Basic Cancer Info

As part of the series co-sponsored by GRACE and LUNGevity, challenging cases in lung cancer discussed with multiple experts, here's one on the common but vexing scenario of a patient with mediastinal node-positive (stage IIIA N2) NSCLC. This is among the most controversial clinical settings in lung cancer, as illustrated by the wide range of answers of how the experts in this program would manage the same patient. Some of the experts even note that the way that such a patient would be managed at their center would depend on the people weighing in on the case.

Plenary Session: Lung Cancer in Never Smokers

Continuing with this series of case-based podcasts we've done in partnership with LUNGevity, we'll again have a series of experts offer their own perspective to another challenging scenario. All are with the same format of me hosting and presenting the case to Drs. Bob Doebele from University of Colorado and Jyoti Patel from Northwestern University, who participated in the live webinar version of this, then followed in the recording by other terrific colleagues of mine weighing on the same case. These experts are:

The much-anticipated manuscript from the NCI-sponsored National Lung Screening Trial (NLST) was just published on line in the New England Journal of Medicine, with an editorial by Dr. Harold Sox.

The following is laden with personal opinion as much as actual evidence. Feel free to take it or leave it.

It's probably the biggest debate in lung cancer right now, and the answers are evolving every few months:

1) Which patients should be tested for molecular markers like EGFR, KRAS, ALK, etc.?

2) What tests should be sent?

3) When should these studies be sent? Right at the time of diagnosis ("reflex testing"), or after an oncologist has assessed how important these tests are really going to be, and decide which studies to send accordingly?

This is the first of a series of podcasts we've done, developed in partnership with LUNGevity Foundation, in which I present the same challenging cases in lung cancer management to a series of experts to learn the range of views offered by them, then the multiple thoughtful comments by all of them discussing the same single featured case for each podcast. The first discussants in each podcast will be Drs. Bob Doebele from University of Colorado and Jyoti Patel from Northwestern University, who are then followed by other terrific colleagues of mine:

I am sorry to say that there were few surprises or earth-shatteringly positive results at this year's ASCO meeting in Chicago (unless you count my button-shattering belly expansion from too many pizza lunches and dinners). However, in my mind there was one presentation that stood out above the others in terms of real hope for a particularly frustrating subset of lung cancer patients, namely those with EGFR activating mutations that develop resistance to Iressa (gefitinib) or Tarceva (erlotinib).

Our multidisciplinary thoracic oncology tumor board is dynamic and a highlight of the week, facilitated in equal parts by the fact that our group genuinely enjoys each other’s company and that it is the source of some engaging debate about the potential best way to manage several complex scenarios in lung cancer.