Dr. David Gerber, University of Texas-Southwestern, reviews the current questions in managing locally advanced NSCLC with chemo/radiation as introduction to key issues addressed in trials from ASCO 2013.

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The Radiation Therapy Oncology Group (RTOG) has been working on a large randomized trial in patients with stage III, locally advanced, unresectable NSCLC that asked two key questions:

1) is the best dose of radiation the "old" standard of 60 Gray (Gy), over about 6 weeks, or a higher dose of 74 Gy that has been found to be feasible?

2) Is there a value in adding weekly Erbitux (cetuximab), the antibody to the epidermal growth factor receptor (EGFR), along with weekly carboplatin/Taxol (paclitaxel) and concurrent chest radiation therapy (RT)?

Drs. Nate Pennell, Mary Pinder, and Jack West discuss the START trial of L-BLP-25 (tecemotide) immunotherapy in locally advanced NSCLC.

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One of the highest profile clinical studies over the last few years has been the START trial of Stimuvax, also known as L-BLP-25 or tecemotide, an immunotherapy that looked promising in a randomized phase II trial that led to a subsequent phase III trial that administered Stimuvax or placebo after chemo and radiation for locally advanced (stage III) NSCLC, as described more in this post about STIMUVAX and the START trial from early 2007.

Dr. Greg Riely from Memorial Sloan-Kettering notes how he feels molecular marker results for patients with earlier stage lung cancer can potentially be valuable.

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Dr. Heather Wakelee from Stanford University discusses the open question of whether patients with resectable or locally advanced NSCLC should have testing for molecular markers, as well as how we might use this information in clinical practice.

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Dr. Jack West, medical oncologist at Swedish Cancer Institute in Seattle, Washington, talks about the right amount of chemotherapy for patients with locally advanced, non-small cell lung cancer. For more information, visit www.swedish.org/lungcancer

Here's a brief video on the basic premise of treating locally advanced non-small cell lung cancer. 

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I'll plan to do others in which I'll cover more details on it.  And if you've got video topics for me to cover, just offer your suggestions. 

Here's another case in the recording I did with Drs. Jyoti Patel from Northwestern and Bob Doebele from University of Colorado, discussing a series of perplexing cases in lung cancer management, then combining their comments with the responses from several other terrific experts (Drs. Suresh Ramalingam, Jonathan Goldman, Julie Brahmer, Heather Wakelee, and Karen Reckamp) about the same case.

Our multidisciplinary thoracic oncology tumor board is dynamic and a highlight of the week, facilitated in equal parts by the fact that our group genuinely enjoys each other’s company and that it is the source of some engaging debate about the potential best way to manage several complex scenarios in lung cancer.