Lung Cancer

Following the excellent podcast by Dr. Rogerio Lilenbaum, lung cancer expert and now Chair of Cleveland Clinic Florida in Weston, on Considerations and Challenges of Treating Elderly Patients with Lung Cancer, he fielded questions from me and the folks in the live audience who attended. Here's that question and answer session, provided in audio and with the associated transcript. There isn't really any video/figures for this one.

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Like Charlie Brown always thinking that this time will be different when he tries to kick the football without Lucy pulling it away, we get lulled into thinking that we know the intuitive, obvious answer in medicine without really testing it, only to find that our assumption was wrong yet again.

Here's the presentation by my friend and colleague Dr. Rogerio Lilenbaum, a great medical oncologist now serving as Director of Hematology/Oncology at the Cleveland Clinic Foundation in South Florida (Weston, FL).

I'm at Swedish Hospital, not in Stockholm, Sweden now, where the European Multidisciplinary Cancer Congress is going on. But there, the preliminary results of the AVAPERL phase III randomized trial were just reported, and they certainly look encouraging for the combination of Alimta (pemetrexed) and Avastin (bevacizumab) as a maintenance therapy for patients with Avastin-eligible advanced NSCLC who hadn't progressed after four cycles of cisplatin/Alimta/Avastin, compared with maintenance Avastin alone.

Introduction

Thyroid transcription factor-1 (TTF-1) is a protein seen on the surface of thyroid cells, but also on about 70-75% lung adenocarcinomas and only a small minority (~10%) of squamous cell NSCLC tumors. In fact, the presence of TTF-1 on a NSCLC tumor provides a good hint for the pathologist that this is an adenocarcinoma. It's an immunohistochemical (IHC) test that is done on the vast majority of lung cancers, and there's some new information that suggests it may also be useful for predicting which patients are especially unlikely to have an EGFR mutation or ALK rearrangement.

For non-small cell lung cancer patients with multiple brain metastases, the standard approach of whole brain radiotherapy is not necessarily standard for each and every patient. Each patient's specific situation may sometimes be best approached with various combinations of surgery, radiation, medical/systemic therapy, and non-cancer directed treatment.

The marker known as an anaplastic lymphoma kinase (ALK) translocation has been all over the lung cancer news in recent weeks, most notably in the setting of being the marker in about 4% of patients with non-small cell lung cancer (NSCLC) that is correlated with a high probability of response to the ALK inhibitor crizotinib, which was just approved by the FDA for patients whose tumors demonstrate this marker on a test in a central reference laboratory.

Here's another case in the recording I did with Drs. Jyoti Patel from Northwestern and Bob Doebele from University of Colorado, discussing a series of perplexing cases in lung cancer management, then combining their comments with the responses from several other terrific experts (Drs. Suresh Ramalingam, Jonathan Goldman, Julie Brahmer, Heather Wakelee, and Karen Reckamp) about the same case.