Dr. Shirish Gadgeel on Managing Locally Advanced NSCLC

Our next podcast slide presentation comes from Dr. Shirish Gadgeel, medical oncologist at Wayne State University in Detroit.  He came out to Seattle for a physician education program I run and was kind enough to stay for our NSCLC Patient Education Forum, where he spoke on our Current Standards of Care for Locally Advanced (Stage [...]

Podcast: Play in new window | Download

Consolidation Tarceva after Chemo/Radiation for Locally Advanced NSCLC: At Least It Isn’t Significantly Harmful

Perhaps the most unexpected clinical trial result in lung cancer over the past 5 years was the finding in the large Southwest Oncology Group (SWOG) 0023 trial that randomized several hundred patients to maintenance therapy with either the oral EGFR inhibitor  Iressa (gefitinib) or a placebo after chemo/radiation concurrently and then consolidation taxotere (docetaxel).  While [...]

Managing Locally Advanced NSCLC: Summary from a Talk to Patients & Caregivers

Here is the third portion of a talk I did at the Seattle-based non-profit Cancer Lifeline in May, and this section focuses on our current standards for managing unresectable locally advanced (stage III NSCLC).   This covers theissues of sequential vs. concurrent chemo with radiation and the important issue of whether additional consolidation chemo after the [...]

Podcast: Play in new window | Download

Prophylactic Cranial Irradiation for Stage III NSCLC: Some Answers, Some Open Questions

   In my last few weeks as a GRACE guest faculty, I have been struck by the number of forum discussions that deal with brain metastases.  Brain metastases are a growing problem in non-small cell lung cancer (NSCLC), as well as in multiple other cancers.  Why is this?  Twenty years ago, patients who developed brain [...]

Interview with Dr. Suresh Ramalingam: Current Standards and Controversies in Locally Advanced NSCLC

   Dr. Suresh Ramalingam is a longtime friend of mine and a national leader in the field of lung cancer.  He is the Director of the Lung Cancer Program at the Winship Cancer Institute at Emory University in Atlanta, and he was kind enough to sit down with me to talk about his perspective on [...]

Podcast: Play in new window | Download

What I Really Do: Locally Advanced, Unresectable NSCLC

   The setting of unresectable, stage IIIA or IIIB NSCLC (without a malignant pleural effusion) is currently one for which what we feel is best for the patient isn’t necessarily something for which we have good evidence.  For fit patients, there is a strong consensus that giving concurrent chemo with radiation provides a modestly but [...]

Erbitux with Radiation in More Marginal Patients with Locally Advanced NSCLC

   One of the core ideas in the management of stage III, or locally advanced, NSCLC is that unresectable disease that is being treated with curative intent is most effectively treated with a combination of concurrent systemic (”whole body”) therapy and chest radiation to all of the visible cancer.  The systemic therapy, which has been [...]

Integrating Alimta and Cetuximab in Locally Advanced NSCLC

   As a follow-up to my last post on the appeal of developing new regimens for combining with radiation in treatment of locally advanced unresectable NSCLC, I wanted to highlight work being done by the Cancer and Leukemia Group B (CALBG), one of the major cancer cooperative research groups in the US.  As I mentioned [...]

Introducing Erbitux and Other Agents into Treatment of Locally Advanced NSCLC: RTOG Experience

While there have been new agents introduced and rapidly changing standards in advanced NSCLC, another 40% of patients with NSCLC have locally advanced (stage III) NSCLC, many of whom with disease that is not resectable but is potentially curable with agressive chemo and radiation. Last year’s ASCO meeting included results [...]

Surgery for T4 Tumors: The Importance of Local vs. Distant Failure Risk

   People who have been following my comments know that I am often questioning the wisdom of surgery in patients who don’t fit the usual criteria for resection, which is most commonly pursued in stage I and II NSCLC and is often considered an option for some patients with stage IIIA NSCLC.  To provide a [...]