In the last decade, the treatment of NSCLC has evolved very significantly, and one of the leading ways has been that we've gone from having no established role for treatment after initial, first line therapy to having multiple agents with a proven benefit. It's worth clarifying that as maintenance therapy is increasingly being considered as an option after first line therapy, a distinction between this and second line therapy.

The historic standard for advanced NSCLC up until a few years ago was for patients to complete 4-6 cycles of platinum-based doublet chemo, and then for patients who were doing well and had responded or demonstrated stable disease to take a break from treatment and be followed until progression. At that point, many patients would re-initiate chemo or targeted therapy with an oral agent like Tarceva (erlotinib).

When I was a medical student, the question about lung cancer that was always asked on "the Boards" had to do with the difference between stage IIIA and stage IIIB non-small cell lung cancer (NSCLC). The reason this question was always asked is because patients with stage IIIA NSCLC might be considered for surgery, whereas patients with stage IIIB NSCLC would not be considered for surgery and instead would be treated with chemotherapy and radiation. The idea is that young doctors should be able to make that distinction and to direct patients to the appropriate specialist/treatment.

Several weeks ago, my colleagues Dr. Tom Hensing from North Shore Health System in Chicago, affiliated with the University of Chicago, and Dr. David Jackman from Dana Farber Cancer Institute in Boston, were kind enough to take the time to go over a series of cases in a webinar format. We reviewed the time line of several patients with advanced NSCLC, focusing on two central questions:

1) For various clinical situations, which molecular markers would you be inclined to recommend?

Dr. Mark Socinski, international leader in the field of lung cancer, from the University of North Carolina at Chapel Hill, gave a terrific presentation on timing and selection of treatment after the first line setting for advanced NSCLC. In addition to the podcast of his presentation itself, here now is the question and answer session that followed it.

The Q&A portion includes slides with the questions as well as some slides that illustrate key points. Below, you'll find the audio and video versions of the podcast, the figures, and also the transcript of the program.

It was nearly three years ago when the results of a randomized phase III trial of the chemotherapy agent Javlor (vinflunine) compared with standard second line Taxotere (and its proven survival benefit in previously treated advanced NSCLC), both drugs given IV every three weeks.

I'm very pleased to offer the podcast materials for the recent webinar by Dr. Mark Socinski, medical oncologist and leader of the excellent Thoracic Oncology Program at the University of North Carolina, in Chapel Hill. He's been a long-time leader of the entire field of lung cancer for many years, and he's among the best at synthesizing new information into a cogent perspective.

Here is the audio and video versions of the podcast, along with the figures and transcript that go with the program.

[powerpress]

Over the past several months the topic of so-called maintenance therapy in advanced NSCLC has been one of the most timely and controversy questions in lung cancer. We've had posts here covering a trial testing immediate vs.

At ASCO a little over a month ago we learned the preliminary results of the SATURN trial that compared "maintenance" Tarceva (erlotinib), the oral EGFR inhibitor, to an oral placebo in patients who showed no progression after four cycles of first line chemotherapy.