As more and more oncologists become aware of the importance of testing for at least the EGFR mutation in tumor, and soon, perhaps, in blood, it seems likely that more patients will have their first systemic treatment for advanced non-small cell lung cancer (NSCLC) be an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), usually Tarceva (erlotinib), until Iressa (gefitinib) is re-approved (perhaps).

In the same issue of the New England Journal of Medicine that contained the IPASS trial results, Dr. Rosell and colleagues reported results of their effort to institute large-scale EGFR mutation testing in lung cancer patients in Spain, who then received erlotinib (Tarceva).

Member Neil Berch just wrote a nice summary of the four large randomized clinical trials being done with Zactima (vandetanib), an oral targeted therapy that can block both the VEGF (angiogenic) and EGFR pathways. In fact, the name vandetanib comes from blocking V and E.

Over the past couple of years a few large trials have emerged that have shown some value in switching patients to a new chemotherapy after, for instance, four cycles of first line chemo for advanced NSCLC, vs. an otherwise very reasonable alternative of stopping treatment in non-progressing patients and following them off of treatment, until progression.

With special thanks to Harvey and Bernice Janssen for providing support to make it possible, I'm pleased to post a new video presentation on the topic of Timing the Transition to Maintenance/Second Line Chemotherapy for Advanced NSCLC. We can expect new information to emerge in the coming months and years, but here is the current snapshot of what we know, along with a little describing what I think (noted as such), about this important topic today.

[powerpress]

For those accessing the audio only version (mp3), the accompanying figures are here, as well as a transcript:

One of the core issues in managing advanced NSCLC is second line chemotherapy, which was established as improving survival several years ago. This video presentation provides a brief summary of the work that led to the common use of chemotherapy in previously treated patients. Most typically, this is taxotere (docetaxel) or alimta (pemetrexed), and this presentation describes why we focus most commonly on these chemo agents.

[powerpress]

Several weeks ago, I described the results of a survey I sent out to several colleagues who are lung cancer experts around the country, asking how they would manage a case of a newly diagnosed Caucasian never-smoking patient with advanced NSCLC, adenocarcinoma, and asymptomatic subcentimeter brain metastases, treated with whole brain RT before starting systemic therapy.

We'll break from brain metastases for a while to talk about another potential avenue of targeted therapy in lung cancer: the cyclo-oxygenase, or COX, pathway.