The antibody to the epidermal growth factor receptor erbitux (cetuximab) (introductory post here) has been used as an effective treatment for colon and also head and neck cancer for several years, but its role in lung cancer has yet to be defined.

Although I've previously written about the question about optimal duration of therapy for first-line chemotherapy in advanced NSCLC (post here), these conclusions have been based on a limited number of trials. One study randomized patients to three or six cycles of rather old chemo and found no significant differences (abstract here).

As I described in my prior post, the marker ERCC1 (excision-repair cross complementing group 1) is a prognostic variable that is associated with a more favorable survival in patients who aren't treated with chemo after surgery for early stage NSCLC. But this marker also appears to be predictive of resistance to cisplatin and a worse survival in patients treated with platinum-based chemo after surgery.

Although I’ve described this concept in a few posts over the past year, it’s time for me to dedicate some real discussion to the concept of individualizing treatment with the ERCC1 marker. ERCC1 stands for excision repair cross-complementing group 1, and it helps repair damage to DNA.

The standard of care for at least stage I and II NSCLC is surgery, sometimes followed by chemotherapy. We know, however, that not every patient who presents with early stage NSCLC is healthy enough to pursue surgery, whether due to general age-related or other illnesses, or due specifically to a low pulmonary reserves, usually from years of smoking.

Among the key issues in following patients with a history of treated lung cancer is the pattern of recurrence. We need to have a sense of when the risk is highest and where people are more likely to demonstrate new evidence of disease. Fortunately, there are several studies that can help us with these questions.

There's a general concept out there that chemo is ineffective in treating brain metastases, and in fact, I've mentioned it in some comments here in the past. The reasoning behind this is that we know there's a blood-brain barrier, and we've presumed that chemo is blocked from crossing it.

Throughout multiple discussions of adjuvant chemotherapy, I've focused on the traditional approach used in the US and Europe of 3-4 cycles of platinum-based chemo, treating for up to about three months with a rather intensive approach. However, in Japan, they've studied the value of a different form of adjuvant treatment, with a drug called UFT that is generally well-tolerated, mild, and taken for 1-2 years by mouth.

In a very recent post I provided an introduction to the special case in NSCLC known as a Pancoast tumor, including a historical perspective of how it has evolved from being perceived initially as an untreatable, uniformly fatal diagnosis to a cancer that could be cured with radiation and then surgery in a significant minority of patients (35% in one large series).

One subtype of lung cancer that we haven’t specifically talked about is called a Pancoast tumor, named for the doctor who first described them. A Pancoast tumor is a NSCLC that is located in a groove called the superior sulcus (Pancoast tumors are also sometimes referred to as superior sulcus tumors), at the top (or apex) of each of the lungs. Here's the appearance of one on a chest x-ray: