Lung cancer remains the leading cause of cancer-related death in the. Evolving Treatment Paradigms in Non-Small Cell Lung Cancer

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Lung cancer remains the leading cause of cancer-related death in the. Evolving Treatment Paradigms in Non-Small Cell Lung Cancer"

Transcription

1 PRINTER-FRIENDLY VERSION AT CLINICALONCOLOGY.COM Evolving Treatment Paradigms in Non-Small Cell Lung Cancer KATHRYN F. MILEHAM, MD Staff Oncologist HEATHER D. BROOKS, MD Staff Oncologist EDWARD S. KIM, MD Chair, Solid Tumor Oncology and Investigational Therapeutics Donald S. Kim Distinguished Chair for Cancer Research Levine Cancer Institute Carolinas HealthCare System Charlotte, North Carolina Lung cancer remains the leading cause of cancer-related death in the United States, accounting for 30% and 26% of all cancer deaths in men and women, respectively, and exceeding the predicted death rates for breast and colorectal cancers combined. 1 The overall 5-year relative survival is a staggering 15.6%. 2 Non-small cell lung cancer (NSCLC) is the most common histologic subtype, accounting for more than 85% of all lung cancer cases. The evolution of conventional lung cancer treatment and personalized therapy continues. Screening studies finally have established a role for early detection. However, very few patients present with earlystage disease. With the majority of patients presenting with advanced disease, better evaluation and treatment decisions using histology and molecular therapies are desperately needed. Current treatment plans have resulted in an increased median overall survival (OS) from 2 months to more than 12 months. 3,4 Still, the need for improved outcomes with reduced treatment toxicity persists in a time when personalized therapy is evolving into a standard. Conventional Chemotherapy Since 1997, the American Society of Clinical Oncology (ASCO) has recommended the use of cisplatin-based chemotherapy for patients with advanced NSCLC and an adequate performance status. This was based on a meta-analysis of 52 clinical trials with more than 9,000 patients. 5 Cisplatin-based chemotherapy showed a 27% reduction in the risk for death at 1 year. 6 CLINICAL ONCOLOGY NEWS SEPTEMBER

2 Subsequent clinical trials focused on increasing efficacy using newer agents and decreasing toxicity by substituting carboplatin for cisplatin. Although the role of platinum-based doublet regimens as a mainstay has been well established, this paradigm is changing dynamically as newer agents are developed and molecular targets are identified. Two variables must be considered in the choice of a platinum-based doublet: the platinum agent used (cisplatin or carboplatin) and the agent combined with the platinum. Chemotherapeutics approved for use in this setting include paclitaxel, gemcitabine, vinorelbine, docetaxel, and pemetrexed (Alimta, Lilly). Results from a large trial comparing cisplatin-paclitaxel with 3 other regimens (carboplatin-paclitaxel, cisplatin-docetaxel, and cisplatin-gemcitabine) found no significant difference in OS (median 7.9 months) among the 4 regimens. 7 Of note, there were less serious toxicities reported in patients treated with carboplatin-paclitaxel. More recently, nanoparticle albumin-bound paclitaxel (Abraxane, Celgene) has been shown to be effective as well as tolerable in NSCLC. Preliminary results from a Phase III trial comparing carboplatin-nab-paclitaxel with carboplatin-paclitaxel showed higher response ra tes (RR) in the nab-paclitaxel arm. 8 When compared with paclitaxel, nab-paclitaxel was associated with reduced incidence of grade 3 or higher nonhematologic toxicities, specifically neuropathy, myalgia, and arthralgia (3% vs 10%), despite the higher paclitaxel dose delivered. A Phase III study of 1,725 patients with advanced NSCLC compared front-line treatment with cisplatin-pemetrexed and cisplatin-gemcitabine. 9 This trial showed similar overall efficacy between the regimens, and, importantly, demonstrated a benefit difference based on histology. When examined by histology, patients with nonsquamous NSCLC treated with cisplatin-pemetrexed sustained a statistically significant survival advantage over those treated with cisplatingemcitabine (median OS, 11.8 and 10.4 months, respectively), including significantly better survival in those with adenocarcinoma (12.6 vs 10.9 months; hazard ratio [HR], 0.84; 95% confidence interval [CI], ; P=0.03). In contrast, patients with squamous cell histology had a shorter median survival when treated with cisplatin-pemetrexed. Identification of specific NSCLC histology has become important in the overall evaluation of patients with lung cancer. Changing Paradigms The increasing influence of histologic subtype in the choice of agents, the identification of new molecular targets, and the availability of targeted agents is changing the strategy for front-line treatment selection in advanced NSCLC. Molecular testing of lung tumors (eg, epidermal growth factor receptor [EGFR] and anaplastic lymphoma kinase [ALK]) to facilitate treatment selection is readily available and can be considered a standard of care, as it is for other solid tumors, including breast and colorectal. This truly allows clinicians to personalize therapy for individual patients. Bevacizumab (Avastin, Genentech), a humanized monoclonal antibody (mab) that inhibits vascular endothelial growth factor (VEGF)-A, not only was the first targeted agent proven to extend survival when added to conventional chemotherapy (carboplatin-paclitaxel) in the front-line treatment of advanced NSCLC, but in Eastern Cooperative Oncology Group (ECOG) 4599, it also was the first treatment regimen to demonstrate a median OS greater than 1 year in any Phase III trial of metastatic NSCLC (12.3 vs 10.3 months; HR, 0.79; CI, ; P=0.003). 4 Prudent patient selection is essential with the use of bevacizumab because increased toxicity and patient deaths have been reported. Somatic mutations in the tyrosine kinase domain of epidermal growth factor receptor (EGFR) gene have been reported in lung cancers (predominantly adenocarcinomas). EGFR mutations are associated with sensitivity to EGFR-targeted therapies. Erlotinib (Tarceva, Genentech), a reversible tyrosine kinase inhibitor (TKI), acting directly at EGFR, is FDA-approved for the treatment of NSCLC after platinum-failure. More recently, 2 notable trials investigated the use of erlotinib in the front-line management of advanced NSCLC patients with EGFR mutations. EURTAC (European Erlotinib Versus Chemotherapy) is a prospective, randomized Phase III trial that investigated whether front-line treatment with erlotinib is superior to platinum-based chemotherapy in patients with EGFR mutations. 10 At the time of interim analysis, progression-free survival (PFS) in the erlotinib arm was superior to that in the chemotherapy arm (9.4 vs 5.2 months; HR, 0.42; P<0.0001). Median OS was not significantly different (22.9 vs 18.8 months; HR, 0.80; P=0.42). The Phase III OPTIMAL (Erlotinib Versus Gemcitabine/Carboplatin in Chemo-naïve State IIIB/IV Non-Small Cell Lung Cancer Patients With Epidermal Growth Factor Receptor Exon 19 or 21 Mutation [ML20981]) trial is evaluating the efficacy of front-line erlotinib versus gemcitabine-carboplatin in 165 patients with advanced NSCLC who harbor EGFR-activating mutations. 11 Treatment with erlotinib improved median PFS (primary end point) when compared with chemotherapy (13.1 vs 4.6 months). Common toxicities associated with erlotinib treatment are rash and diarrhea. Gefitinib (Iressa, AstraZeneca), an inhibitor of the EGFR tyrosine kinase domain, was evaluated in several trials. INTEREST (Iressa Non-small cell lung cancer Trial Evaluating Response and Survival Against Taxotere) compared gefitinib and docetaxel in patients with advanced NSCLC who had received previous platinum-based chemotherapy. 12 Results for all 1,433 patients confirmed noninferiority of gefitinib compared with docetaxel for OS (7.6 vs 8 months; HR, 1.020; CI, ). Patients with EGFR mutations 2

3 treated with gefitinib had longer PFS compared with those treated with docetaxel. 13 In IPASS (Iressa Pan Asia Study), patients with advanced NSCLC who never smoked or formerly were light smokers received either carboplatin-paclitaxel or gefitinib in the front-line setting. Although median PFS was similar in both arms (5.7 vs 5.8 months), patients treated with gefitinib had a significantly higher PFS at 12 months (24.9% vs 6.7%; HR, 0.74; CI, ; P<0.0001). 14 Other strategies targeting the EGFR pathway have been reported. Cetuximab (Erbitux, Bristol-Myers Squibb) is a chimeric mab that inhibits EGFR. The FLEX (First-Line Erbitux in Lung Cancer) trial evaluated front-line cisplatin-vinorelbine with or without cetuximab in patients with EGFR-expressing advanced NSCLC. 15 Cetuximab was then given as continuation maintenance until progressive disease or intolerable side effects developed. The addition of cetuximab improved OS (11.3 vs 10.1 months; HR, 0.871; CI, ; P=0.044). Interestingly, first-cycle rash (commonly associated with EGFR inhibitors) was associated with improved survival. 16 The combination of targeted agents against VEGF and EGFR with platinum-based chemotherapy may result in improved survival benefit. SWOG (Southwestern Oncology Group) 0536 was a Phase II study that combined carboplatin, paclitaxel, cetuximab, and bevacizumab for up to 6 cycles followed by weekly maintenance bevacizumab until disease progression in patients with advanced NSCLC. 17 The combination was found to have an adequate safety profile and has led to an ongoing Phase III trial (SWOG 0819) investigating carboplatin-paclitaxel or carboplatin-paclitaxelbevacizumab with or without concurrent cetuximab in advanced NSCLC. The EML (echinoderm microtubule-associated protein-like) 4-ALK fusion oncogene is a new biomarker that has been identified in a small subset of patients with NSCLC (approximately 4%). 18 Patients with ALK rearrangements have similar characteristics as those with EGFR mutations (adenocarcinoma, nonsmokers, or light smokers); however they often are young and male. 19 Because these patients are resistant to EGFR tyrosine kinase inhibitors (TKIs), identifying patients with ALK rearrangements and customizing therapy to this target has been a focus of research efforts. Fluorescence in situ hybridization (FISH) rather than immunohistochemistry is the diagnostic test of choice to uncover ALK rearrangements Crizotinib (Xalkori, Pfizer) is an ALK and MET TKI that recently was approved by the FDA for patients with ALK-positive advanced NSCLC. Of the 82 patients in the seminal Phase I study, 46 had a confirmed partial response and 1 had a confirmed complete response, for an overall RR of 57% (primary end point). 23 At the mean treatment duration of 6.4 months, 33% had stable disease with minimal toxicities. Evaluation of an expansion cohort suggests a survival advantage in ALK-positive patients treated with crizotinib versus crizotinib-naive ALK-positive patients. 24 Although crizotinib is a new standard of care for patients with ALKpositive advanced NSCLC, 3 ongoing clinical trials (PROFILE 1007, 1005, and 1014) continue to evaluate the role of this targeted therapy. Chromosomal rearrangements involving the ROS1 receptor, a tyrosine kinase, have recently been described in a subset of NSCLC and appear to be therapeutic targets for ALK therapies (eg, crizotinib). The incidence of ROS1 abnormalities has been reported to be between 1% and 2% and seems to be independent of ALK status. 25 Maintenance Therapy Data from multiple trials consistently have shown improvements in survival with maintenance therapy (Table) Strategies include either continuation of one or more of the initial agents (continuation maintenance), the introduction of an additional agent (switch maintenance), or a combination. Pemetrexed and erlotinib are FDA-approved as maintenance therapy. Several trials adding targeted agents to chemotherapy have included a continuation maintenance strategy. In the previously mentioned ECOG 4599 trial, patients receiving bevacizumab with carboplatin-paclitaxel in the experimental arm continued bevacizumab every 3 weeks until progression of disease or intolerable side effects. 4 The FLEX trial also examined the role of cetixumab maintenance after front-line treatment. Patients with EGFRexpressing advanced NSCLC who received cetuximab with chemotherapy in the experimental arm continued cetuximab after chemotherapy until progression or intolerable side effects. 15 In July 2009, the FDA approved pemetrexed for maintenance treatment of patients with advanced NSCLC with nonsquamous histology who had not progressed after initial chemotherapy. This approval was based on data from a Phase III trial of 664 patients with advanced NSCLC who did not progress on an initial platinum-based doublet (non-pemetrexed based) and then received maintenance pemetrexed or placebo. 26 Compared with patients receiving placebo, those who received maintenance pemetrexed had both improved PFS (4.3 vs 2.6 months; HR, 0.50; CI, ; P<0.0001) and OS (13.4 vs 10.6 months; HR, 0.79; CI, ; P=0.012). This provides an example of the efficacy of a switch maintenance strategy. Preliminary data from the PARAMOUNT trial presented at ASCO 2011 support the use of pemetrexed in a continuation maintenance treatment strategy. 27 This Phase III international trial examined 939 patients with advanced nonsquamous NSCLC. Those who did not progress during cisplatin-pemetrexed induction therapy were randomized to receive either maintenance pemetrexed every 3 weeks plus best supportive care (BSC) or placebo plus BSC until evidence of progression. Patients receiving maintenance pemetrexed sustained an improved PFS (HR 0.64; CI, ; P= ), with a 36% reduction in risk for progression. The favorable tolerability profile and ease of administration make 3

4 Table. Selected Trials of Maintenance Therapy in Advanced NSCLC Clinical Trial Treatment Arms N PFS, mo Median OS, mo Fidias et al 29 GC, then immediate docetaxel GC, then delayed docetaxel (P=0.001) (P=0.0853) 9.7 Capuzzo et al 28 (SATURN) CT, then E CT, then P PFS was significantly prolonged with E versus P in all patients (HR, 0.71; 95% CI, ; P<0.0001) Ciuleanu et al 26 Pemetrexed + BSC P + BSC Overall/NSQ/SQ 4.3/4.5/ /2.6/2.6 Overall/NSQ/SQ 13.4/15.5/ /10.3/10.8 Miller et al 30 (ATLAS) CT + B, then B + P CT + B, then B + E (P=0.0012) 4.8 NA Paz-Ares et al 27 (PARAMOUNT) Cisplatin + pemetrexed, then pemetrexed + BSC Cisplatin + pemetrexed, then P + BSC NA Barlesi et al 31 (AVAPERL) Cisplatin + B + pemetrexed, then B + pemetrexed Cisplatin + B + pemetrexed, then B (P=0.001) 6.6 NA Patel et al 32 (PointBreak) Carboplatin + B + pemetrexed, then B + pemetrexed Carboplatin + B + paclitaxel, then B NA NA NA B, bevacizumab; BSC, best supportive care; CI, confidence interval; CT, first-line platinum-based chemotherapy; E, erlotinib; GC, gemcitabine-carboplatin; HR, hazard ratio; NA, not available; NSQ, nonsquamous; OS, overall survival; P, placebo; PFS, progression-free survival; SQ, squamous pemetrexed an appealing option for maintenance therapy in advanced NSCLC. The FDA approved erlotinib in April 2010 for maintenance treatment of patients with advanced NSCLC with nonprogressive disease after front-line platinumbased chemotherapy. This approval was based on the large Phase III SATURN (Sequential Tarceva in Unresectable NSCLC) trial. 28 This trial was one of the first to evaluate maintenance therapy versus placebo in a prospective fashion. Patients with advanced NSCLC (N=1,949) received erlotinib or placebo after platinumbased doublet chemotherapy. Maintenance erlotinib was associated with a statistically significant improvement in both PFS (HR, 0.71; CI, ; P<0.0001) and OS (12 vs 11 months). In an exploratory analysis, patients with EGFR mutations sustained an even greater benefit from maintenance erlotinib. In the Phase III IFCT-GFPC 0502 study, treatmentnaive patients with advanced NSCLC were treated with 4 cycles of cisplatin-gemcitabine. 33 Those who did not progress were randomized to observation, continuation maintenance gemcitabine, or switch-maintenance erlotinib. PFS was significantly prolonged in patients receiving either maintenance with gemcitabine or erlotinib versus observation alone (HR, 0.51; CI, and HR, 0.83; CI, , respectively). Additional strategies for maintenance include a combination of continuation and switch, in which one of the agents from initial therapy is continued, and an additional agent that was not used previously is added. This concept was tested in the ATLAS trial, a Phase III evaluation of bevacizumab with or without erlotinib after completion of chemotherapy with bevacizumab for front-line treatment of advanced NSCLC. 30 Patients who were treated with combination maintenance showed a showed significant improvement in PFS (4.8 vs 3.7 months; HR, 0.722; CI, ; P=0.0012) over those treated only with continuation maintenance. 4

5 Adenocarcinoma or nonsquamous Squamous EGFR-mutation and ALK-translocation testing Chemotherapy doublet ALK-translocation positive EGFR-mutation positive ALK-translocation negative and EGFR-mutation negative Crizotinib Erlotinib Bevacizumab eligible Bevacizumab noneligible Bevacizumab + chemotherapy doublet Non-bevacizumab chemotherapy doublet (pemetrexed-based) Maintenance therapy Pemetrexed Bevacizumab Erlotinib Docetaxel Disease progression Salvage therapy Consider clinical trial Figure. Proposed algorithm for treatment of NSCLC. ALK, anaplastic lymphoma kinase; EGFR, epidermal growth factor receptor; NSCLC, non-small cell lung cancer Final efficacy outcomes of AVAPERL were presented at the 16th ECCO (European CanCer Organisation) 36th ESMO (European Society for Medical Oncology) Multidisciplinary Cancer Congress in September This ongoing Phase III study is evaluating continuation maintenance with bevacizumab with or without pemetrexed following 4 cycles of front-line cisplatin-bevacizumab-pemetrexed in advanced nonsquamous NSCLC. 31 Those who had at least stable disease after front-line treatment were randomized to either bevacizumab alone or bevacizumab plus pemetrexed. The median PFS (primary end point) from the start of induction therapy was 6.6 versus 10.2 months, respectively (HR, 0.50; P<0.001). When evaluated from time of randomization, the median PFS was 3.7 months versus 7.4 months, respectively (HR, 0.48; P<0.001). These encouraging findings will be further evaluated with large Phase III trials. ECOG 5508 is a Phase III study that will randomize 1,282 patients to bevacizumab, pemetrexed, or a combination of bevacizumab and pemetrexed after 4 cycles of initial therapy with carboplatin-paclitaxel-bevacizumab in advanced nonsquamous NSCLC. PointBreak is a separate randomized, open-label Phase III study comparing carboplatin-pemetrexed-bevacizumab followed by maintenance pemetrexed-bevacizumab with carboplatin-paclitaxel-bevacizumab followed by maintenance bevacizumab in advanced nonsquamous NSCLC; patients will receive up to 4 cycles of induction treatment followed by maintenance until progression or treatment discontinuation. 32 Although observation is still an option in patients with disease control after initial chemotherapy, consideration should be made for maintenance therapy, especially in patients with preserved performance status. Options for maintenance therapy in advanced NSCLC include continuation of front-line therapy with bevacizumab, cetuximab, pemetrexed, or gemcitabine, or 5

6 switching to pemetrexed for patients with nonsquamous histologies and erlotinib for those with EGFRmutated tumors. Additional considerations can be made for doublet maintenance therapy. Overcoming Resistance EGFR AND ACQUIRED EGFR RESISTANCE An active area of research centers on mechanisms of resistance to EGFR TKIs, including amplification of the MET oncogene and secondary mutations in EGFR, such as the T790M mutation in exon 20. The T790M mutation is the most common mechanism of acquired resistance, accounting for more than 50% of the cases. Dual EGFR- MET inhibition is a potential approach for overcoming MET-mediated resistance to EGFR inhibitors. ARQ 197 is an oral, selective, non-atp competitive inhibitor of c-met, a receptor tyrosine kinase implicated in cancer cell migration, invasion, and proliferation. A global randomized, double-blind, placebo-controlled Phase II trial compared erlotinib plus ARQ 197 with erlotinib plus placebo in previously treated EGFR inhibitor-naive patients with advanced NSCLC. Median PFS (primary end point) was prolonged with combined treatment (16.1 vs 9.7 weeks; HR 0.81; CI, 0.57, 1.15; P=0.23). PFS was particularly improved among patients with nonsquamous histology, KRAS mutations, and EGFR wild-type status. 34 Another therapy under evaluation is MetMAb, a monovalent mab that specifically binds the Met receptor. OAM4558g was a global randomized, double-blind, placebo-controlled Phase II study comparing erlotinib plus MetMAb with erlotinib plus placebo in the second- or third-line management of advanced NSCLC. The addition of MetMAb to erlotinib in these patients significantly improved PFS and OS in patients who had high expression of Met in their tumors, resulting in 3-fold reduction in the risk for death. 35 There is increasing interest in irreversible EGFR inhibitors, mainly through the discovery of the oral small-molecule EGFR TKI BIBW 2992 (afatinib). Differing from its predecessors, afatinib binds irreversibly to both EGFR and HER-2 and is active against both wild-type and multiple mutant forms of EGFR. A Phase II trial of afatinib in patients with advanced NSCLC who were previously treated with erlotinib or gefitinib was conducted in Japan. The primary end point was objective tumor response. Afatinib was deemed efficacious based on 69% disease control rate of greater than 8 weeks and median PFS of 4.4 months. 36 Additional ongoing studies are investigating the use of afatinib in patients with NSCLC in various treatment settings. One strategy tested combination afatinib with cetuximab in patients with EGFR mutations whose disease has progressed on erlotinib. 37 Disease control was observed in all patients enrolled at the recommended Phase II dose of afatinib, with tumor size reduction up to 76%. At the 2012 ASCO annual meeting, Yang et al presented the results of a large-scale Phase III study assessing the activity of front-line afatinib versus cisplatin and pemetrexed chemotherapy in patients with tumors harboring EGFR mutations. 38 The trial randomized 345 patients and demonstrated significantly prolonged PFS for those treated with afatinib compared with those treated with chemotherapy (median 11.1 vs 6.9 months; HR, 0.58 [ ]; P=0.0004). In patients with common mutations (Del19/L858R) (n=308), median PFS was 13.6 months in the afatinib group versus 6.9 months in the chemotherapy group (HR, 0.47 [ ]; P<0.0001). The objective response rate also was significantly higher with afatinib versus chemotherapy (56% vs 23%; P<0.0001). This is the first randomized study to demonstrate benefit of an oral targeted therapy versus chemotherapy in a molecularly selected population. EML4-ALK AND CRIZOTINIB RESISTANCE EML4-ALK is a novel fusion oncogene occurring in about 3% to 7% of NSCLC cases. 24 The fusion results from a small inversion within chromosome 2p, leading to expression of a constitutively activated, chimeric tyrosine kinase. EGFR mutations and EML4-ALK rearrangements are generally mutually exclusive. 39 Patients tend to respond rapidly to crizotinib, but many develop resistance after about 1 year of therapy, and increased brain metastases have been reported. 40 The FDA recently approved crizotinib for patients with advanced NSCLC with ALK-positive rearrangements as demonstrated via the Abbott Vysis test. Second-generation ALK TKIs and heat shock protein 90 inhibitors as strategies to treat crizotinib-resistant tumors are under way. 41 Newer Targeted Therapies The recent advances in the treatment of NSCLC have involved the integration of targeted therapeutics and more accurately defining the subset of patients who are most likely to benefit from a given treatment. We have attempted to use clinical factors such as tobacco history, gender, and ethnicity to determine appropriate therapy. However, because 60% of lung cancers carry an identifiable mutation, 42 there is movement toward assessing genetic factors more quickly. The Lung Cancer Mutation Consortium (LCMC) has reported the frequencies, characteristics, and therapeutic options for genetic mutations found in lung cancer. Additionally, appropriate patients are offered participation in LCMC-linked clinical trials of agents targeting the identified mutation. The importance of histology cannot be underestimated. Although targeted therapies have improved outcomes for patients with adenocarcinoma of the lung, patients with squamous cell carcinoma very rarely respond to these same agents. In addition to EGFR, the other promising targets including EML4-ALK, KRAS, and MET also may be limited to adenocarcinoma. Given that squamous cell lung cancers account for about 25% of new lung cancer cases and 40,000 deaths per year in the United States, it is important to identify and understand the genomic alterations that drive this histologic subtype. To date, 3 molecular targets have been 6

7 identified in squamous cell carcinomas: Fibroblast growth factor receptor 1 (FGFR1) is amplified in about 20% of squamous cell lung cancer 43 and PI3KCA and DDR2 mutations each have been identified in about 3% of squamous cell carcinomas. 44 All of these mutations represent promising targets for future therapy, and they are already being considered for clinical trials. Although studies continue to evaluate therapies based on tumor histologic profiles, the BATTLE (Biomarker-integrated Approaches of Targeted Therapy for Lung Cancer Elimination) trial tackled personalized treatment based on tumor molecular biomarker profiles. This was the first completed prospective, biopsy-mandated, biomarker-based, adaptively randomized study in patients with heavily pretreated NSCLC. Based on results from core needle biopsy specimens, patients were treated with erlotinib, vandetanib (Caprelsa, AstraZeneca), erlotinib plus bexarotene (Targretin, Eisai), or sorafenib (Nexavar, Bayer). 45 Patients with mutant-kras tumors benefited from sorafenib. Attention has also been placed on targeting BRAF mutations, especially because most of the identified mutations in NSCLC seem to be mutually exclusive. 46 Thus, agents such as vemurafenib (Zelboraf, Genentech) and dasatinib (Sprycel, Bristol-Myers Squibb), which have shown activity in V600E BRAF mutations and DDR2 mutations, respectively, 44,47 are being evaluated in these settings. All of these efforts are substantial steps toward individualized lung cancer therapy. Conclusion Paradigms in all stages of treatment of advanced NSCLC are evolving toward targeted molecular therapies with better tolerability profiles. Based on recent studies, new standards of management in advanced NSCLC must be considered including maintenance strategies and targeted therapies. To improve our management of lung cancer patients, more tissue should be collected (eg, core biopsies) to evaluate upfront not only histology but also biomarker profiles. The BATTLE trial has already demonstrated the feasibility of this type of approach in advanced NSCLC. 45 One day, we hope patients with lung cancer will be treated according to a biomarker tumor profile and not limited by their age or performance status. Unique treatment strategies can then be directed to each patient on a truly individual basis. Finally, broader clinical trial participation should be encouraged to enhance our knowledge of how to continue to improve outcomes in a disease that remains the leading cause of cancer death in the United States. References 1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61(2):69-90, PMID: Erratum in: CA Cancer J Clin. 2011;61(2): National Cancer Institute. SEER stat facts sheets: lung and bronchus. Accessed August 6, Breathnach OS, Freidlin B, Conley B, et al. Twenty-two years of phase III trials for patients with advanced non-small-cell lung cancer: sobering results. J Clin Oncol. 2001;19(6): , PMID: Sandler A, Gray R, Perry MC, et al. Paclitaxel-carboplatin alone or with bevacizumab for non-small-cell lung cancer. N Engl J Med. 2006;355(24): , PMID: Erratum in: N Engl J Med. 2007;356(3): Douillard JY, Tribodet H, Aubert D, et al. Adjuvant cisplatin and vinorelbine for completely resected non-small cell lung cancer: subgroup analysis of the Lung Adjuvant Cisplatin Evaluation. J Thorac Oncol. 2010;5(2): ; PMID: Non-small Cell Lung Cancer Collaborative Group. Chemotherapy in non-small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomized clinical trials. BMJ. 1995;311(7010): , PMID: Schiller JH, Harrington D, Belani CP, et al. Comparison of four chemotherapy regimens for advanced non-small-cell lung cancer. N Engl J Med. 2002;346(2):92-98, PMID: Socinski MA, Bondarenko IN, Karaseva NA, et al. Results of a randomized, phase III trial of nab-paclitaxel (nab-p) and carboplatin (C) compared with cremophor-based paclitaxel (P) and carboplatin as first-line therapy in advanced non-small cell lung cancer (NSCLC). J Clin Oncol. 2010;28(18 suppl): Abstract LBA Scagliotti GV, Parikh P, von Pawel J, et al. Phase III study comparing cisplatin plus gemcitabine with cisplatin plus pemetrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol. 2008;26(21): , PMID: Rosell R, Gervais R, Vergnenegre A, et al. Erlotinib versus chemotherapy (CT) in advanced non-small cell lung cancer (NSCLC) patients (p) with epidermal growth factor receptor (EGFR) mutations: Interim results of the European Erlotinib Versus Chemotherapy (EURTAC) phase III randomized trial. J Clin Oncol. 2011;29(suppl): Abstract Zhou C, Wu YL, Chen G, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutationpositive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised phase 3 study. Lancet Oncol. 2011;12(8): , PMID: Kim ES, Hirsh V, Mok T, et al. Gefitinib versus docetaxel in previously treated non-small cell lung cancer (INTEREST): a randomized phase III trial. Lancet. 2008;372(9652): , PMID: Douillard JY, Shepherd FA, Hirsh V, et al. Molecular predictors of outcome with gefitinib and docetaxel in previously treated non-small-cell lung cancer: data from the randomized phase III INTEREST trial. J Clin Oncol. 2009;28(5): , PMID: Mok TS, Wu YL, Thongprasert S, et al. Gefitinib or carboplatinpaclitaxel in pulmonary adenocarcinoma. N Engl J Med. 2009;361(10): , PMID: Pirker R, Pereira JR, Szczesna A, et al. Cetuximab plus chemotherapy in patients with advanced non-small-cell lung cancer (FLEX): an open-label randomised phase III trial. Lancet. 2009;373(9674): , PMID: Pirker R, Rodrigues-Pereira J, Szczesna A, et al. Prognostic factors in advanced NSCLC: experience from the FLEX trial. J Clin Oncol. 2009;27(15 suppl): Abstract Kim ES, Herbst RS, Moon J, et al. S0536: Carboplatin, paclitaxel, cetuximab and bevacizumab followed by cetuximab and bevacizumab maintenance in advanced non-small cell lung cancer (NSCLC), a SWOG phase II study. PD Presented at: 2009 IASLC World Congress on Lung Cancer; July 31-August 4, 2009; San Francisco, CA. 18. Soda M, Choi YL, Enomoto M, et al. Identification of the transforming EML4-ALK fusion gene in non-small cell lung cancer. Nature. 2007;448(7153): , PMID: Shaw AT, Yeap BY, Mino-Kenudson M, et al. Clinical features and outcome of patients with non-small-cell lung cancer who harbor EML4-ALK. J Clin Oncol. 2009;27(26): , PMID:

8 20. Kim H, Yoo SB, Choe JY, et al. Detection of ALK gene rearrangement in non-small cell lung cancer: a comparison of fluorescence in situ hybridization and chromogenic in situ hybridization with correlation of ALK protein expression. J Thorac Oncol. 2011;6(8): , PMID: Perol M, Chouaid C, Milleron BJ, et al. Maintenance with either gemcitabine or erlotinib versus observation with predefined second-line treatment after cisplatin-gemcitabine induction chemotherapy in advanced NSCLC: IFCT-GFPC 0502 phase III study. J Clin Oncol. 2010;28(15 suppl): Abstract Rodig SM, Mino-Kenudson M, Dacic S, et al. Unique clinicopathologic features characterize ALK-rearranged lung adenocarcinoma in the western population. Clin Cancer Res. 2009;15(16): , PMID: Mino-Kenudson M, Chirieac LR, Law K, et al. A novel, highly sensitive antibody allows for the routine detection of ALK-rearranged lung adenocarcinomas by standard immunohistochemistry. Clin Cancer Res. 2010;16(5): , PMID: Kwak EL, Bang Y-J, Camidge DR, et al. Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med. 2010;363: , PMID: Erratum in: N Engl J Med. 2011;364(6): Shaw AT, Yeap BY, Solomon BJ, et al. Impact of crizotinib on survival in patients with advanced, ALK-positive NSCLC compared with historical controls. J Clin Oncol. 2011;29(suppl): Abstract Bergethon K, Shaw AT, Ou SH, et al. ROS1 rearrangements define a unique molecure class of lung cancers. J Clin Oncol. 2012;30(8): , PMID: Ciuleanu T, Brodowicz T, Zielinski C, et al. Maintenance pemetrexed plus best supportive care versus placebo plus best supportive care for non-small-cell lung cancer: a randomised, double-blind, phase 3 study. Lancet. 2009;374(9699): , PMID: Paz-Ares LG, De Marinis F, Dediu M, et al. PARAMOUNT: Phase III study of maintenance pemetrexed (pem) plus best supportive care (BSC) versus placebo plus BSC immediately following induction treatment with pem plus cisplatin for advanced nonsquamous non-small cell lung cancer (NSCLC). J Clin Oncol. 2011;29(suppl): Abstract CRA Cappuzzo F, Ciuleanu T, Stelmakh L, et al. SATURN: A doubleblind, randomized, phase III study of maintenance erlotinib versus placebo following nonprogression with first-line platinum-based chemotherapy in patients with advanced NSCLC. J Clin Oncol. 2009;27(15 suppl): Abstract Fidias PM, Dakhil SR, Lyss AP, et al. Phase III study of immediate compared with delayed docetaxel after front-line therapy with gemcitabine plus carboplatin in advanced non-small cell lung cancer. J Clin Oncol. 2009;27(4): , PMID: Miller VA, O Connor P, Soh C, et al. A randomized, double-blind, placebo-controlled, phase IIIb trial (ATLAS) comparing bevacizumab (B) therapy with or without erlotinib (E) after completion of chemotherapy with B for first-line treatment of locally advanced, recurrent, or metastatic non-small cell lung cancer (NSCLC). J Clin Oncol. 2009;27(18 suppl): Abstract LBA Barlesi F, de Castro J, Dvornichenko V, et al. AVAPERL (MO22089): Final efficacy outcomes for patients (pts) with advanced nonsquamous non-small cell lung cancer (nsnsclc) randomized to continuation maintenance (mtc) with bevacizumab (bev) or bevacizumab + pemetrexed (pem) after first-line bevacizumabcisplatin (cis)-pem treatment (tx). Eur J Cancer. 2011;47(2 suppl): Abstract LBA Schiller JH, Akerley WL, Brugger W, et al. Results from ARQ : a global randomized placebo-controlled phase II clinical trial of erlotinib plus ARQ 197 versus erlotinib plus placebo in previously treated EGFR inhibitor-naïve patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). J Clin Oncol. 2010;28(18 suppl): Abstract LBA Spigel DR, Ervin TJ, Ramlau R, et al. Final efficacy results from OAM4558g, a randomized phase II study evaluating MetMAb or placebo in combination with erlotinib in advanced NSCLC. J Clin Oncol. 2011;29(suppl): Abstract Yamamoto N, Katakami N, Atagi S, et al. A phase II trial of afatinib (BIBW 2992) in patients (pts) with advanced non-small cell lung cancer previously treated with erlotinib (E) or gefitinib (G). J Clin Oncol. 2011;29(suppl): Abstract Janjigian YY, Groen HJ, Horn L, et al. Activity and tolerability of afatinib (BIBW 2992) and cetuximab in NSCLC patients with acquired resistance to erlotinib or gefitinib. J Clin Oncol. 2011;29(suppl): Abstract Yang, J, Schuler M, Yamamoto N, et al. LUX-Lung 3: A randomized, open-label, phase III study of afatinib versus pemetrexed and cisplatin as first-line treatment for patients with advanced adenocarcinoma of the lung harboring EGFR-activating mutations. J Clin Oncol. 2012;(suppl): Abstract LBA Takahashi T, Sonobe M, Kobayashi M, et al. Clinicopathologic features of non-small-cell lung cancer with EML4-ALK fusion gene. Ann Surg Oncol. 2010;17(3): , PMID: Choi YL, Soda M, Yamashita Y, et al. EML4-ALK mutations in lung cancer that confer resistance to ALK inhibitors. N Engl J Med. 2010;363(18): , PMID: Katayama R, Khan TM, Benes C, et al. Therapeutic strategies to overcome crizotinib resistance in non-small cell lung cancers harboring the fusion oncogene EML4-ALK. Proc Natl Acad Sci USA. 2011;108(18): , PMID: Kris MG, Johnson BE, Kwiatkowski DJ, et al. Identification of driver mutations in tumor specimens from 1,000 patients with lung adenocarcinoma: The NCI s Lung Cancer Mutation Consortium (LCMC). J Clin Oncol. 2011;29(suppl): Abstract CRA Dutt A, Ramos AH, Hammerman PS, et al. Inhibitor-sensitive FGFR1 amplification in human non-small cell lung cancer. PloS One. 2011;6(6):e20351, PMID: Hammerman PS, Sos ML, Ramos AH, et al. Mutations in the DDR2 kinase gene identify a novel therapeutic target in squamous cell lung cancer. Cancer Discov. 2011;1(1):78-89, PMID: Kim ES, Herbst RS, Wistuba II, et al. The BATTLE trial: personalizing therapy for lung cancer. Cancer Discov. 2011;1(1):44-53, PMID: Patel JD, Bonomi P, Socinski MA, et al. Treatment rationale and study design for the pointbreak study: a randomized, open-label phase III study of pemetrexed/carboplatin/bevacizumab followed by maintenance pemetrexed/bevacizumab versus paclitaxel/carboplatin/bevacizumab followed by maintenance bevacizumab in patients with stage IIIB or IV nonsquamous non-small cell lung cancer. Clin Lung Cancer. 2009;10(4): , PMID: Kobayashi M, Sonobe M, Takahashi T, et al. Clinical significance of BRAF gene mutations in patients with non-small cell lung cancer. Anticancer Res. 2011;31(12): , PMID: Johnson FM, Tang X, Tran H, et al. Phase II study of dasatinib in non-small cell lung cancer (NSCLC). J Clin Oncol. 2009;27(suppl): Abstract e

Evolving Treatment Paradigms in Non-Small Cell Lung Cancer

Evolving Treatment Paradigms in Non-Small Cell Lung Cancer PRINTER-FRIENDLY VERSION AT PHARMACYPRACTICE NEWS.COM Evolving Treatment Paradigms in Non-Small Cell Lung Cancer CALEB T. CHU, MD, MPH Postdoctoral Fellow Department of Thoracic/Head and Neck Medical Oncology

More information

Maintenance therapy in in Metastatic NSCLC. Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai

Maintenance therapy in in Metastatic NSCLC. Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai Maintenance therapy in in Metastatic NSCLC Dr Amit Joshi Associate Professor Dept. Of Medical Oncology Tata Memorial Centre Mumbai Definition of Maintenance therapy The U.S. National Cancer Institute s

More information

Lung cancer is the leading cause of cancer-related death in the United

Lung cancer is the leading cause of cancer-related death in the United Evolving Treatment Paradigms in Non-Small Cell Lung Cancer MARGARET E. M. VAN METER, MD Medical Oncology Fellow Division of Cancer Medicine The University of Texas M.D. Anderson Cancer Center Houston,

More information

Non-Small Cell Lung Cancer

Non-Small Cell Lung Cancer Non-Small Cell Lung Cancer in East tasia Chia-Chi (Josh) Lin, MD, PhD 林 家 齊 Director of Phase I Center, e Department of Oncology, National Taiwan University Hospital Clinical Associate Professor, Department

More information

Advancing Personalized Therapy for Advanced Non-Small Cell Lung Cancer

Advancing Personalized Therapy for Advanced Non-Small Cell Lung Cancer GUIDING THE WAY White Paper Advancing Personalized Therapy for Advanced Non-Small Cell Lung Cancer is a serum proteomic test for patients with advanced non-small cell lung cancer that helps healthcare

More information

NCCN Non-Small Cell Lung Cancer V.1.2011 Update Meeting 07/09/10

NCCN Non-Small Cell Lung Cancer V.1.2011 Update Meeting 07/09/10 Guideline Page and Request NSCL-3 Stage IA, margins positive delete the recommendation for chemoradiation. Stage IB, IIA, margins positive delete the recommendation for chemoradiation + Stage IIA, Stage

More information

Shifting the Paradigm for Maintenance Therapy for Non small-cell Lung Cancer

Shifting the Paradigm for Maintenance Therapy for Non small-cell Lung Cancer J Hong Kong Col Radiol. 2010;13(Suppl):S16-21 ORIGINAL ARTICLE Shifting the Paradigm for Maintenance Therapy for Non small-cell Lung Cancer VHF Lee Department of Clinical Oncology, Queen Mary Hospital,

More information

Corporate Medical Policy

Corporate Medical Policy Corporate Medical Policy Molecular Analysis for Targeted Therapy for Non-Small Cell Lung File Name: Origination: Last CAP Review: Next CAP Review: Last Review: molecular_analysis_for_targeted_therapy_for_non_small_cell_lung_cancer

More information

Successes and Limitations of Targeted Cancer Therapy in Lung Cancer

Successes and Limitations of Targeted Cancer Therapy in Lung Cancer Successes and Limitations of Targeted Cancer Therapy in Lung Cancer Kenichi Suda a, b Tetsuya Mitsudomi a a Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama,

More information

Treatment Paradigms in Advanced Non Small-Cell Lung Cancer

Treatment Paradigms in Advanced Non Small-Cell Lung Cancer Treatment Paradigms in Advanced Non Small-Cell Lung Cancer Caroline E. McCoach, MD, PhD, and Karen Kelly, MD Dr McCoach is a clinical research fellow and Dr Kelly is a professor of medicine, an associate

More information

ALCHEMIST (Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trials)

ALCHEMIST (Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trials) ALCHEMIST (Adjuvant Lung Cancer Enrichment Marker Identification and Sequencing Trials) 3 Integrated Trials Testing Targeted Therapy in Early Stage Lung Cancer Part of NCI s Precision Medicine Effort in

More information

National Horizon Scanning Centre. Vandetanib (Zactima) for advanced or metastatic non-small cell lung cancer. December 2007

National Horizon Scanning Centre. Vandetanib (Zactima) for advanced or metastatic non-small cell lung cancer. December 2007 Vandetanib (Zactima) for advanced or metastatic non-small cell lung cancer December 2007 This technology summary is based on information available at the time of research and a limited literature search.

More information

EGFR gene mutations Ex 19 Ex 21 Paez et al, Science 2004

EGFR gene mutations Ex 19 Ex 21 Paez et al, Science 2004 Evolution of knowledge in NSCLC Pao and Girard, Lancet Oncology 2011 Fattori da considerare nella scelta terapeutica del NSCLC nel 2012 Stadio di malattia PS Età Comorbidità Compliance e desiderio del

More information

Harmesh Naik, MD. Hope Cancer Clinic HOW DO I MANAGE STAGE 4 NSCLC IN 2012: STATE OF THE ART

Harmesh Naik, MD. Hope Cancer Clinic HOW DO I MANAGE STAGE 4 NSCLC IN 2012: STATE OF THE ART Harmesh Naik, MD. Hope Cancer Clinic HOW DO I MANAGE STAGE 4 NSCLC IN 2012: STATE OF THE ART Goals Discuss treatment options for stage 4 lung cancer: New and old Discuss new developments in personalized

More information

Treatment Paradigm in NSCLC Treatment

Treatment Paradigm in NSCLC Treatment Treatment Paradigm in NSCLC Treatment Era of Targeted Therapy Aumkhae Sookprasert, MD Medicine Department, KKU Which factors taken to be account in NSCLC treatment? 1. Staging 2. ECOG performance status

More information

Emerging Drug List GEFITINIB

Emerging Drug List GEFITINIB Generic (Trade Name): Manufacturer: Gefitinib (Iressa ) formerly referred to as ZD1839 AstraZeneca NO. 52 JANUARY 2004 Indication: Current Regulatory Status: Description: Current Treatment: Cost: Evidence:

More information

KRAS Mutation Analysis in Non-Small Cell Lung Cancer (NSCLC) Original Policy Date

KRAS Mutation Analysis in Non-Small Cell Lung Cancer (NSCLC) Original Policy Date MP 2.04.43 KRAS Mutation Analysis in Non-Small Cell Lung Cancer (NSCLC) Medical Policy Section Medicine Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013

More information

SYSTEMIC THERAPY FOR STAGE IV NON-SMALL CELL LUNG CANCER: AMERICAN SOCIETY OF CLINICAL ONCOLOGY CLINICAL PRACTICE GUIDELINE UPDATE

SYSTEMIC THERAPY FOR STAGE IV NON-SMALL CELL LUNG CANCER: AMERICAN SOCIETY OF CLINICAL ONCOLOGY CLINICAL PRACTICE GUIDELINE UPDATE Which patients with stage IV NSCLC should be treated with chemotherapy? NSCLC with nonsquamous cell carcinoma, negative or unknown EGFR-sensitizing mutation and ALK gene rearrangement status, and PS 0-1

More information

Management of stage III A-B of NSCLC. Hamed ALHusaini Medical Oncologist

Management of stage III A-B of NSCLC. Hamed ALHusaini Medical Oncologist Management of stage III A-B of NSCLC Hamed ALHusaini Medical Oncologist Global incidence, CA cancer J Clin 2011;61:69-90 Stage III NSCLC Includes heterogeneous group of patients with differences in the

More information

Chemotherapy in Advanced Non-Small Cell Lung Cancer: Optimal Treatment Approach for Elderly and Patients With Poor Performance Status

Chemotherapy in Advanced Non-Small Cell Lung Cancer: Optimal Treatment Approach for Elderly and Patients With Poor Performance Status Chemotherapy in Advanced Non-Small Cell Lung Cancer: Optimal Treatment Approach for Elderly and Patients With Poor Performance Status Tracey L. Evans, MD Abstract In spite of advances in molecular profiling

More information

Medication Policy Manual. Topic: Alimta, pemetrexed Date of Origin: May 12, 2010

Medication Policy Manual. Topic: Alimta, pemetrexed Date of Origin: May 12, 2010 Medication Policy Manual Policy No: dru213 Topic: Alimta, pemetrexed Date of Origin: May 12, 2010 Committee Approval Date: February 17, 2015 Next Review Date: February 2016 Effective Date: March 1, 2015

More information

Name of Policy: Molecular Analysis for Targeted Therapy of Non-Small-Cell Lung Cancer (NSCLC)

Name of Policy: Molecular Analysis for Targeted Therapy of Non-Small-Cell Lung Cancer (NSCLC) Name of Policy: Molecular Analysis for Targeted Therapy of Non-Small-Cell Lung Cancer (NSCLC) Policy #: 468 Latest Review Date: October 2015 Category: Laboratory Policy Grade: B Background/Definitions:

More information

Sur les nouveaux médicaments et les perspectives qu ils offrent (traitement à la carte et survie longue)

Sur les nouveaux médicaments et les perspectives qu ils offrent (traitement à la carte et survie longue) Sur les nouveaux médicaments et les perspectives qu ils offrent (traitement à la carte et survie longue) Professeur Jean Trédaniel Unité de cancérologie thoracique Hôpital Saint-Louis Comparison of Four

More information

Pharmacogenomic Approaches. Luis Paz-Ares Hospital Universitario Virgen del Rocio Seville, Spain

Pharmacogenomic Approaches. Luis Paz-Ares Hospital Universitario Virgen del Rocio Seville, Spain Pharmacogenomic Approaches Luis Paz-Ares Hospital Universitario Virgen del Rocio Seville, Spain Pharmacogenetics & Pharmacogenomics Medicine tailored to the individual Genetic information, including the

More information

Non Small Cell Lung Cancer: Scientific Discoveries and the Pursuit of Progress

Non Small Cell Lung Cancer: Scientific Discoveries and the Pursuit of Progress Non Small Cell Lung Cancer: Scientific Discoveries and the Pursuit of Progress Lung Cancer Accounts for 14% of All New Cancer Diagnoses in the United States 1 Lung cancer is the second most common malignancy

More information

Pharmacogenomic markers in EGFR-targeted therapy of lung cancer

Pharmacogenomic markers in EGFR-targeted therapy of lung cancer Pharmacogenomic markers in EGFR-targeted therapy of lung cancer Rafal Dziadziuszko, MD, PhD University of Colorado Cancer Center, Aurora, CO, USA Medical University of Gdansk, Poland EMEA Workshop on Biomarkers,

More information

Medical Policy Manual. Date of Origin: August 2010. Topic: Molecular Analysis for Targeted Therapy of Non- Small Cell Lung Cancer (NSCLC)

Medical Policy Manual. Date of Origin: August 2010. Topic: Molecular Analysis for Targeted Therapy of Non- Small Cell Lung Cancer (NSCLC) Medical Policy Manual Topic: Molecular Analysis for Targeted Therapy of Non- Small Cell Lung Cancer (NSCLC) Section: Genetic Testing Policy No: 56 Date of Origin: August 2010 Last Reviewed Date: December

More information

NON-SMALL CELL LUNG CANCER STAGE IV

NON-SMALL CELL LUNG CANCER STAGE IV NON-SMALL CELL LUNG CANCER STAGE IV Effective Date: November, 2013 The recommendations contained in this guideline are a consensus of the Alberta Provincial Thoracic Tumour Team synthesis of currently

More information

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness Department of Veterans Affairs Health Services Research & Development Service Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost-Effectiveness

More information

Targeted therapies and brain metastases in lung cancer patients. Benjamin Besse, MD, PhD. Medical Oncologist. 19 septembre 2014

Targeted therapies and brain metastases in lung cancer patients. Benjamin Besse, MD, PhD. Medical Oncologist. 19 septembre 2014 Targeted therapies and brain metastases in lung cancer patients Benjamin Besse, MD, PhD Medical Oncologist 19 septembre 2014 Targeted therapies and brain mets! Brain mets in NSCLC! Specific targeted therapies!

More information

Second-Line Therapy in Non Small-Cell Lung Cancer: The DELTA Between Different Genotypes Widens

Second-Line Therapy in Non Small-Cell Lung Cancer: The DELTA Between Different Genotypes Widens VOLUME 32 NUMBER 18 JUNE 20 2014 JOURNAL OF CLINICAL ONCOLOGY ONCOLOGY GRAND ROUNDS Second-Line Therapy in Non Small-Cell Lung Cancer: The DELTA Between Different Genotypes Widens Alona Zer and Natasha

More information

Targeting angiogenesis in NSCLC: Clinical trial update Martin Reck Lung Clinic Grosshansdorf Grosshansdorf, Germany

Targeting angiogenesis in NSCLC: Clinical trial update Martin Reck Lung Clinic Grosshansdorf Grosshansdorf, Germany Targeting angiogenesis in NSCLC: Clinical trial update Martin Reck Lung Clinic Grosshansdorf Grosshansdorf, Germany This presentation was selected by the 15 th World Conference on Lung Cancer Program Committee

More information

Targeted agents in lung cancer: EGFR TKI and beyond

Targeted agents in lung cancer: EGFR TKI and beyond Targeted agents in lung cancer: EGFR TKI and beyond David CL Lam, MBBS, PhD, MD, FCCP, FACP, FRCP, FAPSR Clinical Assistant Professor Department of Medicine University of Hong Kong 13 Nov, 2014 The Changing

More information

Metastatic Non Small Cell Lung Cancer Management: Novel Targets and Recent Clinical Advances

Metastatic Non Small Cell Lung Cancer Management: Novel Targets and Recent Clinical Advances Metastatic Non Small Cell Lung Cancer Management: Novel Targets and Recent Clinical Advances Jonathan W. Riess, MD, and Heather A. Wakelee, MD Dr. Riess is a Fellow and Dr. Wakelee is an Assistant Professor

More information

Third-line or fourth-line chemotherapy in non-small-cell lung cancer patients with relatively good performance status

Third-line or fourth-line chemotherapy in non-small-cell lung cancer patients with relatively good performance status Available online at www.sciencedirect.com Journal of the Chinese Medical Association 74 (2011) 209e214 Original Article Third-line or fourth-line chemotherapy in non-small-cell lung cancer patients with

More information

REPORT ASCO 2011 CHICAG0 : RESPIRATORY ONCOLOGY Johan Vansteenkiste / Christophe Dooms, Univ. Hospital Leuven and Leuven Lung Cancer Group

REPORT ASCO 2011 CHICAG0 : RESPIRATORY ONCOLOGY Johan Vansteenkiste / Christophe Dooms, Univ. Hospital Leuven and Leuven Lung Cancer Group 1 REPORT ASCO 2011 CHICAG0 : RESPIRATORY ONCOLOGY Johan Vansteenkiste / Christophe Dooms, Univ. Hospital Leuven and Leuven Lung Cancer Group 10 MESSAGE HIGHLIGHTS Early stage non-small cell lung cancer

More information

Treatment of Advanced Non small-cell Lung Cancer: a Fast Changing Paradigm

Treatment of Advanced Non small-cell Lung Cancer: a Fast Changing Paradigm Hong Kong J Radiol. 2012;15(Suppl):S64-71 REVIEW ARTICLE Treatment of Advanced Non small-cell Lung Cancer: a Fast Changing Paradigm P Teo Room 522, Central Building, 1 Pedder Street, Central, Hong Kong

More information

Is the third-line chemotherapy feasible for non-small cell lung cancer? A retrospective study

Is the third-line chemotherapy feasible for non-small cell lung cancer? A retrospective study Turkish Journal of Cancer Volume 34, No.1, 2004 19 Is the third-line chemotherapy feasible for non-small cell lung cancer? A retrospective study MUSTAFA ÖZDO AN, MUSTAFA SAMUR, HAKAN BOZCUK, ERKAN ÇOBAN,

More information

Treatment of Stage IV Non-small Cell Lung Cancer

Treatment of Stage IV Non-small Cell Lung Cancer CHEST Supplement DIAGNOSIS AND MANAGEMENT OF LUNG CANCER, 3RD ED: ACCP GUIDELINES Treatment of Stage IV Non-small Cell Lung Cancer Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest

More information

Stato dell arte e prospettive delle terapie a bersaglio molecolare nel carcinoma polmonare

Stato dell arte e prospettive delle terapie a bersaglio molecolare nel carcinoma polmonare Stato dell arte e prospettive delle terapie a bersaglio molecolare nel carcinoma polmonare Giorgio V. Scagliotti Università di Torino Dipartimento di scienze cliniche & biologiche giorgio.scagliotti@unito.it

More information

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY

POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY Original Issue Date (Created): 9/1/2011 Most Recent Review Date (Revised): 1/27/2015 Effective Date: 11/2/2015 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS

More information

The EGFR mutation and precision therapy for lung cancer

The EGFR mutation and precision therapy for lung cancer for lung cancer Outcomes in advanced lung cancer have seen meaningful improvement in the past decade thanks to new precision drug therapies. Because tumors usually develop resistance to the drugs, scientists

More information

Published Ahead of Print on April 11, 2011 as 10.1200/JCO.2010.31.8923. J Clin Oncol 29. 2011 by American Society of Clinical Oncology

Published Ahead of Print on April 11, 2011 as 10.1200/JCO.2010.31.8923. J Clin Oncol 29. 2011 by American Society of Clinical Oncology Published Ahead of Print on April 11, 2011 as 10.1200/JCO.2010.31.8923 The latest version is at http://jco.ascopubs.org/cgi/doi/10.1200/jco.2010.31.8923 JOURNAL OF CLINICAL ONCOLOGY A S C O S P E C I A

More information

( targeted therapy ) ( oncogenesis ) ( epidermal. growth factor receptor tyrosine kinase inhibitor EGFR-TKI ) ( epidermal growth

( targeted therapy ) ( oncogenesis ) ( epidermal. growth factor receptor tyrosine kinase inhibitor EGFR-TKI ) ( epidermal growth 2008 19 8-13 growth factor receptor tyrosine kinase inhibitor EGFR-TKI ) ( targeted therapy ) ( oncogenesis ) ( epidermal factor receptor monoclonal antibody EGFR-moAb ) growth factor monoclonal antibody

More information

Thorakale Onkologie. ASCO 2013 Aktuelle Studien TZ Berlin Buch 12.6.2013

Thorakale Onkologie. ASCO 2013 Aktuelle Studien TZ Berlin Buch 12.6.2013 Triple negativ Thorakale Onkologie ASCO 2013 Aktuelle Studien TZ Berlin Buch 12.6.2013 Driver Oncogene Mutations in non sq-nsclc Genome Res. 2012 November; 22(11): 2109 2119 8021: Detection of EGFR-activating

More information

Clinical development of AZD9291 in non-small cell lung cancer

Clinical development of AZD9291 in non-small cell lung cancer Clinical development of AZD9291 in non-small cell lung cancer Rachael Lawrance (AstraZeneca) PSI One Day Meeting: The Innovative, Challenging and Diversified World of Respiratory Disease 13 Nov 2015 Overview

More information

Update on Targeted Therapies of NSCLC

Update on Targeted Therapies of NSCLC Update on Targeted Therapies of NSCLC Tanja Cufer, MD, PhD University Clinic Golnik Medical Faculty Ljubljana, Slovenia Bled 2014 1 Systemic Therapy of Advanced NSCLC: Chemotherapy Range Cht improves survival

More information

New Trends & Current Research in the Treatment of Lung Cancer, Pt. II

New Trends & Current Research in the Treatment of Lung Cancer, Pt. II New Trends & Current esearch in the Treatment of Lung Cancer, Pt. II Howard (Jack) West, MD President & CEO, GACE Medical Director, Thoracic Oncology Program Swedish Cancer Institute Seattle, WA Cancer

More information

Targeted Therapy What the Surgeon Needs to Know

Targeted Therapy What the Surgeon Needs to Know Targeted Therapy What the Surgeon Needs to Know AATS Focus in Thoracic Surgery 2014 David R. Jones, M.D. Professor & Chief, Thoracic Surgery Memorial Sloan Kettering Cancer Center I have no disclosures

More information

targeted therapy a guide for the patient

targeted therapy a guide for the patient targeted therapy FOR LUNG CANCER a guide for the patient TABLE OF CONTENTS lung cancer basics... 2-3 Gene changes... 4-5 Testing... 7-8 Targeted therapy... 9-11 Drugs Targeting EGFR... 12 Drugs Targeting

More information

Lung Cancer: More than meets the eye

Lung Cancer: More than meets the eye Lung Cancer Education Program November 23, 2013 Lung Cancer: More than meets the eye Shantanu Banerji MD, FRCPC Presenter Disclosure Faculty: Shantanu Banerji Relationships with commercial interests: Grants/Research

More information

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost Effectiveness

Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost Effectiveness Treatment of Metastatic Non-Small Cell Lung Cancer: A Systematic Review of Comparative Effectiveness and Cost Effectiveness Investigators: Paul G. Shekelle, MD, PhD, Director Alicia R. Maher, MD Clinical

More information

Future Directions in Clinical Research. Karen Kelly, MD Associate Director for Clinical Research UC Davis Cancer Center

Future Directions in Clinical Research. Karen Kelly, MD Associate Director for Clinical Research UC Davis Cancer Center Future Directions in Clinical Research Karen Kelly, MD Associate Director for Clinical Research UC Davis Cancer Center Outline 1. Status of Cancer Treatment 2. Overview of Clinical Research at UCDCC 3.

More information

SEARCH METHODOLOGY SEARCH STRATEGY #1 (SYSTEMATIC REVIEWS): PubMed 1966-3/16/2012 Cochrane Database of Systematic Reviews All years

SEARCH METHODOLOGY SEARCH STRATEGY #1 (SYSTEMATIC REVIEWS): PubMed 1966-3/16/2012 Cochrane Database of Systematic Reviews All years Appendix A. Search Strategy for Systematic Reviews and Cost-Effectiveness Analyses (Search #1) TREATMENT OF METASTATIC NON-SMALL-CELL LUNG CANCER SEARCH METHODOLOGY SEARCH STRATEGY #1 (SYSTEMATIC REVIEWS):

More information

REPORT ASCO 2002 ORLANDO : LUNG CANCER Johan F. Vansteenkiste, MD, PhD, Univ. Hospital and Leuven Lung Cancer Group

REPORT ASCO 2002 ORLANDO : LUNG CANCER Johan F. Vansteenkiste, MD, PhD, Univ. Hospital and Leuven Lung Cancer Group REPORT ASCO 2002 ORLANDO : LUNG CANCER Johan F. Vansteenkiste, MD, PhD, Univ. Hospital and Leuven Lung Cancer Group In the 2002 edition of the ASCO meeting, a total of 315 abstracts in the field of respiratory

More information

REFERENCE CODE GDHC212DFR PUBLICAT ION DATE JUNE 2013 GSK1572932A (NON-SMALL CELL LUNG CANCER) FORECAST AND MARKET ANALYSIS TO 2022

REFERENCE CODE GDHC212DFR PUBLICAT ION DATE JUNE 2013 GSK1572932A (NON-SMALL CELL LUNG CANCER) FORECAST AND MARKET ANALYSIS TO 2022 REFERENCE CODE GDHC212DFR PUBLICAT ION DATE JUNE 2013 GSK1572932A (NON-SMALL CELL LUNG CANCER) GSK1572932A (NON-SMALL CELL LUNG CANCER) - Executive Summary GSK1572932A (MAGE-A3): Key Metrics in NSCLC Markets

More information

Non-small cell lung cancer, advanced or metastatic, switch-therapy after gemcitabine/carboplatin

Non-small cell lung cancer, advanced or metastatic, switch-therapy after gemcitabine/carboplatin COMPENDIA TRANSPARENCY TRACKING FORM DRUG: Docetaxel INDICATION: Non-small cell lung cancer, advanced or metastatic, switch-therapy after gemcitabine/carboplatin COMPENDIA TRANSPARENCY REQUIREMENTS 1 Provide

More information

Follow this and additional works at: http://digitalcommons.wustl.edu/open_access_pubs

Follow this and additional works at: http://digitalcommons.wustl.edu/open_access_pubs Washington University School of Medicine Digital Commons@Becker Open Access Publications 2015 Survival outcome according to KRAS mutation status in newly diagnosed patients with stage IV non-small cell

More information

Piano Generale di Emergenza Presidio Ospedaliero di Livorno Viale Alfieri 36

Piano Generale di Emergenza Presidio Ospedaliero di Livorno Viale Alfieri 36 Aprile 2011 EGFR-TKIs for the treatment of advanced NSCLC with EGFR mutations Piano Generale di Emergenza Presidio Ospedaliero di Livorno Viale Alfieri 36 Federico Cappuzzo Istituto Toscano Tumori Ospedale

More information

Cancer Treatments Subcommittee of PTAC Meeting held 18 September 2015. (minutes for web publishing)

Cancer Treatments Subcommittee of PTAC Meeting held 18 September 2015. (minutes for web publishing) Cancer Treatments Subcommittee of PTAC Meeting held 18 September 2015 (minutes for web publishing) Cancer Treatments Subcommittee minutes are published in accordance with the Terms of Reference for the

More information

Systemic Therapy for Stage IV Non-Small Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update

Systemic Therapy for Stage IV Non-Small Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update Systemic Therapy for Stage IV Non-Small Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update Introduction The purpose of this guideline update is to revise the 2011

More information

Pulmonary and Critical Care Regional Symposium April 25, 2015

Pulmonary and Critical Care Regional Symposium April 25, 2015 Pulmonary and Critical Care Regional Symposium April 25, 2015 2015: Molecular Medicine, Resistance Mutations and Immunotherapy. Keeping Up With The Latest in NSCLC Barbara J. Gitlitz MD Associate Professor

More information

non-small-cell lung cancer Quimioterapia adjuvante para câncer de pulmão não pequenas

non-small-cell lung cancer Quimioterapia adjuvante para câncer de pulmão não pequenas Adjuvant chemotherapy for non-small-cell lung cancer Quimioterapia adjuvante para câncer de pulmão não pequenas células Daniel B. Costa, MD, PhD, MMSc Division i i of Hematology/Oncology l Beth Israel

More information

Breast and Lung Cancer Biomarker Research at ASCO: Changing Treatment Patterns

Breast and Lung Cancer Biomarker Research at ASCO: Changing Treatment Patterns July 2013 Edition Vol. 7, Issue 7 Breast and Lung Cancer Biomarker Research at ASCO: Changing Treatment Patterns By Julie Katz, MPH, MPhil Biomarkers played a prominent role in the research presented in

More information

A Review of Treatment in Non-small-cell Lung Cancer. Athanasios G Pallis

A Review of Treatment in Non-small-cell Lung Cancer. Athanasios G Pallis A Review of Treatment in Non-small-cell Lung Cancer Athanasios G Pallis Medical Oncologist, Department of Medical Oncology, University General Hospital of Heraklion Abstract Non-small-cell lung cancer

More information

Cetuximab (Erbitux) MM.04.005 05/10/2005. HMO; PPO; QUEST Integration 01/01/2015 Section: Prescription Drugs Place(s) of Service: Office: Outpatient

Cetuximab (Erbitux) MM.04.005 05/10/2005. HMO; PPO; QUEST Integration 01/01/2015 Section: Prescription Drugs Place(s) of Service: Office: Outpatient Cetuximab (Erbitux) Policy Number: Original Effective Date: MM.04.005 05/10/2005 Line(s) of Business: Current Effective Date: HMO; PPO; QUEST Integration 01/01/2015 Section: Prescription Drugs Place(s)

More information

Cancer Treatment Reviews

Cancer Treatment Reviews Cancer Treatment Reviews 38 (2012) 416 430 Contents lists available at SciVerse ScienceDirect Cancer Treatment Reviews journal homepage: www.elsevierhealth.com/journals/ctrv Antitumour Treatment EGFR-mutated

More information

MEDICAL POLICY EFFECTIVE DATE: 12/20/07 REVISED DATE: 12/18/08, 12/17/09, 02/17/11, 12/15/11, 12/20/12, 12/19/13, 02/19/15

MEDICAL POLICY EFFECTIVE DATE: 12/20/07 REVISED DATE: 12/18/08, 12/17/09, 02/17/11, 12/15/11, 12/20/12, 12/19/13, 02/19/15 MEDICAL POLICY SUBJECT: GENOTYPING - EPIDERMAL GROWTH PAGE: 1 OF: 6 If a product excludes coverage for a service, it is not covered, and medical policy criteria do not apply. If a commercial product, including

More information

To Treat or Not to Treat: When Is Adjuvant EGFR TKI Therapy Appropriate?

To Treat or Not to Treat: When Is Adjuvant EGFR TKI Therapy Appropriate? To Treat or Not to Treat: When Is Adjuvant EGFR TKI Therapy Appropriate? Ramsey Asmar, MD, and Balazs Halmos, MD Abstract The use of epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI)

More information

Understanding series. new. directions. 1-800-298-2436 LungCancerAlliance.org. A guide for the patient

Understanding series. new. directions. 1-800-298-2436 LungCancerAlliance.org. A guide for the patient Understanding series LUNG CANCER: new treatment directions 1-800-298-2436 LungCancerAlliance.org A guide for the patient TABLE OF CONTENTS What s New in lung cancer? Advancements...4 Changes in genes that

More information

NON-SMALL CELL LUNG CANCER

NON-SMALL CELL LUNG CANCER NON-SMALL CELL LUNG CANCER Executive Summary In 2012, an estimated 1.8 million people were diagnosed with lung cancer resulting in 1.6 million deaths (http://globocan.iarc.fr/pages/fact_sheets_cancer.aspx).

More information

targeted cancer therapy

targeted cancer therapy LUNG CANCER TREATMENTS What you need to know about... targeted cancer therapy foreword About LUNGevity LUNGevity is the largest national lung cancer-focused nonprofit, changing outcomes for people with

More information

Câncer de Pulmão. Benefício e emprego das novas drogas. XIV Congresso da Sociedade Brasileira de Radioterapia

Câncer de Pulmão. Benefício e emprego das novas drogas. XIV Congresso da Sociedade Brasileira de Radioterapia + Câncer de Pulmão Benefício e emprego das novas drogas XIV Congresso da Sociedade Brasileira de Radioterapia Maikol Kurahashi, MD. Oncologia Clínica Hospital Santa Casa de Curitiba Declaração de conflitos

More information

Lung Cancer: New Biological Insights and Recent Therapeutic Advances

Lung Cancer: New Biological Insights and Recent Therapeutic Advances CA CANCER J CLIN 2011;61:91 112 Lung Cancer: New Biological Insights and Recent Therapeutic Advances Suresh S. Ramalingam, MD 1 ; Taofeek K. Owonikoko, MD, PhD 2 ; Fadlo R. Khuri, MD 3 Abstract Approximately

More information

Elderly Patients with Advanced Non-Small Cell Lung Cancer: What Treatment?

Elderly Patients with Advanced Non-Small Cell Lung Cancer: What Treatment? 4 The Open Lung Cancer Journal, 2011, 4, 4-9 Open Access Elderly Patients with Advanced Non-Small Cell Lung Cancer: What Treatment? Antonio Rossi * Division of Medical Oncology, S.G. Moscati Hospital,

More information

Targeted Therapies in Lung Cancer

Targeted Therapies in Lung Cancer Targeted Therapies in Lung Cancer I Edited by: Simona Carnio Thoracic Oncology Division - St Luigi Hospital Orbassano (TO) - Italy Silvia Novello Department of Oncology - University of Torino - Italy Why

More information

Corso Integrato di Clinica Medica ONCOLOGIA MEDICA AA 2010-2011 LUNG CANCER. VI. THERAPY. III. TARGETED THERAPY FOR NON SMALL CELL LUNG CANCER Prof.

Corso Integrato di Clinica Medica ONCOLOGIA MEDICA AA 2010-2011 LUNG CANCER. VI. THERAPY. III. TARGETED THERAPY FOR NON SMALL CELL LUNG CANCER Prof. Corso Integrato di Clinica Medica ONCOLOGIA MEDICA AA 2010-2011 LUNG CANCER. VI. THERAPY. III. TARGETED THERAPY FOR NON SMALL CELL LUNG CANCER Prof. Alberto Riccardi Targeted therapies. I. Signaling pathways

More information

Current Progress for Non-Small Cell Lung Cancer Treatment

Current Progress for Non-Small Cell Lung Cancer Treatment Chemotherapy : Mechanisms of Action Current Progress for Non-Small Cell Lung Cancer Treatment Topo inhibitors Alkylators CHR Tubulin active agents Topo I,II Pt Wen-Pin Su, M.D./ Prof. Wu-Chou Su National

More information

EGFR and ALK TKI Therapy in Advanced NSCLC: Molecular Basis and When and Why to Stop or Change

EGFR and ALK TKI Therapy in Advanced NSCLC: Molecular Basis and When and Why to Stop or Change EGFR and ALK TKI Therapy in Advanced NSCLC: Molecular Basis and When and Why to Stop or Change Paul A. Bunn, Jr, MD, Dudley Chair and Professor, Univ. of Colorado Cancer Center, Aurora, CO, USA Consultant:

More information

Summary ID# 13095. Clinical Study Summary: Study H3E-EW-B012

Summary ID# 13095. Clinical Study Summary: Study H3E-EW-B012 Page 1 Summary ID# 13095 Clinical Study Summary: Study H3E-EW-B012 First-line Treatment of Non-Small Cell Lung Cancer under Routine Conditions: Observational Study on Overall Survival Date summary electronically

More information

Non-Small Cell Lung Cancer: Clinical and Economic Considerations in Targeting Therapy Based on Molecular Profiling

Non-Small Cell Lung Cancer: Clinical and Economic Considerations in Targeting Therapy Based on Molecular Profiling Established 1995 SUPPLEMENT www.ajmc.com Non-Small Cell Lung Cancer: Clinical and Economic Considerations in Targeting Therapy Based on Molecular Profiling Highlights n Shifting Paradigms in Non-Small

More information

Proposal for Tyrosine Kinase Inhibitors for Non Small Cell Lung Cancer

Proposal for Tyrosine Kinase Inhibitors for Non Small Cell Lung Cancer 31 May 2012 Proposal for Tyrosine Kinase Inhibitors for Non Small Cell Lung Cancer PHARMAC is seeking feedback on a proposal to: fund gefitinib (Iressa) as a first line treatment for patients with locally

More information

Advanced EGFR Mutation-Positive Non Small-Cell Lung Cancer: Case Report, Literature Review, and Treatment Recommendations

Advanced EGFR Mutation-Positive Non Small-Cell Lung Cancer: Case Report, Literature Review, and Treatment Recommendations Special Report Advanced EGFR Mutation-Positive Non Small-Cell Lung Cancer: Case Report, Literature Review, and Treatment Recommendations Andrew Kuykendall, MD, and Alberto Chiappori, MD Background: Lung

More information

Protocol. Molecular Analysis for Targeted Therapy of Non-Small- Cell Lung Cancer

Protocol. Molecular Analysis for Targeted Therapy of Non-Small- Cell Lung Cancer Molecular Analysis for Targeted Therapy of Non-Small- Cell Lung (20445) (Formerly Epidermal Growth Factor Receptor [EGFR] Mutation Analysis for Patients with Non-Small Cell Lung [NSCLC] and KRAS Mutation

More information

Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast Cancer

Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast Cancer Gemcitabine, Paclitaxel, and Trastuzumab in Metastatic Breast Cancer Review Article [1] December 01, 2003 By George W. Sledge, Jr, MD [2] Gemcitabine (Gemzar) and paclitaxel show good activity as single

More information

Zeroing in on Non-Small Cell Lung Cancer: Integrating Targeted Therapies into Practice

Zeroing in on Non-Small Cell Lung Cancer: Integrating Targeted Therapies into Practice Lung Cancer: Integrating Targeted Therapies into Practice Table of Contents Program Information... 2 Faculty Biographies... 3 Genomic Profiling of NSCLC for EGFR Inhibitors... 4 Fred R. Hirsch, MD, PhD

More information

Lessons learned from gefitinib and crizotinib clinical trials in NSCLC

Lessons learned from gefitinib and crizotinib clinical trials in NSCLC Lessons learned from gefitinib and crizotinib clinical trials in NSCLC Shun Lu Shanghai Lung Cancer Center Shanghai Chest Hospital affiliated to Jiao Tong University New Era of Cancer Care: Genomic Era

More information

Avastin in breast cancer: Summary of clinical data

Avastin in breast cancer: Summary of clinical data Avastin in breast cancer: Summary of clinical data Worldwide, over one million people are diagnosed with breast cancer every year 1. It is the most frequently diagnosed cancer in women 1,2, and the leading

More information

REPORT PERSPECTIVES IN LUNG CANCER 2010 AMSTERDAM

REPORT PERSPECTIVES IN LUNG CANCER 2010 AMSTERDAM REPORT PERSPECTIVES IN LUNG CANCER 2010 AMSTERDAM Valerie Van Damme, Isabelle Wauters, Johan Vansteenkiste Univ. Hospital Leuven and Leuven Lung Cancer Group Introduction Perspectives in Lung Cancer (PILC)

More information

Chapter 7: Lung Cancer

Chapter 7: Lung Cancer Chapter 7: Lung Cancer Contents Chapter 7: Lung Cancer... 1 Small Cell... 2 Good PS + Limited stage... 2 Cisplatin/etoposide... 2 Concurrent chemotherapy + XRT... 2 Good / Intermediate PS... 2 Carboplatin

More information

DECISION AID SET. STAGE IV Non-Small Cell Lung Cancer (NSCLC)

DECISION AID SET. STAGE IV Non-Small Cell Lung Cancer (NSCLC) DECISION AID SET STAGE IV Non-Small Cell Lung Cancer (NSCLC) Dear Clinician: This set of DECISION AIDS is based on ASCO s Clinical Practice Guideline Update on Chemotherapy for Stage IV NSCLC (2009). ASCO

More information

DECISION AND SUMMARY OF RATIONALE

DECISION AND SUMMARY OF RATIONALE DECISION AND SUMMARY OF RATIONALE Indication under consideration Clinical evidence Crizotinib as 2nd line treatment for patients with anaplastic lymphoma kinase (ALK) positive lung cancer Score The application

More information

Genomic Medicine The Future of Cancer Care. Shayma Master Kazmi, M.D. Medical Oncology/Hematology Cancer Treatment Centers of America

Genomic Medicine The Future of Cancer Care. Shayma Master Kazmi, M.D. Medical Oncology/Hematology Cancer Treatment Centers of America Genomic Medicine The Future of Cancer Care Shayma Master Kazmi, M.D. Medical Oncology/Hematology Cancer Treatment Centers of America Personalized Medicine Personalized health care is a broad term for interventions

More information

Come è cambiata la storia naturale della malattia

Come è cambiata la storia naturale della malattia Malattia Metastatica del Carcinoma del Grosso Intestino Tecniche e terapie Innovative Come è cambiata la storia naturale della malattia Antonio Frassoldati Oncologia Clinica - Ferrara 29 ottobre 2011 Colorectal

More information

Non-Small Cell Lung Cancer Treatment Protocols

Non-Small Cell Lung Cancer Treatment Protocols Medscape Reference Reference News Reference Education MEDLINE Non-Small Cell Lung Cancer Treatment Protocols Author: Marvaretta M Stevenson, MD; Chief Editor: Jules E Harris, MD more... Updated: Oct 16,

More information

Non-small cell lung cancer (NSCLC) is the most

Non-small cell lung cancer (NSCLC) is the most Vol 3 April 2011 Clinical Pharmacist 109 First-line treatment for non-small cell lung cancer is surgery; but many patients are not suitable and, for these patients, management may involve radiotherapy,

More information

Avastin in breast cancer: Summary of clinical data

Avastin in breast cancer: Summary of clinical data Avastin in breast cancer: Summary of clinical data Worldwide, over one million people are diagnosed with breast cancer every year 1. It is the most frequently diagnosed cancer in women 1,2, and the leading

More information

Cancer Treatments Subcommittee of PTAC Meeting held 2 March 2012. (minutes for web publishing)

Cancer Treatments Subcommittee of PTAC Meeting held 2 March 2012. (minutes for web publishing) Cancer Treatments Subcommittee of PTAC Meeting held 2 March 2012 (minutes for web publishing) Cancer Treatments Subcommittee minutes are published in accordance with the Terms of Reference for the Pharmacology

More information

Prognostic and Predictive Factors in Oncology. Mustafa Benekli, M.D.

Prognostic and Predictive Factors in Oncology. Mustafa Benekli, M.D. Prognostic and Predictive Factors in Oncology Mustafa Benekli, M.D. NCI Definitions ESMO Course -Essentials of Medical Oncology -Istanbul 2 Prognostic factor: NCI Definition A situation or condition, or

More information

Drug/Drug Combination: Bevacizumab in combination with chemotherapy

Drug/Drug Combination: Bevacizumab in combination with chemotherapy AHFS Final Determination of Medical Acceptance: Off-label Use of Bevacizumab in Combination with Chemotherapy for the Treatment of Metastatic Breast Cancer Previously Treated with Cytotoxic Chemotherapy

More information