Lung Cancer

Late last year, I reviewed the approval of the agent XGEVA (denosumab) for patients with skeletal metastases from solid tumors after a randomized phase III trial demonstrated a significant reduction in the rate of development of skeletal-related events compared with the pre-existing standard of Zometa (zoledronic acid) for bone metastases.

As part of the series co-sponsored by GRACE and LUNGevity, challenging cases in lung cancer discussed with multiple experts, here's one on the common but vexing scenario of a patient with mediastinal node-positive (stage IIIA N2) NSCLC. This is among the most controversial clinical settings in lung cancer, as illustrated by the wide range of answers of how the experts in this program would manage the same patient. Some of the experts even note that the way that such a patient would be managed at their center would depend on the people weighing in on the case.

Good morning, GRACErs.

Plenary

Last night I had the good fortune to attend the fun young lung dinner. I had a lot of fun seeing old friends, and greatly enjoyed making a few new ones:

Plenary Session: Lung Cancer in Never Smokers

Continuing with this series of case-based podcasts we've done in partnership with LUNGevity, we'll again have a series of experts offer their own perspective to another challenging scenario. All are with the same format of me hosting and presenting the case to Drs. Bob Doebele from University of Colorado and Jyoti Patel from Northwestern University, who participated in the live webinar version of this, then followed in the recording by other terrific colleagues of mine weighing on the same case. These experts are:

The much-anticipated manuscript from the NCI-sponsored National Lung Screening Trial (NLST) was just published on line in the New England Journal of Medicine, with an editorial by Dr. Harold Sox.

The following is laden with personal opinion as much as actual evidence. Feel free to take it or leave it.

It's probably the biggest debate in lung cancer right now, and the answers are evolving every few months:

1) Which patients should be tested for molecular markers like EGFR, KRAS, ALK, etc.?

2) What tests should be sent?

3) When should these studies be sent? Right at the time of diagnosis ("reflex testing"), or after an oncologist has assessed how important these tests are really going to be, and decide which studies to send accordingly?