The ASCO meeting I'm at right now is so insanely busy during the days and nights that it's next to impossible to carve out the time to write posts during the meeting. While the talk show hosts just show re-runs while they're on vacation, we're at least going to put up some new content, even if it's from work previously done (and this is far from a vacation).

With special thanks to Harvey and Bernice Janssen for providing support to make it possible, I'm pleased to post a new video presentation on the topic of Timing the Transition to Maintenance/Second Line Chemotherapy for Advanced NSCLC. We can expect new information to emerge in the coming months and years, but here is the current snapshot of what we know, along with a little describing what I think (noted as such), about this important topic today.

[powerpress]

For those accessing the audio only version (mp3), the accompanying figures are here, as well as a transcript:

Erlotinib (Tarceva) was approved for treatment of progressive non-small cell lung cancer (NSCLC) after the BR21 study that showed that tarceva not only improved survival but also improved lung cancer symptoms and quality of life. This study and others have also taught us that the benefit of tarceva is much better in those who had never smoked and less effective in current smokers.

A few weeks ago I described a blood test for predicting survival after getting an oral epidermal growth factor receptor (EGFR) inhibitor that is just becoming commercially available. This is called the Veristrat test and from company called Biodesix.

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 general rules in oncologist is that we typically use our most effective treatments first, and often early, though there are certainly exceptions. Women with metastatic breast cancer may have a higher response rate by receiving combination chemotherapy than single agent chemo, but when a gentle single drug chemotherapy or hormone therapy option will do very well and provide fewer side effects, that’s usually the approach we recommend until bigger guns are needed.

Back when I first started doing this, one of my earliest posts (see here) was on the question of whether EGFR tyrosine kinase inhibitors (TKIs) (see introduction to this work in prior post).

I'm very happy to present an audio interview with Dr. Eric Vallières, an excellent thoracic surgeon and Surgical Director of the Lung Cancer Program at Swedish Cancer Institute. Within the lung cancer community, he actually happens to be among the most well known thoracic surgeons in the country and even world, and he has a major expertise in the integration of chemotherapy and other systemic therapies for early stage lung cancer.

One of the most pressing issues in lung cancer research is in identifying patients who could benefit from a particular drug, both to increase their chances of having a good outcome and to spare everyone else from an ineffective drug with unnecessary toxicity. There have been some exciting advances in this field, but before I elaborate I want to give some (simplified) background on how drugs are traditionally developed. Classically, potential cancer drugs are tested on cancer cell lines in a Petri dish, and if the drug appears to kill the cells, it is then tested in animals.

Several years ago, we learned that EGFR tyrosine kinase inhibitors (TKIs) were not a very helpful strategy for an unselected population of frail patients in the US, clearly inferior to standard chemotherapy (see prior posts here and here).