For our 4th video in the GRACE Spanish Lung Cancer Library, Antonio Calles, MD joined GRACE to discuss what the role of Avastin (bevacizumab) is in treating advanced NSCLC today.

For our third video in the GRACE Spanish Lung Cancer Library, Antonio Calles, MD, Medical Oncologist, Thoracic Oncology Program, Hospital General Universitario, Gregorio Marraron, Madrid, Spain joined GRACE to discuss how NSCLC subtype (histology) can alter chemotherapy recommendations in advanced NSCLC.

Here's a brief video that explains my approach to a so-called "mixed response" to treatment for a lung cancer.  

[powerpress]

There isn't a formal teaching or "best answer" about how to approach this issue, but what I explain here is a common and I think very sensible strategy for a still controversial clinical setting (if I do say so myself).  I'd welcome your comments.

I hope you find it helpful if you or someone you care about faces this situation.

For years it has been generally accepted that the choices for the second drug in a platinum doublet for treating metastatic non-small cell lung cancer (NSCLC) were pretty much interchangeable. The question of whether cisplatin is better than carboplatin is a separate question, one which GRACE’s own Dr.

With all this recent talk about never-smokers with lung cancer, and the interest in stories of patients with so-called “oligometastatic” cancer (minimal metastatic burden to perhaps a single site), I thought I would describe a recent case in my clinic as an illustration of how I use this information in everyday decision making. Mrs. D, a very fit 36 year-old woman with a young child at home, presented to her family doctor last year with back pain. It didn’t seem to be getting better, so her doctor ordered an x-ray of the back which showed a very nasty-looking spot in the lower spine.

One of the basic concepts of oncology is that you treat patients with different drugs once they've shown progression on a treatment, rather than continue that a patient has presumably become resistant to. However, there are some exceptions to this: many or most women with breast cancer continue the antibody herceptin (trastuzumab) even after progression, adding it to one chemo and then the next, and the same is often done with avastin in colon cancer and sometimes lung cancer as well.

With the recent publication of the Eli Lilly-sponsored phase III trial of immediate versus delayed Taxotere (docetaxel) after the completion of first-line chemotherapy in patients with advanced NSCLC (abstract of paper by Fidias and colleagues here), I think the time has come to critically evaluate this as a potentially practice-changing concept.

We have long noted that there is a clear association of smoking history with effectiveness of oral EGFR tyrosine kinase inhibitors (TKIs). Part of this is because never-smokers have a high incidence of carrying activating EGFR mutations, but also potentially because current smokers actually metabolize EGFR TKIs faster (see prior post).

A press release today informs us that the ATLAS trial of maintenance avastin (bevacizumab) combined with tarceva (erlotinib) vs. avastin with placebo was positive for a significant improvement in progression-free survival (PFS). We had already learned that the very similar SATURN, of maintenance tarceva vs.