The ASCO meeting I'm at right now is so insanely busy during the days and nights that it's next to impossible to carve out the time to write posts during the meeting. While the talk show hosts just show re-runs while they're on vacation, we're at least going to put up some new content, even if it's from work previously done (and this is far from a vacation).

Over the past couple of years a few large trials have emerged that have shown some value in switching patients to a new chemotherapy after, for instance, four cycles of first line chemo for advanced NSCLC, vs. an otherwise very reasonable alternative of stopping treatment in non-progressing patients and following them off of treatment, until progression.

With special thanks to Harvey and Bernice Janssen for providing support to make it possible, I'm pleased to post a new video presentation on the topic of Timing the Transition to Maintenance/Second Line Chemotherapy for Advanced NSCLC. We can expect new information to emerge in the coming months and years, but here is the current snapshot of what we know, along with a little describing what I think (noted as such), about this important topic today.

[powerpress]

For those accessing the audio only version (mp3), the accompanying figures are here, as well as a transcript:

One of the core issues in managing advanced NSCLC is second line chemotherapy, which was established as improving survival several years ago. This video presentation provides a brief summary of the work that led to the common use of chemotherapy in previously treated patients. Most typically, this is taxotere (docetaxel) or alimta (pemetrexed), and this presentation describes why we focus most commonly on these chemo agents.

[powerpress]

One of the key points that has been established in first line treatment of advanced NSCLC is that two drug chemotherapy is superior to one drug chemo. Several trials from a decade ago showed that a two drug "platinum doublet" led to a longer overall survival than either a platinum alone (typically cisplatin at the time that these trials were performed) or another agent, such as paclitaxel alone.

With last week's FDA approval of alimta in the first line setting for NSCLC, we're likely to see a lot of alimta (pemetrexed) use shift from the second and third line setting to first line. Alimta's been a very popular choice for previously treated patients, based on issues like the relatively convenient schedule of a ten minute infusion one day every three weeks, no hair loss, and typically less of a drop in blood counts than seen with some other regimens.

Yesterday, as described in a press release, the FDA approved the regimen of cisplatin and alimta as a first line therapy for advanced NSCLC, based on the positive results from a trial called "JMDB" by the sponsor company (Eli Lilly).

As a follow-up to my last post on the appeal of developing new regimens for combining with radiation in treatment of locally advanced unresectable NSCLC, I wanted to highlight work being done by the Cancer and Leukemia Group B (CALBG), one of the major cancer cooperative research groups in the US.

As described in my last post, one of the interesting points we've seen from the recent trial of maintenance alimta vs. placebo after first line chemo for advanced NSCLC is that alimta's beneficial effects appear to be concentrated on the 2/3 of patients with non-squamous cancers, while the patients with squamous cell NSCLC did no better with alimta than with placebo.

I think one of the most important lead stories from ASCO 2008 got buried. Nobody's really talking about it yet, but they should.