Basic Cancer Info

I'm proud to say that many years ago I sent Dr. Heather Wakelee from Stanford a set of my slides on post-operative therapy for early stage NSCLC -- we' ve been friends since we were both getting started in our careers.

In practicing oncology, one of my patients’ (and even more so, the families’) greatest concerns is how long it takes between when the patient was first diagnosed with probable lung cancer and when they can begin treatment. Of course this is a completely natural reaction, and is based on a lot of very real concerns.

As we head in to National Lung Cancer Awareness Month, we are all aware of the role cigarettes and tobacco play in the cause of lung cancer. We also are aware that not ALL lung cancers are caused by smoking, and that 10% of men and 20% of women who are diagnosed in the U.S. with lung cancer are never-smokers.

At the time that OncTalk (the predecessor to GRACE) was just getting off the ground in the fall of 2006 (wow, three years have gone quickly!), Avastin (bevacizumab) was just getting FDA approval in the first line treatment of advanced NSCLC.

As the next installment of the podcast series from the GRACE NSCLC Patient Education Forum, I'm pleased to offer a presentation by the Chief of the Thoracic Oncology Division at Swedish Medical Center in Seattle -- my own institution. Dr. Aye has been at the center of the program from the beginning, and whatever success our center has achieved in the field is a reflection on his steady leadership. He was one of the leading reasons I felt I would be happy at Swedish, and nearly seven years later, I can say that he's been one of my favorite aspects of working there.

When one reviews the excitement that has been generated over the last several years in regards to the advancement of therapy for NSCLC, it becomes painfully apparent that patients with adenocarcinoma have reaped the greatest benefits, and patients with squamous cell lung cancer have been more or less left out in the cold. The addition of Avastin to doublet chemotherapy prolongs life for patients with non-squamous cell lung cancer, while patients with squamous cell lung cancers have an increased risk of life-threatening bleeding from the lungs.

This is the first of the presentations by guest speakers at our NSCLC Patient Education Forum back in September. Dr. Gerard Silvestri is a pulmonologist, a lung disease specialist (not only cancer), and he is also one of the most important leaders in lung cancer within the field of pulmonology, as both a writer of some very important work and as a great speaker.

GRACE is very happy to have the opportunity to present this podcast by Dr. Heather Wakelee, medical oncologist at renowned lung cancer expert at Stanford University Cancer Center. The focus of this particular program, supported by an educational grant from GlaxoSmithKline, is on the most important research questions and clinical trials in the field of post-operative therapy for resected NSCLC.

When most oncologists think about the EGFR inhibitor tarceva (erlotinib), they think of the uncommon but very memorable patient who has a spectacular response within a few weeks of starting it, then continues to do well on it for a year or more. These patients are most commonly never-smokers, often Asian, and almost invariably have an adenocarcinoma. In contrast, many oncologists perceive there to be little to no value in giving tarceva to patients with squamous tumors, and many don’t even bother to offer it to these patients.

I would consider the recently published IPASS trial that compared Iressa (gefitinib) to standard chemo of carbo/taxol (paclitaxel) to be an extremely influential trial in lung cancer that has essentially ushered in a new era of molecularly-defined guidance of our treatment for many patients with advanced NSCLC, and we can expect that this is how we’ll be approaching a much broader population of lung cancer patients.