Dr. Bob Doebele from the University of Colorado offers his perspective on whether targeted therapies will be able to applied to broader populations of patients with advanced NSCLC than those primarily with minimal smoking histories and an adenocarcinoma.

[powerpress]

A topic that came up in a recent expert round table case discussion was the issue of how to manage a patient with a lung cancer for which the pathology report says "NSCLC not otherwise specified (NOS)", or "poorly differentiated NSCLC, NOS". What does this actually mean, and what does it mean in terms of treatment options?

I had the opportunity to sit down with Dr. Matthew Horton, a pathologist who works with my own group at Swedish Cancer Institute in Seattle, at a pathology company called CellNetix. He did subspecialty training in lung pathology and is a terrific resource for my colleagues and me, and now for a wider audience.

At the time that OncTalk (the predecessor to GRACE) was just getting off the ground in the fall of 2006 (wow, three years have gone quickly!), Avastin (bevacizumab) was just getting FDA approval in the first line treatment of advanced NSCLC.

When most oncologists think about the EGFR inhibitor tarceva (erlotinib), they think of the uncommon but very memorable patient who has a spectacular response within a few weeks of starting it, then continues to do well on it for a year or more. These patients are most commonly never-smokers, often Asian, and almost invariably have an adenocarcinoma. In contrast, many oncologists perceive there to be little to no value in giving tarceva to patients with squamous tumors, and many don’t even bother to offer it to these patients.

The most expert lung cancer pathologists in the world are planning a revision of the classification of lung adenocarcinomas that is expected to be approved and implemented next year, and it's going to make some big changes. Specifically, it's planning to eliminate the diagnosis of bronchioloalveolar carcinoma (BAC), reflecting our evolving understanding of this disease.