Ask and ye shall receive! The leading requiest for a video podcast presentation was for a summary of the subject of locally advanced, unresectable stage III NSCLC. Here you go:

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Sorry it's a little rushed, but it's a struggle to do a topic justice with a 10 minute limit (the most YouTube accepts). In the future, we'll try to divide bigger topics into two podcasts if it's going to require cramming into a 10 minute interval. It may help for you to have the images and transcript available, so here they are:

Malignant mesothelioma is a relatively rare but particularly deadly malignancy that arises from the lining of the pleural (chest) cavity or peritoneal (abdominal) cavity. About 70% of cases of mesothelioma are directly related to asbestos exposure, usually with about 30 or 40 years between exposure and diagnosis. While there are only about 2200 cases per year in the USA, this number is expected to increase over the next decade, as workers exposed to asbestos earlier in their lives eventually begin to manifest symptoms of the malignancy.

Several years ago, I participated in a clinical trial with a combination of carboplatin and irinotecan for treatment of extensive SCLC, just now being published (abstract here).

Although there has always been lattitude for individualizing treatment, I think developments in the last few years have added so many options that pretty much any standards we had from a few years ago have eroded.

With the recent publication of the Eli Lilly-sponsored phase III trial of immediate versus delayed Taxotere (docetaxel) after the completion of first-line chemotherapy in patients with advanced NSCLC (abstract of paper by Fidias and colleagues here), I think the time has come to critically evaluate this as a potentially practice-changing concept.

Interview by medical oncologist Dr. Howard (Jack) West with fellow medical oncologist and lung cancer expert Dr. Janessa Laskin from the British Columbia Cancer Agency in Vancouver, BC, Canada on current standards and controversial topics in post-operative (adjuvant) chemotherapy for early stage, resected NSCLC.

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Transcript here: Transcript Laskin on Adjuvant Chemo

A quick point on the importance of biology over treatment. Years ago, I highlighted the results in the TRIBUTE trial of chemo with placebo or combined with erlotinib (tarceva) at the same time (biomarker study abstract here), which showed that patients with EGFR mutations had a much better survival whether they received an EGFR inhibitor or not:

This pilot video slide presentation covers the development of our current standards for first line chemotherapy to treat advanced non-small cell lung cancer.

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These series will be called GRACEcasts (love it?), and we're in the process of developing a bunch of audio interviews with experts for an audio channel, and multiple video presentations, which are going to be about 10 minutes each, just little chapters at one time.

Let's return to what happened with Anne S., who I introduced in the last post. The highlights are that I met this woman in September of 2005, when she was 79, slowing down from many medical issues unrelated to cancer, wary about chemo, and with a cancer that was metastatic but that had progressed only minimally in the months between the initial detection of her cancer and when I first saw her. We agreed that attentive follow-up made sense.

In addition to the presentations about the evidence, I thought it might be helpful to highlight some of my own clinic cases that can illustrate how I use the principles in practice. These cases should highlight that many if not most people don't exactly follow the "classic" example, and that if we were to open the case files from most oncologists, we'd find that it's very common (and appropriate) to bend the guidelines, to individualize based on the particular issues of a specific person. And I think it may also be helpful to see the range of what's possible.