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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.

Real Advances for KRAS Mutation-Positive NSCLC: Dr. Neal Reviews MEK Inhibitor Selumetinib
Sat, 09/15/2012 - 15:29
Author
Howard (Jack) West, MD, Associate Clinical Professor, Medical Oncology, Executive Director, Employer Services, Founder, President and CEO of GRACE

Dr. Neal continues his summary of ASCO 2012 highlights with a discussion of KRAS mutation-positive advanced NSCLC, a group that actually represents the largest group of NSCLC patients with a defined molecular marker, but also a group for whom we haven't had enough good answers.  Here, Dr. Neal summarizes the very promising work with the MEK inhibitor selumetinib combined with Taxotere (docetaxel), compared with Taxotere alone, for patients with advanced NSCLC and a KRAS mutation.  While the efficacy looks very favorable, it appears to come with a price of increased side effects that may prove to be prohibitively challenging.  Nevertheless, it qualifies as a potential breakthrough for a very significant subpopulation of patients with advanced NSCLC for whom we haven't had prior breakthroughs.

Below you'll find the video and audio versions of the podcast, along with the transcript and figures for this program. 

Dr. Neal ASCO 2012 LC Highlights Selumetinib KRAS mutn pos Adv NSCLC Audio Podcast

Dr. Neal ASCO 2012 LC Highlights Selumetinib KRAS mutn pos Adv NSCLC Transcript

Dr. Neal ASCO 2012 LC Highlights Selumetinib KRAS mutn pos Adv NSCLC Figs

Dr. Neal will continue with the controversial question of how best to manage a patient with a known EGFR mutation after they have completed potentially curative surgery for early stage lung cancer, describing a study he led.

But for now, the question centers around how much of a problem are side effects.  Here, a potentially useful advance in treatment was associated with a nearly 50% chance of being hospitalized from side effects.  To most oncologists, that's more damage than we can readily accept causing in someone we're treating with a goal of balancing life prolongation with quality of life.  Would most of you favor accepting a promising treatment with a threatening side effect profile, or would you favor waiting until we learn more, optimize how we use the drug, or perhaps find a related drug that might provide the benefit with fewer side effects?

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