Scans - PET-CT, etc.

Lung cancer screening is one of my least favorite topics to discuss because it's probably one of the biggest areas where there is a gulf between the medical establishment's party line and the expectations of many patients and advocates. I tackled a discussion of screening a few years ago that included the anticipated benefits as well as the challenges with LC screening (nowadays really focusing on low dose, spiral CT).

One of the basic concepts of oncology is that you treat patients with different drugs once they've shown progression on a treatment, rather than continue that a patient has presumably become resistant to. However, there are some exceptions to this: many or most women with breast cancer continue the antibody herceptin (trastuzumab) even after progression, adding it to one chemo and then the next, and the same is often done with avastin in colon cancer and sometimes lung cancer as well.

As I described in a post last year, one of the common features of angiogensis inhibitors is that lesion often cavitate, shrinking not only from the outside in, but hollowing out and dying from the inside out.

One of the principles of screening is that the likelihood of detecting a cancer depends greatly on the risk that a person being screen has for developing that cancer. Low risk means that it is very likely that any abnormality that is detected is more likely to be unrelated to cancer. And because of that, nearly all of the screening efforts thus far have focused on patients with a significant smoking history.

Continuing on the introduction to the concept from a recent prior post, the issue of whether it’s important to see an improvement in progression-free survival (PFS) if there is no improvement in overall survival (OS) after additional therapy is going to be a central issue in lung cancer management, relevant in several key issues in coming years.

One of the topics that frequently occurs in the clinic, and that patients often ask about, is the situation in which there is some suggestion of slight progression. This can take the form of many different situations: a rising tumor marker (see

Some members had previously asked about a breath test to detect lung cancer, and at the time I was not familiar with this work.

Thanks to member Carlos for bringing to our attention a high profile article in the New York Times today about some controversy now surrounding the Early Lung Cancer Action Project (ELCAP) trial, probably the most influential study of CT screening that has been done. Let me disclose immediately that my own institution, Swedish Hospital in Seattle, is a participating site in ongoing CT screening work led by Dr.

Intuitively, you'd think that people who are doing worse while getting treated for lung cancer are not going to do as well as people who have improvement in their symptoms after treatment starts. But how much do patient symptoms count in our current medical system for deciding whether a treatment is working or not, and when to move to a new therapy? The answer is that patient reported symptoms don't have a clear role yet.

An interesting article just came out in the Journal of Clinical Oncology from researchers at Duke, led by Dr. Ed Patz of the Radiology Department there (abstract here).