Basic Cancer Info

We've discussed the potential importance of micrometastatic disease or circulating tumor cells, but another way to assess them is to check for the presence of occult (and microscopic) metastases (OMs) in bone marrow or lymph nodes.

Following the excellent podcast by Dr. Rogerio Lilenbaum, lung cancer expert and now Chair of Cleveland Clinic Florida in Weston, on Considerations and Challenges of Treating Elderly Patients with Lung Cancer, he fielded questions from me and the folks in the live audience who attended. Here's that question and answer session, provided in audio and with the associated transcript. There isn't really any video/figures for this one.

[powerpress]

Here's the presentation by my friend and colleague Dr. Rogerio Lilenbaum, a great medical oncologist now serving as Director of Hematology/Oncology at the Cleveland Clinic Foundation in South Florida (Weston, FL).

Introduction

Thyroid transcription factor-1 (TTF-1) is a protein seen on the surface of thyroid cells, but also on about 70-75% lung adenocarcinomas and only a small minority (~10%) of squamous cell NSCLC tumors. In fact, the presence of TTF-1 on a NSCLC tumor provides a good hint for the pathologist that this is an adenocarcinoma. It's an immunohistochemical (IHC) test that is done on the vast majority of lung cancers, and there's some new information that suggests it may also be useful for predicting which patients are especially unlikely to have an EGFR mutation or ALK rearrangement.

The marker known as an anaplastic lymphoma kinase (ALK) translocation has been all over the lung cancer news in recent weeks, most notably in the setting of being the marker in about 4% of patients with non-small cell lung cancer (NSCLC) that is correlated with a high probability of response to the ALK inhibitor crizotinib, which was just approved by the FDA for patients whose tumors demonstrate this marker on a test in a central reference laboratory.

There's a problem in our discussions of standard treatment for patients with higher risk resected early stage NSCLC, and that is that there is a pretty clearly defined standard of care of giving typically around 4 cycles of cisplatin-based chemotherapy to reduce the risk of recurrence, but in truth, the majority of people in the real world don't get it. Still, I wouldn't want to imply that the problem is definitely that doctors aren't giving the right treatment to people who should definitely be getting it.

The question of "who should be tested?" for an epidermal growth factor receptor (EGFR) mutation and potentially other molecular markers is among the most timely questions in lung cancer management today. The field has changed dramatically since the initial description of the mutation, associated with a high probability of an impressive and often prolonged response to EGFR tyrosine kinase inhibitor (TKI) therapy, back in 2004.