Lung Cancer

Many of you already participating on the lung cancer section of the GRACE site have seen the first few responses by Dr. Aggarwal, though they have preceded my proper introduction of her.  Apologies -- we had talked a few months ago about having her start sometime around now, though I hadn't anticipated her laudable enthusiasm and courage to jump right in.  So let me now provide a little background.  

In my thoracic oncology tumor board today, we discussed a situation that comes up fairly often: a patient has a collapsed lung lobe from a tumor near the middle of the chest, with some regional lymph nodes involved, and the surgeon thinks he's likely to need the whole lung removed because the location of the tumor is nestled in just the wrong place.  The patient has enough lung function to undergo surgery, but losing an entire lung (pneumonectomy) is a big loss, and he's already only a debatable candidate to be able to undergo surgery safely.  So the question emerges, "Can we give

One of the very common themes that emerges in the questions from the GRACE community is whether a "local therapy" such as focal radiation or surgery could be useful for advanced NSCLC.

The idea is simple enough: we want to identify the patients with a resected early stage NSCLC that has a high risk of recurrence, so that we can give them additional therapy, usually in the form of post-operative (adjuvant) chemotherapy, while sparing this additional challenging and even potentially dangerous therapy for the people who have a more favorable prognosis.  Right now, the system we generally use to identify patients at higher vs.

One of the lung cancer surgeons I work closely with sent me and a couple of the radiation oncologists at my center a report that just came out from a group in Kyoto highlighting that they have a seen a notable proportion of their patients develop late recurrences, even well beyond five years, among their patients who underwent stereotactic body radiation therapy (SBRT) for node-negative early stage NSCLC many year

A few months ago, I had a patient in my clinic who is a lifelong never-smoker with an adenocarcinoma.  I had her tumor checked for molecular markers, which revealed that she had both an activating EGFR mutation (exon 19 deletion) and a T790M mutation associated with resistance (see Dr. Pennell's excellent summary for an introduction to EGFR mutations).

Drs. Bob Doebele, Ross Camidge, and their colleagues at the University of Colorado just published an interesting and clinically relevant paper in Clinical Cancer Research that looked in detail at the mechanisms of resistance in ALK rearrangement positive patients to the ALK inhibitor XALKORI (crizotinib).

Thanks (and congratulations) to GRACE member Craig, who highlighted the just-published report that is the first to characterize the frequency and clinical features of the newly identified ROS1 rearrangement, identified in 2007, similar in structure to an ALK rearrangement, and found to also be responsive in preclinical cell lines to ALK inhibitor therapy.

Several weeks ago we did a webinar, co-sponsored with LUNGevity Foundation, with Dr.

Dr. Pinder previously covered the potentially clinically relevant target of HER2/neu (HER2) mutations for lung cancer.   Specifically, she noted that Herceptin (trastuzumab), an antibody against the HER2 receptor (in the same family as EGFR, which is also known as HER1), but it hasn't been especially impressive in NSCLC thus far.