Tales from the Clinic: Mucinous BAC

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In my last post I outlined the typical clinical scenario for pneumonic bronchioloalveolar carcinoma (BAC), which is typically the mucinous subtype of this unusual disease. In fact, we are still actively learning a great deal about BAC, enough for the lung cancer experts to begin to develop a more sophisticated view that the mucinous and non-mucinous subtypes have different behaviors and respond differently to treatments.

Pneumonic BAC: The Subtype Very Unlike Other Forms of BAC

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One of the issues with BAC is that I've referred to it as potentially very indolent, but as we've learned more about BAC, it's become clear that there is a great degree of heterogeneity in BAC cases. We're learning that the cases that are more often slowly progressing and sometimes exceptionally responsive to EGFR inhibitors like tarceva and iressa are far more likely to be non-mucinous BAC. These typically have the appearance of innumerable small nodules throughout the lungs.

Trial of Ongoing Chemo vs. Switch to Iressa for Japanese Patients with Advanced NSCLC

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An interesting trial presented at ASCO 2008 came out of Japan, asking the question of whether there is an advantage to continuing first line platinum-based doublet chemo for up to six cycles or whether it might be better to give just three cycles and then switch from chemo right to the EGFR inhibitor iressa in Japanese patients with advanced NSCLC (abstract here).

Actions Speak Louder than Words: When Pathology and the Clinical Picture Don't Fit

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I've been involved in a wide range of discussions, both here and in my own clinical, about the fairly common situation of how to approach a situation in which the story on paper and what you see actually happening are incompatible. For instance, last week I and several of my colleagues participated in a journal club (a group discussion of a new and/or controversial journal article or two), in which the topic was the potential utility of doing surgery for unusually early small cell lung cancer tumors.

Insulin-Like Growth Factor Receptor-1 Inhibitor Continues to Look Favorable in Squamous Cell NSCLC

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One of the abstracts in lung cancer that I noted as being particularly noteworthy before ASCO 2008, but which I haven't managed to mention since, is a trial of a monoclonal antibody known as CP-751,871 that targets and inhibits insulin-like growth factor receptor-1(IGF-1R), a molecule that appears to be involved with cell growth, balance of programmed cell death, and likelihood of metastatic spread (abstract he

Removing Lymph Nodes During NSCLC Surgery: “How Does It Play in Peoria?”

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In the past couple of posts we’ve seen that based on evidence from Japan and Rome, number of lymph nodes resected and also the absolute number of positive nodes and/or proportion of positive nodes may be important prognostic variable. A third abstract I reviewed on the same subject came from Peoria, IL, and illustrated a key reason why using these variables may not be as consistently useful as we’d like, at least in many parts of the world.

Is Number of Positive Lymph Nodes in Resected NSCLC Important for Prognosis?

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At this year's ASCO meeting, I had the opportunity to review and provide commentary on several presentations from other researchers, all on the topic of how to refine our ability to predict how patients will do after surgery for stage I - IIIA NSCLC, with an idea that this information can help guide decisions about who should receive chemo and who shouldn't.