In addition to the presentations about the evidence, I thought it might be helpful to highlight some of my own clinic cases that can illustrate how I use the principles in practice. These cases should highlight that many if not most people don't exactly follow the "classic" example, and that if we were to open the case files from most oncologists, we'd find that it's very common (and appropriate) to bend the guidelines, to individualize based on the particular issues of a specific person. And I think it may also be helpful to see the range of what's possible.

While we work on making audio and video presentations available as podcasts and on youtube, I wanted to make the initial video presentation available for people who want to see the format and have an internet connection fast enough to download a LARGE file (>80 MB) in a timely way. If you're interested, click here to download the file, using a workaround application.

I've covered stage IIIA NSCLC in several prior posts, mentioning that it's a clinical setting that is among the most controversial, but I don't think I've really described my real world approach. To review, the controversy is that for stage IIIA NSCLC with mediastinal lymph node involvement on the same side as the tumor (N2 nodes), some people would recommend surgery as a main treatment strategy, and others would recommend chemo and radiation without surgery.

When I first described the developing work with the EGFR monoclonal antibody erbitux (cetuximab) two years ago (see prior post), I described a trial that was just getting started called SWOG 0536.

One of my good friends in the lung cancer community, Dr. Ed Kim from MD Anderson, was in town tonight and gave a talk that I attended.

At the recent Chicago lung cancer meeting, the idea of maintenance therapy emerged as a hot topic that is experiencing ongoing changes in our treatment approaches over time. The controversies about this topic begin with the very terminology. Here are four proposed names for the same basic idea:

1) maintenance therapy, which implies that one of the initial treatments is being continued on a longitudinal basis

My kids are right in the middle of that time when they watch SpongeBob and see commercials for toys, cereals, and music, nearly every one is puncuated at the end with, "Daddy, can we get that? I want that." There comes a time in everyone's life, hopefully early on, when we learn that we won't actually find eternal bliss with every advertised item.

As a general rule, companies don't sit on great news with their drugs. Without any insider knowledge, this was my concern about why we hadn't heard anything about the results of three major lung cancer trials with the agent Zactima (vandetanib), which I had written a post about 8 months ago (see prior post about these trials with Zactima, an oral agent that inhibits both VEGF, a major mediator of angiogenesis, and the EGFR pathway).

Continuing on the introduction to the concept from a recent prior post, the issue of whether it’s important to see an improvement in progression-free survival (PFS) if there is no improvement in overall survival (OS) after additional therapy is going to be a central issue in lung cancer management, relevant in several key issues in coming years.

Well, it happened again that the first word came from the financial community (report here), as we learned today that a large trial testing the value of maintenance tarceva (erlotinib), the oral EGFR inhibitor, provides a significant improvement in progression-free survival (PFS). In the following slide, I show the design for two similar trials that test the value of tarceva after four cycles of first line treatment of advanced NSCLC.