Delays in Treatment for Lung Cancer: Frustrating, but Do They Impact Survival?

In practicing oncology, one of my patients’ (and even more so, the families’) greatest concerns is how long it takes between when the patient was first diagnosed with probable lung cancer and when they can begin treatment. Of course this is a completely natural reaction, and is based on a lot of very real concerns.
Often [...]

Video Podcast Presentation on Locally Advanced NSCLC

   Ask and ye shall receive!  The leading requiest for a video podcast presentation was for a summary of the subject of locally advanced, unresectable stage III NSCLC.  Here you go:
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Sorry it’s a little rushed, but it’s a struggle to do a topic justice with a 10 minute limit (the most YouTube accepts).  In the future, we’ll [...]

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Trimodality Therapy (Chemotherapy, Surgery, and Radiation) for Malignant Mesothelioma: Can Some Patients actually be Cured?

Malignant mesothelioma is a relatively rare but particularly deadly malignancy that arises from the lining of the pleural (chest) cavity or peritoneal (abdominal) cavity. About 70% of cases of mesothelioma are directly related to asbestos exposure, usually with about 30 or 40 years between exposure and diagnosis. While there are only about 2200 cases per [...]

The Carboplatin/Irinotecan Combination for SCLC: A Phase II Study

    Several years ago, I participated in a clinical trial with a combination of carboplatin and irinotecan for treatment of extensive SCLC, just now being published (abstract here).   As a bit of background about the potential utility of irinotecan, the well established cornerstone of treatment of extensive SCLC for about two decades has been a [...]

The Shifting Ground in Advanced NSCLC: A Quick Survey of the Experts

   Although there has always been lattitude for individualizing treatment, I think developments in the last few years have added so many options that pretty much any standards we had from a few years ago have eroded. Particularly in a world in which the eligibility for avastin (bevacizumab) has is debatable (with growing experience of [...]

A New Look at Maintenance Treatment after First-Line Chemotherapy in NSCLC

  With the recent publication of the Eli Lilly-sponsored phase III trial of immediate versus delayed Taxotere (docetaxel) after the completion of first-line chemotherapy in patients with advanced NSCLC (abstract of paper by Fidias and colleagues here), I think the time has come to critically evaluate this as a potentially practice-changing concept. Call it whatever [...]

Tarceva Dose Escalation in Current Smokers: Could Higher Doses Improve Results?

   We have long noted that there is a clear association of smoking history with effectiveness of oral EGFR tyrosine kinase inhibitors (TKIs).   Part of this is because never-smokers have a high incidence of carrying activating EGFR mutations, but also potentially because current smokers actually metabolize EGFR TKIs faster (see prior post).   We’ve seen a [...]

ATLAS: Another Trial Shows Benefit for “Maintenance”/Early Second Line Therapy

    A press release today informs us that the ATLAS trial of maintenance avastin (bevacizumab)  combined with tarceva (erlotinib) vs. avastin with placebo was positive for a significant improvement in progression-free survival (PFS).  We had already learned that the very similar SATURN, of maintenance tarceva vs. placebo in patients who weren’t on avastin was also positive [...]

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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EGFR and K-Ras Mutations in Patients with Early Stage NSCLC

   We’ve seen clear evidence that patients who have tumors with certain mutations in the EGFR gene are highly likely to respond to oral EGFR inhibitors like tarceva (erlotinib) or iressa (gefitinib) – with response rates that are in the 70% range and often last for many months or even a few years (see prior post).   On the [...]