Lung Cancer

Dr. Lecia Sequist describes the state of the art and her view of current best practices on molecular testing for advanced non-small cell lung cancer.

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Dr. Geoffrey Oxnard describes the new finding of individuals with an inherited T790M mutation in the EGFR gene, the unclear significance of it, and a study being conducted to learn more about it.

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We were fortunate enough to have Dr. William Pao of Vanderbilt-Ingram Cancer Center in Nashville join us to discuss his pioneering My Cancer Genome project in his own words:

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Dr. Jack West, medical oncologist at Swedish Cancer Institute in Seattle, Washington, talks about the right amount of chemotherapy for patients with locally advanced, non-small cell lung cancer. For more information, visit www.swedish.org/lungcancer

I just did a brief video for Swedish Medical Center on the issue of low dose CT screening for lung cancer, which has been proven to improve survival.  Though Dr. Otis Brawley, Chief Medical Officer of the American Cancer Society, just wrote a book about the risk of over-diagnosis of cancer, the ACS has just officially endorsed lung cancer screening, recognizing its value.

The only problem is that it really isn't being done. I discuss a bit on the resistance to screening here:

Here I briefly discuss a challenging case of a patient who has an exon 20 mutation in the EGFR gene, which isn't one of the mutation types associated with a high probability of responding well to an oral EGFR inhibitor.  I cover the approach I favored and also some limited information that has just emerged to help clarify what we might expect for patients with an uncommon to rare variant  of an EGFR mutation (~5% of mutations detected).

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I hope it's interesting and helpful.  As always, I welcome your comments and questions.

This is the first in a series of "uncut" videos that I'm starting that will focus on illustrative cases from my clinic that highlight some broader teaching points.  This particular video is on the decision-making process that led me to recommend adjuvant chemotherapy for a patient who underwent surgery for a 3.5 cm lung adenocarcinoma without lymph node involvement.

Here's a recent video podcast I just did on the publication just out in Lancet Oncology, describing a randomized phase II study led by my friend Pasi Janne, from Dana Farber Cancer Institute in Boston.

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The report of the phase II randomized trial of MEK inhibitor selumetinib for KRAS mutation-positive NSCLC was just published in Lancet Oncology.  Here's my discussion of some of the highlights of this work and what this means.

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The question of how best to manage "acquired resistance" to a targeted therapy like an EGFR or ALK inhibitor in someone who has had a great response for a long time can be complicated and really doesn't have a best answer.  However, other doctors and many patients here and in the brick and mortar world ask me about how I approach it, and I've got some real opinions about it.  I'll qualify my further comments by saying that my own views have evolved over the years as we've gained more information as we get more clinical data and practical experience.