Several weeks ago I had the opportunity to discuss a series of cases of locally advanced NSCLC with a couple of expert colleagues: Dr. George Blumenschein, medical oncologist in the Division of Thoracic & Head/Neck Oncology at MD Anderson Cancer Center in Houston, TX; and Dr. Walter Curran, radiation oncologist who heads the Division of Radiation Oncology at the Winship Cancer Center at Emory University in Atlanta, GA. Dr.
Our next podcast slide presentation comes from Dr. Shirish Gadgeel, medical oncologist at Wayne State University in Detroit. He came out to Seattle for a physician education program I run and was kind enough to stay for our NSCLC Patient Education Forum, where he spoke on our Current Standards of Care for Locally Advanced (Stage III) NSCLC.
Here's his presentation in audio and video formats, along with the transcript and copies of the slides.
As the next installment of the podcast series from the GRACE NSCLC Patient Education Forum, I'm pleased to offer a presentation by the Chief of the Thoracic Oncology Division at Swedish Medical Center in Seattle -- my own institution. Dr. Aye has been at the center of the program from the beginning, and whatever success our center has achieved in the field is a reflection on his steady leadership. He was one of the leading reasons I felt I would be happy at Swedish, and nearly seven years later, I can say that he's been one of my favorite aspects of working there.
With special thanks to the support of the Lung Cancer Connection and longtime member and friend of GRACE Myrtle Chidester, I am very happy to offer a new video podcast presentation on one of the most controversial and interesting areas of lung cancer management. Stage IIIA NSCLC with N2 mediastinal node involvement generates debates among the experts as well as at local hospital tumor boards everywhere, on a weekly basis.
In my last post I wrote about the prognostic value of molecular markers like EGFR and K-Ras that have generally been studied in patients with advanced NSCLC and treated with EGFR inhibitors, but these studies looked at prognosis in patients with early stage NSCLC who underwent surgery. These studies also provided some interesting results on the prognostic value of some clinical variables as well.
We've seen clear evidence that patients who have tumors with certain mutations in the EGFR gene are highly likely to respond to oral EGFR inhibitors like tarceva (erlotinib) or iressa (gefitinib) -- with response rates that are in the 70% range and often last for many months or even a few years (see prior post).
In prior posts I've described the special circumstance of a Pancoast tumor, which is a tumor at the top of the lung that tends to grow into the spine, ribs, and sometimes the nerves going to the arm. These cases are a major challenge because surgery is often something to consider, because they often grow locally more than speading to the rest of the body, but surgery can be a special challenge because the vertebrae are generally not considered to be resectable.
This audio interview by medical oncologist Dr. Jack West of radiation oncologist and lung cancer expert Dr. Vivek Mehta covers the current and emerging treatment options for radiation alternatives to treat early stage non-small cell lung cancer (NSCLC).
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.
To begin with, my overall impression is that the preponderance of evidence on adjuvant (post-operative) chemotherapy supports that it can reduce the recurrence risk and improve the survival at five years, which I'd presume to be pretty close to the "cure rate". The benefit isn't uniformly distributed for all patients: higher risk patients, as defined by stage and other additional factors like number of lymph nodes involved and the grade of the cancer, also matter.