Here I briefly discuss a challenging case of a patient who has an exon 20 mutation in the EGFR gene, which isn't one of the mutation types associated with a high probability of responding well to an oral EGFR inhibitor.  I cover the approach I favored and also some limited information that has just emerged to help clarify what we might expect for patients with an uncommon to rare variant  of an EGFR mutation (~5% of mutations detected).

[powerpress]

I hope it's interesting and helpful.  As always, I welcome your comments and questions.

Here's a video I just did in response to my recent spate of molecular marker studies I've sent in the last 4-6 weeks that have come back with quite a few positive results for an EGFR mutation or ALK rearrangement, as well as one patient positive for a ROS1 rearrangement.  For each of these patients, the results have had a major impact in the opportunity for them to receive an oral therapy with a high probability of response, and in a few cases, we've already seen a significant improvement.

One of the current controversies in the field of lung cancer is whether we should be doing biopsies routinely when a patient develops progression of their disease, particularly in the setting of acquired resistance to a molecularly targeted therapy.  There are some academic oncologists who favor this approach, but I think there's a very good reason why this isn't and shouldn't be the current standard of care.

[powerpress]

It has been a long time since we've talked about Nexavar (sorafenib), an oral anti-angiogenic targeted therapy that works as a "multi-kinase inhibitor"  and is FDA approved in some other cancers such as renal cell and liver cancer.  In lung cancer, some small, early research done years ago revealed that it has activity in at least a minority of patients with advanced NSCLC.

We've covered a wide range of topics  in our "ASCO 2012 Lung Cancer Highlights" podcast series over the last few weeks.  This webinar and the podcasts from it featured Drs.

Here is Dr. Neal's summary from the ASCO 2012 Lung Cancer Highlights program of the SELECT Trial, which he led and presented, of adjuvant (post-operative) Tarceva (erlotinib) for patients with resected early stage EGFR mutation-positive NSCLC.

As part of our program on lung cancer highlights, Dr.

The response of cancers with a specific driver mutation , such as an EGFR mutation or ALK rearrangement, to a targeted inhibitor of that target, is often dramatic and long-lasting, but it is also almost always limited in duration, typically lasting several months or a few years.  Beyond that point, we tend to see a subset of the cancer cells become resistant progress, perhaps manifested as one or several  new lesions or growth of one area against a background of most of the remainder of the cancer still being well-controlled.  

One of the questions that comes up fairly frequently is what to make of a "mixed response" to systemic therapy: after several weeks or months of treatment, a scan shows some areas of known disease shrinking, but others are growing.  Why might this happen? What does it mean? And what should it lead us to do?

Folks here know that just about every day we discuss questions of what molecular marker test to order for lung cancer, how important it is, how it's done, what tissue is needed, and other very timely and practical issues in lung cancer.  These are questions that evolve every few months, as new research emerges with different markers.