Dr. Jack West, Brendan Bietry, and Janet Freeman-Daily take questions from the audience about financial assistance, legal protections, and patient support.

Janet Freeman-Daily, a ROS1 lung cancer patient since 2011, talks about the importance of patients' involvement in their own health care and the support that exists online to help patients navigate the system.

The response of cancers with a specific driver mutation , such as an EGFR mutation or ALK rearrangement, to a targeted inhibitor of that target, is often dramatic and long-lasting, but it is also almost always limited in duration, typically lasting several months or a few years.  Beyond that point, we tend to see a subset of the cancer cells become resistant progress, perhaps manifested as one or several  new lesions or growth of one area against a background of most of the remainder of the cancer still being well-controlled.  

The short answer is no.

Introduction to Molecular Markers

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.

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.