Basic Cancer Info

The following is the edited transcript and figures from a webinar presentation made by Dr. Heather Wakelee, medical oncologist and Associate Professor at Stanford Cancer Center, on Never-Smokers and Gender Differences in Lung Cancer.

Introduction to Molecular Markers

The rate of our progress in lung cancer and other settings in medicine reaches a bottleneck in the slow rate at which clinical trials are completed. Nevertheless, only about 3% of patients with cancer in the US participate in clinical trials, and the number is even a little lower for people with lung cancer.

Occasionally at meetings, oncologists are confronted with a marketing study done by the pharmaceutical industry that reveals that something like half of patients diagnosed with lung cancer never receive any treatment.

In the last decade, the treatment of NSCLC has evolved very significantly, and one of the leading ways has been that we've gone from having no established role for treatment after initial, first line therapy to having multiple agents with a proven benefit. It's worth clarifying that as maintenance therapy is increasingly being considered as an option after first line therapy, a distinction between this and second line therapy.

Although the ASCO Plenary session presentation on ALK inhibition with crizotinib was a darling of the entire conference and led to a post I wrote about on the way back from the meeting, there was actually a second presentation on lung cancer in t

The historic standard for advanced NSCLC up until a few years ago was for patients to complete 4-6 cycles of platinum-based doublet chemo, and then for patients who were doing well and had responded or demonstrated stable disease to take a break from treatment and be followed until progression. At that point, many patients would re-initiate chemo or targeted therapy with an oral agent like Tarceva (erlotinib).

There is no question that the recognition of an activating mutation in the gene for the epidermal growth factor receptor (EGFR) has revolutionized our understanding of why some patients with advanced/metastatic NSCLC develop a profound benefit from the class of oral EGFR tyrosine kinase inhibitors (TKIs).

EGFR stands for epidermal growth factor receptor, which is a molecule on the surface of many cancer cells that can be activated to activate signals that promote cell growth and cell division. Though this target may play a role for many kinds of cancer, non-small cell lung cancer (NSCLC) is one type in which this target protein is seen in a majority of people's cancers.

The initial or "first line" management of advanced NSCLC has evolved quite a bit over the past 10 years, in that time moving from a much more uniform approach of very similar treatment for just about everyone to a revised approach that is far more individualized. First, we assess key issues like the subtype of NSCLC, focusing largely on whether it is squamous cell or non-squamous NSCLC, because treatment tends to diverge very early based on this factor.