At this year's ASCO meeting, I had the opportunity to review and provide commentary on several presentations from other researchers, all on the topic of how to refine our ability to predict how patients will do after surgery for stage I - IIIA NSCLC, with an idea that this information can help guide decisions about who should receive chemo and who shouldn't.

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.

I think one of the most important lead stories from ASCO 2008 got buried. Nobody's really talking about it yet, but they should.

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

Within the lung cancer community, the biggest story from the ASCO meeting was the long-awaited plenary session presentation (abstract here) of the FLEX trial of chemo with or without the EGFR monoclonal antibody Erbitux (cetuximab) that we knew was statistically significantly positive for an overall survival benefit as far back as September of last year (see

When I first started OncTalk, there was a lot of buzz about celebrex (celecoxib) as a cancer drug, but almost all of it was among patients talking about it on the internet: oncologists watching the field hadn't been impressed by the early returns, including this one (despite the fact that some of my earliest work in lung cancer was on cyclo-oxygenase-2, or COX-2, the target of celebrex).

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.

Last year, a provocative trial was presented at ASCO that compared early vs. later taxotere as second line therapy. I described that study here, and it showed a very significant improvement in progression-free survival (PFS) and a near significant improvement in overall survival (OS) for the recipients of taxotere immediately after four cycles of first line chemo for advanced NSCLC.

At the 1st ESMO-IASLC Lung Cancer Conference in Geneva last week I saw a presentation that I thought would interest this general readership. The study, presented by Dr Grossi, from Italy, is a retrospective review of 61 patients with advanced NSCLC of all subtypes treated with either Tarceva (erlotinib) or Iressa (gefitinib) in the 1st or 2nd line setting. The groups were similar, remember this was not a randomized prospective study; the median age was 65 for those receiving Tarceva and 74 for those on Iressa. About 26% of the whole group were never/former smokers.

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.