Here's a situation in which I learned something from the questions raised by people here online. A handful of people with extensive disease small cell lung cancer (ED-SCLC) in the last year or two have mentioned receiving radiation for areas of residual apparent disease after receiving initial chemotherapy. I had noted that I had never done this and didn't really see a clear rationale for pursuing a local treatment like radiation for a disease that has already declared itself as spreading throughout the body.

One topic that is rarely considered in the management of SCLC is the role of surgery. The main reason is that the vast majority of patients presenting with SCLC either have extensive disease that has spread throughout the body (2/3 of SCLC presentations) or at least already have rather bulky nodal disease that would make then a less-than-ideal candidate for surgery even if they had NSCLC; the other key component of this bias against surgery is the strong tendency for SCLC to have micrometastatic disease even early in the disease process.

Last year, I had the occasion in two prior posts (here and here) to highlight a new agent called amrubicin that is being studied in relapsed SCLC. At an ASCO conference where most of the news in SCLC was disappointing, amrubin studies again appeared promising.

As described in my last post, one of the interesting points we've seen from the recent trial of maintenance alimta vs. placebo after first line chemo for advanced NSCLC is that alimta's beneficial effects appear to be concentrated on the 2/3 of patients with non-squamous cancers, while the patients with squamous cell NSCLC did no better with alimta than with placebo.

Getting back to the issue of differences in side effects and efficacy of treatments based on differences in individuals and populations, let’s continue the story of how different populations appear to have significant differences in how the do on the same treatment regimen. In a

While the differences in anticipated clinical benefits from EGFR tyrosine kinase inhibitors like tarceva and iressa are well known (summarized in prior post), less well appreciated is the potentially significant differences in results with garden variety standard chemotherapy.

Member Wendy asked me about a drug called picoplatin that I had heard of but really didn't have much familiarity with. This gave me an occasion to flesh out some background on this agent, which is being developed as a potential therapy for patients previously treated for lung cancer.

There's been several discussions about the potential value of maintenance therapy after the initial chemotherapy for SCLC; I've discussed this subject in a prior post, in which I focused on chemo -- while the results haven't been strong enough to lead to a change in standard practice, at least one trial showed a strong trend in the right direction.

Dr. Laskin has appreciated the warm welcome. Not only have you not scared her off, she's written her first post for us.

By the way, it's misleading to have my name and picture and "about the author" next to these posts by our new faculty -- the software upgrade will fix this. Here's her picture, so you can associate a name with a face (I had threatened to use a Wonder Woman picture if she didn't supply one).

This bit of news slipped under the radar for the past six weeks, but oral topotecan was approved by the FDA for the treatment of SCLC that has recurred at least 45 days after the last chemotherapy had been given. I'm a little embarrassed to say that I hadn't noted this, but it really got very little airplay. Part of it is that topotecan was already available and approved for recurrent SCLC in its IV form.