A substantial revision of the staging system was presented at the World Conference on Lung Cancer in Korea this week. This project involved multiple lung cancer experts from all over the world and from a variety of specialties over the last several years, who reviewed the data on approximately 100,000 lung cancer cases, both NSCLC and SCLC. They looked at various ways to break down this large database of cases in order to provide a more accurate prognosis for patients.

Let's move to combinations of velcade with other anti-cancer agents. My friend, Dr.Angela Davies from the University of California at Davis, led a single-arm phase II trial conducted by the Southwest Oncology Group, SWOG 0339, that evaluated the combination of velcade with gemcitabine and carboplatin (abstract here).

Staging in lung cancer, as well has two categories, clinical and pathologic. The clinical staging is based on what appears on scans like the CT and PET scan that are now pretty routine parts of the staging workup. Our scans are better than ever before, but some lymph nodes with cancer involvement are not enlarged and have no visible abnormalities, and no scan can pick up lesions that are only visible as a small collection of cancer cells under a microscope.

The question of whether to use cisplatin or carboplatin in our "platinum-based chemotherapy doublets" that are the most common treatment for the first-line treatment of NSCLC has been a smoldering debate in lung cancer for more than a decade. Although at this point carboplatin is by far and away more commonly used than the generally less tolerable cisplatin, whether these are completely identical in their efficacy isn't entirely clear. Nobody questions that they're very close.

I've recently received some questions about the advantages and disadvantages of maintenance Avastin as a single agent for patients after completion of 6 cycles of first line chemo and avastin together for avastin-eligible patients. While this is generally considered to be a standard of care, many oncologists question whether it should be done. It's worth looking at how that standard came about and the strength of the evidence for it.

Our tendency in oncology is that once we find a new active drug in cancer, we try to add it to our current standard treatment approach and see if we can do better than what our current standard achieves. More is better. And we knew that the epidermal growth factor receptor inhibitors Iressa and Tarceva could lead to significant shrinkage of some lung cancers. So the lung cancer community was relatively optimistic about the clinical trials that compared chemo alone to the same chemo with Iressa or Tarceva.

So far, I've only written a few introductory posts on mesothelioma, but there were some interesting presentations at ASCO 2007 about the topic. One described the results of an expanded access protocol (EAP), which is when a company gives free access to a drug that is not yet commercially available (generally in exchange for participation in a data-collection study).

This work is still early, but it's been interesting to see a lab-based correlate emerge along with with the observation of women, and particularly older women, doing better in lung cancer studies (several prior posts here).

NOTE: ALL FIGURES CAN BE SEEN BY DOUBLE-CLICKING ON THEM, EVEN THOUGH NOT ALL APPEAR AS THUMBNAIL VIEWS PROPERLY.

When I first started OncTalk, my first priority was to get some basic posts on the site that provided a quick and dirty assessment of the best standards we had for different stages of lung cancer. But not only did several of these gloss over a lot of material very quickly, that was really before I could add figures. I'm going to try to go over some issues that are on the site in a more thorough manner; how chemo and radiation concurrently became the preferred approach for stage III NSCLC is a good place to start.