In Treatment

One of the challenges of cancer care is that we guide our treatments by what clinical trial evidence tells us is best for particular patient populations. However, trials exclude patients who have significant medical issues other than cancer.

There is a principle in management of lung cancer that some patients who have a very limited degree of metastatic disease or progression after a good response may do unusually well with local treatment, such as radiation or surgery, for the isolated area(s) of disease that are metastatic or growing.

This past week, I saw a new patient who had just moved from another part of the country and needed long-term management of her high risk lung cancer.  A never-smoking Asian woman, she was found to have a stage IIIA lung cancer with "N2" mediastinal lymph nodes involving cancer in her mid-chest.

This week I found myself recommending surgery for a patient who had already undergone chemo and chest radiation, then more chemotherapy and more radiation, for limited stage small cell lung cancer (SCLC).   To be clear, there is no standard role for surgery in this setting, no data to support it, and I can’t recall a situation in which I’ve felt surgery was an appropriate approach for previously treated SCLC.

Every few months I see a patient who reminds me of the fallability of mutation testing.

Just last week, I ranked the development of immunotherapies as the leading development in lung cancer in 2013. I don't consider 2013 to be the clear turning point for immunotherapies in lung cancer: they have been the subject of interest and research for many years, and ASCO 2012 really marks their breakout from niche idea to more widespread credibility. But if 2012 was the real launchpad, 2013 saw the rocket really take off. The question is where is it really going?

With the end of the year upon us, I thought I'd offer my perspective on the top 5 developments in lung cancer for 2013:

The end of a year is always a time for reflection on the past alongside hope for the future, so our upcoming lung cancer social media tweet chat on twitter (#LCSM on twitter) will focus on everyone's thoughts of the most significant developments in lung cancer over the past year, along with predictions and hopes for the coming year.

Please join us Thursday, January 2nd at 8 PM Eastern, 5 PM Pacific on Twitter, using the hashtag #LCSM to follow and add to our one-hour chat with the global lung cancer community, where we'll cover the following three questions:

Dr. David Spigel, Sarah Cannon Cancer Center, answers audience questions about squamous lung cancer.

[powerpress]