Refining the Treatment Populations for Erbitux in Lung Cancer: Can We Make the Juice Worth the Squeeze?

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The FLEX trial raises a number of additional points as we struggle to determine how to integrate Erbitux (cetuximab) into the current standards of care. One question is whether we can refine how well we do with Erbitux by using clinical or molecular variables to select better or worse candidates for it. I already mentioned in my prior post that Asian patients (among whom 52% were never-smokers) had a far better survi

Dose Escalation with Tarceva? Dosing to Rash?

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As I've described in a prior post, there is some evidence that patients who develop a rash on tarceva (erlotinib) have an improved survival compared to patients who experience no skin toxicity on tarceva. The key question is whether this is an issue of under-dosing some patients, or if it's just a correlate of overall immune function or constitution in a person, in which case increasing the dose won't improve the outcome.

Arguing Against Molecular Testing for EGFR in NSCLC

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So I’ve been invited to be on the faculty of a lung cancer conference in Kauai next month (yes, a good gig, but this is the first year that the flights are so expensive that I can’t bring my family to this normally very family-friendly event), and my topic is to argue in a debate about whether molecular testing for EGFR should be routinely used in clinical practice.

Biomarkers Predicting Clinical Benefits for BAC Patients Receiving Tarceva

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Continuing with the analysis of a publication about tarceva (erlotinib) for patients with advanced BAC that I introduced in the last post, we'll turn now to the analysis that Dr. Vince Miller and colleagues did on the biomarkers that might predict more or less clinical benefit with an EGFR inhibitor like tarceva (abstract here).

Survival Benefit in Another Erbitux Trial for Advanced NSCLC Reported

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Although it’s only a leak from a “reliable source”, news came yesterday (link here) about a new lung cancer development from a financial source (yet another example of us learning oncology from Wall Streeters). Specifically, we heard that the BMS-099 that I described in a prior post is actually demonstrating a significant benefit in overall survival (OS).

Bevacizumab (Avastin) Dose: An Open Question

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Several members have asked about the appropriate dose of avastin (bevacizumab), which is really still a controversial subject. It's worth exploring how we got here and where we are now.

While other doses of avastin have been used with other tumor types, the first study in lung cancer that used avastin tested two different doses, 7.5 mg/kg or 15 mg/kg combined with carboplatin and taxol (paclitaxel). This work was done at Vanderbilt Univ. Cancer Center by Dr. David Johnson and colleagues, and Dr. Laskin worked with them for a couple of years. This study had the following design:

Tarceva vs. Standard Chemo Compared for Marginal Performance Status Patients, by Dr Laskin

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One of the issues we struggle the most with, as oncologists, patients, and families, is how to choose a therapy that won’t make someone feel worse. There are so many things to factor into these decisions: what is the baseline function of the person, what comorbidities (other chronic illnesses) might interact or interfere, what side effects are acceptable or worth the risk, to what degree is the cancer interfering with their functioning and can this be reversed with chemo, and of course what does any individual patient want and expect from chemo?

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