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December 7, 2012

What does survival benefit in the PARAMOUNT trial of continuation maintenance therapy mean?

  One of the highlights in advanced NSCLC from ASCO 2011 was the early results from the PARAMOUNT trial of continuation maintenance pemetrexed vs. placebo after first line cisplatin-pemetrexed. Among 939 patients with advanced non-squamous NSCLC who were enrolled, 539 (57%) hadn't progressed or experienced prohibitive toxicity after four cycles and were randomized 2:1 to active drug vs. placebo.  While the (progression-free survival) PFS showed a hazard ratio of 0.62 favoring maintenance pemetrexed, the results in 2011 didn't include a presentation of overall survival (OS), which was too preliminary for presentation then. But at ASCO 2012, we saw that there was also a significant improvement of OS from 14.0 to 16.9 months from the time of initiation of first lin...

Posted By: H. Jack West  

November 21, 2012

October 20, 2012

Chemo vs. Erlotinib for EGFR WIld Type: Does the TAILOR Trial Really Fit?

In the US today, either erlotinib or single agent chemo with docetaxel or pemetrexed (the latter for non-squamous NSCLC only) are FDA approved as second line therapies.  In general, the results with these agents have been pretty comparable, including when they have been compared head to head, such as in the

Posted By: H. Jack West  

October 10, 2012

Afatinib for EGFR Mutation-Positive Advanced NSCLC: Is It Better than What We Already Have?

  One of the more anticipated trials from ASCO 2012 was the LUX-Lung 3 trial (Yang et al, ASCO 2012), a global study that compared afatinib, an irreversible oral "pan-HER" family tyrosine kinase inhibitor (TKI), to standard chemo with cisplatin/pemetrexed for EGFR mutation-positive advanced NSCLC. The trial was clinically and statistically significantly positive for the endpoint of progres...

Posted By: H. Jack West  

August 26, 2012

Is Single Agent Chemo Under-treating Marginal Performance Status NSCLC Patients?

Over the last few years, we've seen a lot of data emerge to support the idea that the rather common practice of treating elderly patients with single agent chemo may be doing them a disservice.  In trial after trial, results have shown that the more fit elderly patients do well with the regimens we routinely recommend for younger patients with a good performance status (PS).  OK, it's...

Posted By: H. Jack West  

July 20, 2012

Breaking the KRAS impasse, if we can overcome toxicity

  One of the most provocative presentations in lung cancer at ASCO was by Dr. Pasi Janne from Dana Farber Cancer Institute in Boston, who described a randomized phase II trial of docetaxel with the MEK inhibitor selumetinib vs. docetaxel alone as a second line therapy for patients with advanced NSCLC that harbors a KRAS mutation (

Posted By: H. Jack West  

July 4, 2012

My Top Ten Lung Cancer Highlights from ASCO: The View from 20,000 Feet

  It's long enough that I've now dug myself out after playing catch-up in the return from ASCO.  It's now time for the debrief.  I thought I'd start with a mention of what I'd consider to be the lung cancer highlights from ASCO, then go into some detail about them.  While there was nothing that I think was clearly practice changing, and the only new approval that I can fores...

Posted By: H. Jack West  

May 17, 2012

Should We Continue Targeted Therapies in NSCLC after Acquired Resistance Develops?

Since the EGFR tyrosine kinase inhibitors (TKIs) came into use over the last decade or so, we have continued to explore how best to use them.  From this and good clinical research, what has emerged is our understanding that a subset of patients, highly correlated with the presence of an activating mutation, often have a very dramatic and prolonged (9-12 months median, but often extending i...

Posted By: H. Jack West  

April 6, 2012

Could We Go from Pooled, Collaborative Art Projects to a Poor Man's Cooperative Group?

The idea of people collaborating from all over on a shared project has been highlighted in some cool ways recently.  The "Johnny Cash Project" involves artists from everywhere contributing a few seconds of video material to produce a cohesive video from one of his last songs before he die...

Posted By: H. Jack West  

January 13, 2012

Whose job is it to consider the cost of cancer treatment?

   This issue certainly isn't specific to lung cancer, but the costs of molecular testing and new treatments for lung cancer have added a lot of expense in a setting where, at least for metastatic disease, our efforts provide a hope of prolonging survival but can't realistically confer a cure. With crizotinib now approved at a cost of about $9600/month and only available after we test...

Posted By: H. Jack West  

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About This Blog

Blowing Smoke is a blog featuring a mix of data and timely commentary on lung cancer and other aspects of thoracic oncology.

The content of this blog does not necessarily reflect the viewpoints of Medscape.
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