects.  Anecdotally, I think just [...]

Q&A Session for Dr. Socinski’s Maintenance Therapy for NSCLC Webinar Available

Dr. Mark Socinski, international leader in the field of lung cancer, from the University of North Carolina at Chapel Hill, gave a terrific presentation on timing and selection of treatment after the first line setting for advanced NSCLC.  In addition to the podcast of his presentation itself, here now is the question and answer session [...]

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FDA Ignores ODAC and Approves Tarceva (Erlotinib) as Maintenance Therapy

In an unprecedented move, the US FDA ignored the recommendation by the Oncology Drug Advisory Committee (ODAC) to not approve Tarceva as a maintenance therapy for patients who haven’t demonstrated progressing disease after four cycles of first line chemotherapy for advanced non-small cell lung cancer (NSCLC) and approved Tarceva for this indication yesterday.  Perhaps even [...]