Dr. Alan Sandler from OHSU describes how acquired resistance to targeted therapies in lung cancer is similar to what is seen with chemo and comments on how he manages patients demonstrating gradual acquired resistance in advanced lung cancer.

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We've covered the potential value of systemic therapy for early stage NSCLC in a wide range of posts and podcasts, and to summarize what we've learned in a sentence, it's basically that chemotherapy can significantly increase progression-free survival (PFS) and overall survival (OS) in patients who have undergone curative surgery for stage I-III NSCLC, but the benefit is far more convincing in patients with a high enough risk to justify the potential adverse effects of chemotherapy.

Introduction: Why Chemotherapy?

Dr. Alan Sandler is an international leader in the lung cancer world, also identified as among the most down to earth and funniest people in the field (and though that might not sound like much, he travels with an audio clip of a rim shot to play after his jokes). His talks are light-hearted, but he's so highly regarded because he has also been deeply involved in several of the pivotal research activities that have helped shape our current treatments.

For years it has been generally accepted that the choices for the second drug in a platinum doublet for treating metastatic non-small cell lung cancer (NSCLC) were pretty much interchangeable. The question of whether cisplatin is better than carboplatin is a separate question, one which GRACE’s own Dr.

We all know now that lung cancer, and in particular NSCLC, sits atop the list of cancer killers in the United States and western world. We also have been having extensive discussions on this site about all these great new treatment modalities: better staging (i.e. PET), better surgeries (i.e. VATS), radiosurgery (i.e. gamma knife), better radiation (i.e. IMRT), and better chemotherapy or targeted agents.

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.

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The average age at which lung cancer is diagnosed in the US is 71. Would it be fair to say that at least half of those who are diagnosed with lung cancer are elderly? How do we define “old”? How does age impact the effect of chemotherapy?

Several weeks ago, I described the results of a survey I sent out to several colleagues who are lung cancer experts around the country, asking how they would manage a case of a newly diagnosed Caucasian never-smoking patient with advanced NSCLC, adenocarcinoma, and asymptomatic subcentimeter brain metastases, treated with whole brain RT before starting systemic therapy.

One of the general rules in oncologist is that we typically use our most effective treatments first, and often early, though there are certainly exceptions. Women with metastatic breast cancer may have a higher response rate by receiving combination chemotherapy than single agent chemo, but when a gentle single drug chemotherapy or hormone therapy option will do very well and provide fewer side effects, that’s usually the approach we recommend until bigger guns are needed.