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Dr. Jack West is a medical oncologist and thoracic oncology specialist, and Executive Director of Employer Services at the City of Hope Comprehensive Cancer Center in Duarte, CA.

Challenging Cases in Lung Cancer: Acquired Resistance to an EGFR Inhibitor in a Patient with Advanced NSCLC and EGFR Mutation
Sun, 12/18/2011 - 12:06
Author
Howard (Jack) West, MD, Associate Clinical Professor, Medical Oncology, Executive Director, Employer Services, Founder, President and CEO of GRACE

It's been a while since we released another podcast from the recording I did with Drs. Jyoti Patel from Northwestern and Bob Doebele from University of Colorado earlier this year.  In that session, we covered a series of real life scenarios in managing lung cancer that are at the outer limits of what we can say we know and leave us relying more on our best judgment than on evidence. Along with the comments by Drs. Patel and Doebele, we've then added responses from a collection of additional great lung cancer experts (Drs. Suresh Ramalingam, Jonathan Goldman, Julie Brahmer, Heather Wakelee, and Karen Reckamp) when presented with the same case.  Here, you can see the convergence of principles but also how we sometimes struggle in our varied recommendations.

Here is a podcast of an important topic that comes up here all too often: What do we do for a patient with advanced NSCLC  and a known EGFR mutation who has responded very well and for a long time to an EGFR tyrosine kinase inhibitor (TKI), but now demonstrates rather slow but clear progression compared to their best response?  Should we continue on the EGFR TKI without any changes for a while? When we decide a change is needed, how do we approach that? Do we stop the EGFR TKI temporarily or for good, or do we continue it and add a chemotherapy-based regimen in addition?  And when we reach a point of clear acquired resistance, how valuable is it to do a repeat biopsy? Is this just an arguably a nice thing to consider or an approach that the experts would clearly pursue?

Below you'll find the audio and video versions of the podcast, as well as the transcript and figures (in truth, this isn't a very video-oriented presentation, so you won't miss much by concentrating on the audio and/or the transcript only):

grace-cases-acquired-resistance-to-EGFR-TKI-audio-podcast

grace-cases-acquired-resistance-to-egfr-tki-transcript

grace-cases-acquired-resistance-to-egfr-tki-figures

Folks interested in this topic may also want to check the podcasts from our discussions/webinar with Dr. Lecia Sequist, of Massachusetts General Hospital, who spoke with us earlier about what we know and are still learning about acquired resistance to EGFR TKIs and also her follow-up discussion of the potential insights we might glean from repeat biopsies in this setting.

Thanks to all of our wonderful participants in these case discussions, and to LUNGevity Foundation for partnering with us in supporting this series.

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