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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.

Transitioning Survival from Months to Years in Advanced NSCLC
Sat, 05/10/2014 - 17:21
Author
Howard (Jack) West, MD, Associate Clinical Professor, Medical Oncology, Executive Director, Employer Services, Founder, President and CEO of GRACE

This is a slide presentation I did last week at a local conference, describing the steady, incremental improvements in survival with advanced/metastatic non-small cell lung cancer (NSCLC) that have occurred over the past 10-15 years.  There are still many pessimists who highlight that we haven't cured metastatic lung cancer or most other advanced cancers, but I would contend that it is quite meaningful to be able to tell a patient with cancer that your treatment is quite likely to improve their survival and that, because of it, an ever-growing proportion of patients are living years with it, rather than the expectation of months that prevailed several years ago. 

This presentation highlights a couple of key developments:

1) More patients are receiving more lines of effective therapy. For patients with responsive cancer (unfortunately not everyone with advanced NSCLC), survival is improved not just with first line but also with later lines of treatment. Approaches like maintenance therapy and routine use of second line and later therapy translates to far more patients living beyond a year, sometimes well into the range of years, even independent of molecular markers.

2) A growing minority of patients are found to have a cancer that appears "driven" by a key biomarker for which we have a proven or potential target. Starting with EGFR mutations, seen in about 10% of NSCLC patients in North America, and then ALK rearrangements in another 4-5%, we've since added ROS1 and are looking at additional potentially fruitful targets like BRAF, HER2, and others.  These responses tend to be dramatic and prolonged. Even if the responses lasting years are only available to a minority of patients, we are adding to that minority year after year.

Of note, this slide deck does NOT cover immunotherapy. In part, this is because these strategies still have undefined, unproven benefit.  In addition, immunotherapy for lung cancer was the subject of a separate talk, and I did not want to encroach on that topic.

Here's the presentation. I hope you find it thought-provoking and encouraged that we're making progress, even if it can never be fast enough.

 

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