Keeping with the weekly theme of small cell lung cancer (SCLC), I thought I would comment on a newly published study by the Eastern Cooperative Oncology Group (ECOG), ECOG 3501.

The question of whether we should routinely have advanced NSCLC patients with a response or stable disease after four cycles of first line chemotherapy transition to immediate maintenance therapy or be watched during a treatment break has been the subject of several clinical trials and debates in the lung cancer community over the past couple of years.

For many years, chemotherapy for advanced or metastatic NSCLC had been limited to the use of “doublet” (two-drug) therapy using different combination regimens that were overall found to have very similar outcomes, but with different toxicity (side effect) profiles. Attempts to add a third chemotherapy agent for a triplet regimen, and numerous attempts to add different targeted-therapy agents, had dismal success. Not only did most of the combinations fail to improve on the survival outcomes, they increased the number of side effects compared with doublet chemotherapy alone.

Last week we discussed SATURN, the first of 2 recently presented trials testing the role of maintenance Tarceva (erlotinib) in advanced NSCLC patients. Today I will discuss the ATLAS trial, the last of the 4 major maintenance therapy trials (along with immediate versus delayed Taxotere (docetaxel) and maintenance Alimta (pemetrexed)).

The ASCO meeting I'm at right now is so busy that there really isn't time to write a new post (though I'm still "tweeting from the meeting"). Though the talk show hows just air re-runs of old shows when they're on vacation, I'm trying to continue to add new content to the website during this time (and it's about as far from a vacation as anyone has in Orlando).

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).

With all this recent talk about never-smokers with lung cancer, and the interest in stories of patients with so-called “oligometastatic” cancer (minimal metastatic burden to perhaps a single site), I thought I would describe a recent case in my clinic as an illustration of how I use this information in everyday decision making. Mrs. D, a very fit 36 year-old woman with a young child at home, presented to her family doctor last year with back pain. It didn’t seem to be getting better, so her doctor ordered an x-ray of the back which showed a very nasty-looking spot in the lower spine.

Since the anti-angiogenic agent avastin (bevacizumab) has been shown to confer a survival benefit in a subset of patients with previously untreated advanced NSCLC (see prior post), we have been struggling with questions of whether the restricted eligibility requirements in the pivotal initial avastin trial were necessary.

Several members have asked about the appropriate dose of avastin (bevacizumab), which is really still a controversial subject. It's worth exploring how we got here and where we are now.

While other doses of avastin have been used with other tumor types, the first study in lung cancer that used avastin tested two different doses, 7.5 mg/kg or 15 mg/kg combined with carboplatin and taxol (paclitaxel). This work was done at Vanderbilt Univ. Cancer Center by Dr. David Johnson and colleagues, and Dr. Laskin worked with them for a couple of years. This study had the following design: