cancer in the lung
What is my biomarker? A newly diagnosed lung cancer patient should ask this question before starting treatment. Why? Because the answer to this question can change the odds and the choices for your personalized treatment plan, especially for Black or African American patients. Black and African Americans must ask their doctors, “What is my biomarker?” to ensure they receive the latest targeted therapy treatment that is applicable. Hear from Dr. Sydney Barned and Brandi Bryant in this episode as they discuss their care and what a difference it made in knowing their biomarkers. And maybe even more importantly, they are advocating that every black or African American should ask that question, “What is my biomarker?” There are more options for treating lung cancer and they want to make sure every black or African American patient, like everybody, else gains access to that full range of options. Why do Biomarkers matter in lung cancer treatment? Minority and underserved communities must advocate for themselves to get the best treatments, especially treatment that can increase the quality of their lives. Guest Dr. Osarogiagbon dives into not only the importance of asking, “what is my biomarker?”, but why it is essential that Black and African Americans make this question a priority. Thanks to lung cancer research, he's really excited that lots of biomarkers have been discovered to help doctors split what used to be a single disease, into a disease of many different bits and of different sizes. Understanding biomarkers now allows doctors to predict how the cancer is going to behave. And then determine what treatment is most likely to benefit the patient, in terms of surviving lung cancer - and the quality of life, in response to cancer treatment. “So, you go from 4% to 6% five-year survival, to up to 60%, if you get the right treatment for right cancer. As with ALK mutated lung cancer, so with some of the other subsets, the EGFR mutated lung cancers, the ROS1 mutated lung cancers, the BRAFF mutated lung cancers, the MET exon 14 mutated lung cancer, all... There are at least nine subsets of biomarker-driven lung cancers, and that continues to change all the time. So, that's why it's vital that we get tested, so we know which treatment would benefit us.” - Dr. Raymond Osarogiagbon Guests: Dr. Sydney Barned, a hospitalist at Ann Arundel Medical Center in Annapolis, Maryland, a lung cancer patient, and a member of the LCFA Speakers Bureau Brandi Bryant, a lung cancer patient, and a member of the LCFA Speakers Bureau Dr. Raymond Osarogiagbon, Chief Scientist for Baptist Memorial Health Care, Director of Baptist Cancer Center's Multidisciplinary Thoracic Oncology Program and Thoracic Oncology Research Group, and Principal Investigator of Baptist's Mid-South Minority-Underserved Consortium initiative, NCORP, in Memphis, Tennessee Show Notes | Transcript | Watch the video Resources: What Do I Need to Know About Biomarker Testing? National Comprehensive Cancer Network (NCCN) Guidelines for Non-Small Cell Lung Cancer What is a Liquid Biopsy for Lung Cancer? 7 Signs of Lung Cancer You Should Know
In this episode, Ayesha shared new research about how scientists at the Francis Crick Institute and University College London have found a mechanism of action to explain how air pollution may cause lung cancer in non-smokers. The research findings revealed that people who live in polluted areas have a higher risk of lung cancer, and that particulate matter smaller than 2.5 micrometers (PM2.5) can act on existing genetic mutations to trigger inflammation and the development of cancer. Hear more about the research findings in this episode.Ayesha also talked about how a woman with a unique ability to smell Parkinson's disease has helped scientists develop a new test that may aid in the early diagnosis of the condition. The Scottish woman was able to detect something was off with her husband's body odor more than a decade before he was diagnosed with Parkinson's disease. Find out more about how researchers leveraged her powerful sense of smell to develop the new test.Read the full articles here:New Research Reveals How Air Pollution May Trigger Lung CancerScientists Develop Parkinson's Test Based on Woman's Ability to Smell It For more life science and medical device content, visit the Xtalks Vitals homepage.Follow Us on Social MediaTwitter: @Xtalks Instagram: @Xtalks Facebook: https://www.facebook.com/Xtalks.Webinars/ LinkedIn: https://www.linkedin.com/company/xtalks-webconferences YouTube: https://www.youtube.com/c/XtalksWebinars/featured
ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the voice of the world's oncology professionals. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guests' statements on this podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so data described here may change as research progresses. In the Research Round Up series, ASCO experts and members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today's episode, our guests will discuss new research in lung cancer, lymphoma, and childhood cancer that was presented at the 2022 ASCO Annual Meeting, held June 3-7 in Chicago, Illinois. First, Dr. Charu Aggarwal will discuss 3 studies looking at treatment options for people with non-small cell lung cancer. Dr. Aggarwal is the Leslye Heisler Associate Professor of Medicine in the Hematology-Oncology Division at the University of Pennsylvania's Perelman School of Medicine in Philadelphia, Pennsylvania. She is also the Cancer.Net Associate Editor for Lung Cancer. You can view Dr. Aggarwal's disclosures at Cancer.Net. Dr. Aggarwal: Hello and welcome to this Cancer.Net podcast. I'm bringing you updates from the Annual Meeting of the American Society of Clinical Oncology, held in Chicago in 2022. I'm Dr. Charu Aggarwal. I'm the Leslye Heisler Associate Professor for Lung Cancer Excellence at the University of Pennsylvania's Abramson Cancer Center. I will be discussing updates on 3 studies today that offer insights and new advances in the management of patients with non-small cell lung cancer. I don't have any direct relationship with any of these companies or studies, and you can view a list of my disclosures on the Cancer.Net website. First off, I would like to talk a little bit about advances in the management of patients with EGFR exon 20 mutations. We know that a lot of advances have been made in the management of patients with non-small cell lung cancer, and much of that has been attributed to the fact that we are now able to deliver targeted therapy for a subset of patients. EGFR mutations form one such subset where we have a lot of oral drugs that are available, and we can offer these that improve survival, and patients can avoid chemotherapy, immunotherapy, and other IV infusional therapies. Within the subset of EGFR mutations lies this unique subset of EGFR exon 20 insertion mutations, which have been historically harder to target with currently available EGFR inhibitors. And over the last 5 years, we have seen tremendous growth of opportunities, targets, and new drugs for this subset of patients. The mutations in this subset forms about 2% to 5% of all non-small cell lung cancers. But now we have 2 FDA-approved drugs in this space, one being intravenously administered, amivantamab, and another that is orally available, mobocertinib. We covered this in a podcast as well as a blog, so please check those out on our Cancer.Net website. But building upon that progress, there is now another drug that was reported at ASCO. This drug is called CLN-081. And we saw preliminary activity in a phase 1 and 2 study of this molecule or this drug in patients with EGFR exon 20 insertion mutations. It's an orally available drug. The top line data is that it is safe, it is effective, it was tested in different doses. It was tested at less than 65 milligrams, 100 milligrams, and 150 milligrams, again, as I mentioned, administered orally, and we saw responses and patients that had previously received other therapies and may have progressed on other therapies. And what we found was that this drug also tends to have activity against brain metastases, which I think is this huge unmet need in the management of such patients. So I think more to come, but again, I think offers us an insight into what may be in the future, an attractive drug for our patients with EGFR exon 20 insertion mutations. So stay tuned, more on that in the future. Shifting gears, I would like to now talk about one of the common mutations. So we talked about EGFR exon 20, which is about only 2% to 5%, but the largest subset of mutations in non-small cell lung cancer really revolves around KRAS mutations, and these form about 30% to 35% of all mutations in non-squamous, non-small cell lung cancer. And amongst this group there is another subset which is KRAS G12C non-small cell lung cancer, that forms about 13% of all lung cancers. We have 1 approved drug already in this space by the name of sotorasib that is FDA approved for the management of patients with this particular mutation after having received 1 prior therapy, be it chemo-immunotherapy or immunotherapy. At this year's ASCO meeting, we heard data from a study called KRYSTAL-1, which looked at the activity and safety of another molecule called adagrasib, which is an orally available drug targeting KRAS G12C, again, in a similar population of patients with advanced and metastatic non-small cell lung cancer harboring a mutation. We found that this drug is again effective, the overall response rate was about 43%, the majority of the patients had stabilization of disease, about 80%, and many patients were able to remain on treatment with stabilization of disease. We found that this drug does have side effects and adverse events and most commonly of this were diarrhea, nausea, vomiting, and fatigue. Many patients did require dose reductions, but the activity of the drug remained despite dose reductions. Now, what would be the advantage of this drug against the currently available sotorasib? In another smaller study reported at ASCO, there seemed to be activity in the brain, including intracranial penetration with the use of this molecule, adagrasib, which has not been demonstrated before with other KRAS G12C inhibitors, so I think that makes it a potentially attractive option. Again, I will say that the report of this intracranial activity was in a very small subgroup of patients, so I think needs to be further corroborated in a larger study. Shifting gears again and talking about our last study, so I would like to highlight what do we do if, in case, patients don't have a targetable mutation. I want to highlight that we do have a lot of available options, and we are continuing to improve upon available options. The way we treat such patients is by using immunotherapy, either alone or in combination with chemotherapy. But what do we do after this treatment stops working? Researchers from the Southwestern Oncology Group, or SWOG, launched a massive national effort called Lung-MAP, which is basically a clinical trial that evaluates several different strategies all at once, either for patients with targetable mutations or for patients without a targetable alteration. And they reported results from a study that evaluated the combination of pembrolizumab with ramucirumab in patients that may have progressed after frontline immunotherapy. Now, pembrolizumab is immunotherapy, so the concept was, can we continue immunotherapy beyond progression and perhaps get some synergistic activity by using ramucirumab, which is a drug that prevents blood vessels from forming in the tumor itself. It's an anti-angiogenic agent, meaning that it is a targeted molecule that prevents blood vessel formation and promotes tumor death. What they found was that patients that received pembrolizumab and ramucirumab were more likely to live longer, so overall survival was longer for patients with this combination compared to a physician investigator discretion choice, such as chemotherapy in combination with ramucirumab or other chemotherapies that are otherwise used in the second line setting. And interestingly, we did not find a significant improvement in shrinkage with this combination of pembrolizumab and ramucirumab or a significant reduction in the time of progression-- or, sorry, prolongation of the time of progression of disease. But the overall survival findings are interesting, and I think that's why we are including them in this podcast because that's one of the approaches that is leading to an improvement in survival and improvement in outcomes. I will point out that this is a phase 2 study. These results would need to be validated in a large prospective phase 3 trial so that we can account for certain confounding factors that may have led to these results. Having said that, I think there's a tremendous excitement, there's tremendous excitement in this field. I gave you examples of, or highlighted, 3 studies: one in patients with EGFR exon 20 insertion mutations, another in KRAS G12C mutations, and the third in patients who may have already received either immunotherapy or chemoimmunotherapy. We will continue to update our Cancer.Net website with updates as they come through, new advances, new studies, so thanks for following, thanks for listening, and more to come. Stay tuned. Thank you. ASCO: Thank you, Dr. Aggarwal. Next, Dr. Christopher Flowers will discuss new research in treating people with different subtypes of lymphoma, including mantle cell lymphoma and diffuse large B-cell lymphoma. Dr. Flowers is the Chair of the Department of Lymphoma/Myeloma at The University of Texas MD Anderson Cancer Center and was appointed Division Head ad interim of Cancer Medicine in August 2020. He is also the 2022 Cancer.Net Associate Editor for Lymphoma. You can view Dr. Flowers' disclosures at Cancer.Net. Dr. Flowers: Hello and welcome to this podcast that is a review of late breaking abstracts from the ASCO Meeting and recent updates in lymphoma. I'm Dr. Christopher Flowers, professor and chair of the Department of Lymphoma and Myeloma and Interim Division Head for Cancer Medicine at The University of Texas MD Anderson. And it's my great pleasure to discuss with you some of these late breaking abstracts. I do have some disclosures that are related to the content that I will present from this year's ASCO Meeting and recent studies in lymphomas. Those are available at Cancer.Net. Those relate to my role as a consultant for the development of clinical trials in lymphomas and research funding that MD Anderson has received from companies related to my role in clinical trials in lymphoma and clinical trials across cancers. So, the ASCO Meeting had a host of new information that was presented. Some of that information centers around key clinical trials. One that was a pivotal clinical trial, the SHINE clinical trial, looked at patients with mantle cell lymphoma, a rarer lymphoma subtype, that looked at the combination of bendamustine and rituximab, a standard chemoimmunotherapy combination, compared to that same chemoimmunotherapy combination, bendamustine, rituximab, plus the Bruton's tyrosine kinase inhibitor ibrutinib. Ibrutinib, as some of you may know, is a kind of therapy that is typically used in the relapse setting for patients with mantle cell lymphoma when they have their disease come back. And the SHINE clinical trial was looking at adding it to frontline therapy. What this randomized, controlled trial in the phase 3 setting found was that patients who received the combination of bendamustine, rituximab, plus ibrutinib had improvement in their progression-free survival, meaning that the time that it took for their disease to come back or them to have deaths related to the lymphoma was longer for patients who received this combination. About 2.3 years longer than the group that received bendamustine, rituximab, plus placebo. And in total, that led to a median progression-free survival of 6.7 years. That study has now been published in the New England Journal of Medicine and was led by my colleague Dr. Michael Wong from MD Anderson. Dr. Wong also led another study that was presented at the ASCO Meeting looking at CAR T-cell therapy for patients with mantle cell lymphoma. That study has now been published in the Journal of Clinical Oncology, and it looks at brexucabtagene autoleucel, a kind of CAR T-cell therapy, where that-- the CAR T-cell therapy was successfully manufactured for 71 of the 74 patients in the trial. 68 of those patients received an infusion and the median progression-free survival, so the average amount of time that it took for patients to have progression of their disease, was about 25 months. And so a marked benefit for those patients who were receiving CAR T-cell therapy when their mantle cell lymphoma came back. There also were major breaking abstracts at the ASCO Meeting in the area of diffuse large B-cell lymphoma. As many of you may know, diffuse large B-cell lymphoma is the most common type of lymphoma that occurs in the United States. And there was a breaking trial that was presented in December at the American Society of Hematology Meeting describing polatuzumab, a CD79b antibody drug conjugate, as a new drug in the substitution of frontline therapy for patients with diffuse large B-cell lymphoma in combinations with rituximab, cyclophosphamide, adriamycin, and prednisone, or the pola-R-CHP arm, that compared favorably to rituximab and CHOP chemotherapy, which has been the standard of care for patients with diffuse large B-cell lymphoma. And that trial showed an improvement in progression-free survival. At this year's ASCO Meeting, Franck Morschhauser presented results from looking at subsets of that patient population. Those patients who had BCL2 by immunohistochemistry that was positive or MYC expression by immunohistochemistry that was positive, or both of those, what we call double-expressor lymphomas, those who have poorer risk than standard groups. And those double-expressor lymphomas, treated with pola-R-CHP, had improvement in progression-free survival compared to R-CHOP with a hazard ratio of 0.64 in that group. We also saw in a multitude of analysis that that supported the benefit of pola-R-CHP in patients with both BCL2-positive and MYC-positive diffuse large B-cell lymphoma. Another area that has been very hot in diffuse large B-cell lymphoma clinical trials is the role of bispecific antibodies. Bispecific antibodies are antibodies that bind both to CD20, a marker on the diffuse large B-cell or the lymphoma cells, and to the marker CD3, which is a marker on T-cells which brings the normal T-cells of the immune system in close proximity to the lymphoma cells and then leads to immune-directed killing of lymphoma cells. The agent glofitamab is an agent that was presented by Michael Dickinson at this year's ASCO Meeting in an abstract. And in this study, 107 patients who received more than 1 dose of steady treatment went on to have complete responses in about 35% of patients. And this showed that glofitamab induced durable complete responses and had a very favorable safety profile in patients with relapsed and refractory diffuse large B-cell lymphoma. And in this trial, they compared that also for patients who had prior exposure to CAR T-cells and showed that responses were also good in those patients. Another set of studies has also looked at bispecific antibodies and a whole host of other areas with multitude of other agents. Another study that was presented at this year's ASCO Meeting explored the use of bispecific antibodies in the frontline setting in combination with the R-CHOP regimen that I just discussed. In that study, Lorenzo Falchi presented results of the subcutaneous bispecific antibody epcoritamab in combination with R-CHOP. This was a relatively small study of 33 patients that showed that the combination of epcoritamab plus R-CHOP was something that was safe and tolerable. There were no new treatment emergent adverse events that led to discontinuation of epcoritamab in the study. And there are some adverse events that are of special interest that we see with the bispecific antibodies, and those include the kind of immune-mediated adverse events that we can also see with CAR T-cells, like cytokine release syndrome, or CRS, or neurologic toxicities that we can see there that are also called ICANS. What we've seen in this trial, that about 42% of patients had some form of cytokine release syndrome, but that most severe form of cytokine release syndrome, those that were greater than grade 3 in severity, was only in 3% of patients. And likewise, the neurologic toxicities, or ICANS, that were grade 2 was in only 3% of patients. Relatively few patients completed all therapy by the time that this was presented. Only 10 patients had completed 6 cycles of therapy, but that showed an overall response rate that was quite high in that patient population. There were a whole host of other trials that were presented at this year's ASCO Meeting, and those portend improved kinds of outcomes on the horizon for patients with lymphomas across the spectrum. And I think it's an exciting time moving forward for clinical trials in lymphoma and hopefully, to see new therapies that emerge for the management of this disease. One of those new therapies that happened outside of the ASCO Meeting was the recent FDA approval of CAR T-cell therapy in the relapse setting for follicular lymphoma. And this was based on the ELARA clinical trial. And I think the future is quite bright for therapies and for patients with lymphomas broadly. ASCO: Thank you, Dr. Flowers. Finally, Dr. Daniel Mulrooney will discuss new research in childhood cancers, including a study comparing treatment options for Ewing sarcoma, and several studies on neuroblastoma. Dr. Mulrooney is an Associate Member in the Division of Cancer Survivorship at St. Jude Children's Research Hospital. He is also the Cancer.Net Associate Editor for Pediatric Cancers. You can view Dr. Mulrooney's disclosures at Cancer.Net. Dr. Mulrooney: My name is Dr. Dan Mulrooney from St. Jude Children's Research Hospital. I'm the Deputy Director of the After Completion of Therapy Clinic at St. Jude and primary care for survivors of pediatric solid tumors. The annual ASCO Meeting is typically quite busy and full of research presentations sharing knowledge and advances in cancer treatment and care. Today, I'd like to highlight some of the exciting presentations in pediatric cancer. Please note, I do not have any relationships to disclose related to any of these studies. At this year's meeting, one of the highlights was a European study in patients with relapsed or refractory Ewing sarcoma. Ewing sarcoma is a rare bone cancer that typically occurs in adolescents or young adults. While challenging to treat, it is difficult to cure in patients who have relapsed, and studies are needed to improve the care of these patients. Investigators from 13 European countries and Australia and New Zealand studied the most common relapsed therapies, which include irinotecan and temozolomide, gemcitabine and docetaxel, topotecan and cyclophosphamide, or high-dose ifosfamide. The study enrolled 451 patients between 2014 and 2021 and randomly assigned them to one of these four treatments. Based on response rates, the first 2 arms were dropped and the study was largely a comparison between topotecan cyclophosphamide and high-dose ifosfamide. The main outcome was event-free survival. Event-free survival is a common way in a clinical trial to see how well a treatment works. It measures the time from treatment that the patient remains free of complications, such as return or progression of the cancer. But investigators also looked at overall survival, toxicity, and quality of life. The 6-month event-free survival was better for high-dose ifosfamide at 47% compared to 37% for topotecan cyclophosphamide. The median overall survival was also better for high-dose ifosfamide compared to topotecan cyclophosphamide. The results were best for children younger than 14 years old versus those 14 or greater. Toxicities included fever and neutropenia, nausea, vomiting, and diarrhea. Patients receiving high-dose ifosfamide had more neurologic and kidney toxicities, which might be expected since ifosfamide is known to affect these organ systems, while only descriptive measurements of quality of life appeared higher for those children treated with high-dose ifosfamide compared to topotecan and cyclophosphamide. The strength of this trial is its large size, particularly for a rare cancer, and the fact that it randomized patients to the most commonly used treatment regimens for relapsed Ewing sarcoma. Importantly, data did not previously exist comparing these different treatments. While the results of this study are promising, clearly more needs to be done, and there was a lot of discussion at the ASCO Meeting about how to further improve survival in these patients. This study provides some information for doctors and patients, but importantly, provides data to advance future trials, which will concentrate on incorporating new targeted drugs with high-dose ifosfamide. This study is ongoing and is adding additional arms to continue to improve the outcomes for patients with relapsed or refractory Ewing sarcoma. In addition to this study in Ewing sarcoma, several studies investigating neuroblastoma were presented. Neuroblastoma is the most common extracranial solid tumor in children and for children with high-risk disease requires intensive and prolonged treatment, including chemotherapy, surgery, radiation therapy, and stem cell transplantation. Treatment for these patients has improved since the introduction of immunotherapy, particularly an antibody directed at a particular antigen named GD2 on the neuroblastoma cells. One study showed improvement in outcomes using this antibody for children with relapsed or refractory neuroblastoma, and another study demonstrated feasibility of using this antibody earlier in treatment, which was not previously known to be safe and tolerable. In what is called the BEACON study, investigators tested whether the antibody, called dinutuximab, would be effective when combined with chemotherapy for relapsed or refractory neuroblastoma. They enrolled 65 patients from 2019 to 2021 and randomized these patients to either chemotherapy alone or chemotherapy plus dinutuximab. The median age of these children was 4 years. The overall response rate, which means either a complete or partial response, was 18% for the chemotherapy-only arm but improved to nearly 35% for those treated with chemotherapy and dinutuximab. The progression-free survival was 27% for chemotherapy only and improved to 57% for those treated with chemotherapy and the antibody. There was no change in overall survival, though investigators think this may have been due to some patients who had progressive disease and crossed over to the antibody arm of the study. This presentation was followed by a study from the Children's Oncology Group, which investigated the feasibility of adding antibody treatment earlier in the treatment regimen for neuroblastoma. Prior studies had used antibody later in treatment when the tumor burden is thought to be lower. The endpoint of this study was tolerability measured by toxic deaths or unacceptable toxicities, such as adverse reactions to the medication. For example, sustained low blood pressure requiring a ventilator or breathing machine, or severe neuropathy. 42 high-risk neuroblastoma patients were enrolled from 8 different children's hospitals between 2019 and 2021. 41 of the 42 were able to complete the induction chemotherapy plus the antibody. There were no toxic deaths or unacceptable toxicities. Importantly, 85% were able to complete the next phase of treatment, called the consolidation phase, and 79% were able to complete the following phase after consolidation, called post-consolidation. One-year event-free survival was 83%, and 1-year overall survival was 95%. Now, it's important to know these are still early results, and the trial recently closed, and some of the patients have only completed therapy within the last year. Both of these studies add to the knowledge of chemoimmunotherapy for children with high-risk neuroblastoma. These studies provide a foundation for larger randomized trials that will further advance the care of these children. And finally, another study looked at race, ethnic, and socioeconomic disparities among children treated for high-risk neuroblastoma on Children's Oncology Group studies. There were no differences in event-free survival, but there were differences in overall survival based on ethnicity. The 5-year survival was lowest for Hispanic patients at 47%, 50% for non-Hispanic other ethnicities, which included Asian, Native American, Native Hawaiian, or Pacific Islanders, and 62% for non-Hispanic Black and non-Hispanic White children. Importantly, these investigators also studied household and neighborhood poverty. Overall, survival was lower for children living in poverty, though some of these differences went away when accounting for other factors, such as stage of disease or high-risk features. This study is important because it highlights the increasing need to collect data on clinical trials that may contribute to inequities in outcomes. While most studies collect data on the race and ethnicity of participants, other factors known as social determinants of health, such as income, neighborhood, education, access to health care, and insurance coverage, may also contribute to outcomes in pediatric cancer patients. Overall, the studies highlighted here and presented at this year's ASCO Annual Meeting focused on difficult-to-treat cancers, such as relapse or refractory disease, and they have laid the groundwork for future investigations to continue to improve survival rates for all children diagnosed with a malignancy through improved therapies and by addressing potential social barriers. Thank you for listening to this brief summary of the new research in pediatric oncology presented at the 2022 ASCO Annual Meeting. ASCO: Thank you, Dr. Mulrooney. You can find more research from recent scientific meetings at www.cancer.net. Cancer.Net Podcasts feature trusted, timely, and compassionate information for people with cancer, survivors, and their families and loved ones. Subscribe wherever you listen to podcasts for expert information and tips on coping with cancer, recaps of the latest research advances, and thoughtful discussions on cancer care. And check out other ASCO Podcasts to hear the latest interviews and insights from thought leaders, innovators, experts, and pioneers in oncology. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds lifesaving research for every type of cancer, helping people with cancer everywhere. To help fund Cancer.Net and programs like it, donate at CONQUER.ORG/Donate.
A team from the Francis Crick Institute and University College London thinks that air pollution could play a bigger role in the development of lung cancer than previously thought. Our house doctor Peter Lin talks about how this new research could mean new solutions.
According to the World Health Organisation, air pollution causes 7 million premature deaths every year. We've known for a long time that air pollution causes lots of health problems, including lung cancer – but exactly how the two were linked was somewhat of mystery. Last week, a team from the Francis Crick Institute and University College London presented findings that shed new light on the role between air pollution and lung cancer. And, in doing so, could make us rethink how cancer develops. Madeleine Finlay speaks to the Guardian's science correspondent Hannah Devlin about how scientists uncovered this link – and what it might mean for the future of the field.. Help support our independent journalism at theguardian.com/sciencepod
Lung cancer is one of the most commonly diagnosed type of cancer and so it is fitting that we start the first of our disease-specific oncology series with this diagnosis. This week, we round out our discussion of early stage lung cancer treatment!* When deciding if a patient can get surgery upfront or not, remember the three “Fellow on Call” criteria for early stage lung cancer: - Mass invading other structures or mediastinum- Central lymph nodes (single digit)- Tumor >7 cm* If surgery is NOT an option at this time, where do we go from here?- Treat with upfront concurrent definitive chemoradiation- Treat with “induction” chemotherapy or induction concurrent chemoradiation**If surgery is/may be possible***What are the goals of “induction” treatments? - Eradicate microscopic disease- Improved local control, possibly shrinkage- Adding radiation may allow you to downstage tumor or lymph nodes to have a possible improvement in surgical outcomes* What sorts of discussions are being had a thoracic tumor board in patients with newly diagnosed early stage NSCLC? - Is the patient a surgical candidate?- If the patient is not a surgical candidate, then what are the options:--Definitive concurrent chemoradiation (usually) followed by immunotherapy---Pearl 1: Always choose this if surgeon thinks the patient is unresectable in general even with an induction approach---Pearl 2: Always choose this if 2 out of 3 criteria we discussed above are met---Pearl 3: Always choose this if N3 disease- “Induction” regimen with either chemotherapy alone or concurrent chemoradiation followed by surgery * What's the idea behind “induction” chemo or chemoradiation? - There is a chance that patients with these high risk features may already have micrometastatic disease, so treatment upfront can help address that- There is a chance that after surgery, patient may suffer deconditioning, which may preclude the use of chemo +/- radiation (up to 90% of patients are often eligible for chemoradiation before surgery; this drops to ~60% after surgery)- Local disease control to achieve the best possible surgical outcome (R0 resection) and also prevent any microscopic residual disease from then having the opportunity to spread systemically, especially in areas where the mass may be adjacent to many blood vessels or lymph nodes* What to treat with in the neoadjuvant setting?- Platinum containing regimens (“platinum doublets”):-- Carboplatin + paclitaxel-- Cisplatin + etoposide-- Cisplatin + gemcitable-- Cistplain + pemetrexed- Can combine this with radiation* How does the data about chemotherapy+IO in the neoadjuvant setting fit in here (CHECKMATE 816)?- In patients with Stage IIB to IIIA (8th edition) WITHOUT EGFR or ALK mutation, treatment with NEOADJUVANT chemotherapy q3w x3 cycles (most got cisplatin based therapy) + nivolumab 360mg q3w x3 cycles resulted in improved event free survival (31.6 months vs. 20.8 months) AND pathological complete response was 24.0% vs. 2.2%- Current NCCN guidelines state that if nivolumab is used in neoadjuvant setting, it should not be used in adjuvant setting- There is still uncertainty about how this fits into treatment compared to “traditional” neoadjuvant approaches with chemo+/-radiation*So after neoadjuvant treatment, does everyone go to surgery?- Always re-assess the status of the disease; if there is progression of disease, then will go to definitive chemoradiation- Discuss with surgeons to confirm if the patient is still a surgery candidate* If patient undergoes surgery, then what?- If patient got neoadjuvant therapy and an R0, then they are done with treatment- If R0 resection was not able to achieved, then either radiation “boost” to the area (if they previously got radiation), a course of radiation (if they just got induction chemo) or re-resection- We discuss the adjuvant setting in more detail in Episode 026 (https://www.thefellowoncall.com/tfocpodcast/episode-001disclaimer-wfhgf-ml3b6-9m66a-8rrc4-k8w87-x7xdd-wrzye-4xg8x-t73gt-cxc5s-nmg8f-cfyd6-hgs35-5pcwx-tf6dh-trggt-xzkt7-923gg-rpjzx-6s36p-hk27n-bbpgx-jymml-9lfam-76m4s)** If surgery is not possible*** If patient cannot go through to surgery Definitive chemoradiation:- Same chemotherapy agents as above, but treatment course is longer.- For instance, for NSCLC, total 60Gy in 2Gy divided fractions (5 days/week, 6 weeks of treatment) with chemotherapy* Additional therapy after chemoradiation (PACIFIC Trial) - Found that “consolidation” durvalumab 44% PFS 18 months vs 20% 5year survival benefit 40% vs. ~30% without treatmentReferences:https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1450 - NCCN Lung Cancer guidelines https://www.nejm.org/doi/full/10.1056/nejmoa1709937 - PACIFIC Trial (NEJM 2017)https://www.nejm.org/doi/10.1056/NEJMoa2202170 - CHECKMATE 816 (NEJM 2022) Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast
Cancer innovation has been a longstanding priority in the current administration. But sometimes overlooked is some of the nation's most sophisticated lung cancer research underway at the Department of Veterans Affairs. This includes applying capacities like modernized electronic health records and artificial intelligence to support groundbreaking innovation. Dr. Michael Kelley, director of the National Precision Oncology Program, and Kenute Myrie, portfolio manager at the VA Office of Research and Development, discuss how the agency is advancing understanding of cancer and improving long-term health outcomes for veterans.
Hosts: Hildy Grossman with Jordan Rich co-host Guests: Francisco J. Sánchez-Rivera, Ph.D. and Jane Wilkinson Our prior podcast, “What Did the Human Genome Project Ever Do For Us?” was so exciting and enjoyable that we all felt there was no stopping the conversation with just one podcast. We just had to go on. Our guest, … Continue reading GENETIC ENGINEERING AND LUNG CANCER, This Isn't Science Fiction →
Our lungs are so very important to our overall health. Dr. Ross Michel explores an exciting new technology for lung cancer detection called Ion and discusses how this can be used to aid patients diagnosed with lung cancer.
Lung cancer is one of the most commonly diagnosed type of cancer and so it is fitting that we start the first of our disease-specific oncology series with this diagnosis. An important component of treatment in lung cancer (and many other cancers) is the use of radiation. This week, we continue our discussion about the fundamentals of Radiation Oncology with our guest, Dr. Evan Osmundson. *We hear the terms “hypo-fractioned” and “hyper-fractionated” radiation. What do those mean?- Fractionation, that is breaking up the total dose of radiation into smaller ones, has allowed patients to tolerate the radiation better. The repeat exposure allows the healthy tissue to repair, whereas the tumor is not able to heal as well- Standard fractionation involves keeping the maximum dose per session at 1.8-2Gy/fraction. - Hyper-fractionation is when a patient gets multiple doses per day, each less than 2Gy. This is important in small cell lung cancer, where the standard dose of radiation is 1.5Gy twice daily- Hypo-fractionation os when larger doses are given in each session, typically larger than 2.5-3Gy, often 4-5Gy per fraction. This is analogous to SBRT. *With regards to SBRT, how do you determine the number of sessions? - Typically 3-5 sessions, and this is based on data run through their computer algorithm that allows the dose to be tumoricidal. - More sessions (more likely 5 sessions) if central tumor (
Plus, Eric from Iowa calls the hotline about an important milestone he was able to witness from his puppy. Things You Should Stop Worrying About This WeekThe price of used cars going up A truck carrying Port-o-potties overturning on the freeway Dogs getting monkeypox! A Jersey Shore pier that's shaped like a crossThis episode is sponsored by…Microdose GummiesMicrodose Gummies deliver perfect, entry-level doses of THC that help you feel just the right amount of good. To get free shipping & 30% off your first order, go to Microdose.com, and use code TINY Do YOU have a tiny victory to share? Call the Tiny Victories Hotline: (323) 285-1675We want folks to share their tiny victories on our hotline because, frankly, we'll assume we're just talking into the void every week and nothing matters. Prove us wrong. Did you finally do that thing you were putting off? Tiny victory! Reconnect with someone you haven't been in touch with for ages? Victory! We only ask that you try to keep messages to under a minute so we're able to play it on the show.
Lung cancer is one of the most commonly diagnosed type of cancer and so it is fitting that we start the first of our disease-specific oncology series with this diagnosis. An important component of treatment in lung cancer (and many other cancers) is the use of radiation. Here, we discuss the fundamentals of Radiation Oncology with our guest, Dr. Evan Osmundson. Basic vocabulary: - Fraction/Fractionation: The total dose of radiation divided into smaller doses - Grey: Unit of measure of radiation being delivered in each session - Bragg-Peak effect: Specific to proton therapy (as opposed to photon therapy). It describes the sharp increase in concentration of the energy when hitting the tumor, while minimizing the effects to surrounding tissue. - Radiosensitizing chemotherapy: small doses of chemotherapy used to make the cells more responsive to the deleterious effects of radiation Fundamentals of radiation oncology: *When we make a referral to RadOnc, what happens then? - Send over any available imaging that is available - Team reviews the imaging to ensure that staging is completed - Simulation scan: Uses a CT scan to “simulate” the treatment; specifically map out the tumor and the surrounding organs/structures. Multidisciplinary team reviews the scan to maximize the dose to the tumor and minimizes damage to surrounding structures. - Based on the scans, they test run the treatment on a model to ensure that the simulation on the computer is able to be replicated on a model. - The above is why it can take a while for treatment planning to take place*What sorts of imaging modalities are important to have for patients prior to getting to Rad Onc? - Send prior CT imaging - If planning for radiation to the brain, should get thin-sliced MRI w/ and w/o contrast - If prostate cancer, also consider getting MRI*Many patients express concern about the “mask fitting” - what is that? - To ensure that the same dose of radiation is administered each time, it is important for the patient to remain very still and/or the same position every session. The mask is custom fit to ensure patient is in the correct position. *How do you determine the “maximum dose” of radiation in the mediastinal area is? - The maximum dose tolerance is dependent on the structure in question. A structure “in series” such as the bronchial tree would have profound effects if tissue is injured compared to lung parenchymal tissue (If you damage some, there is plenty more that is able to compensate) - Always concern for spinal cord when radiating the mediastinum *What are side effects you counsel patients on, specifically in thoracic radiation? - Fatigue (usually not debilitating), radiation esophagitis, pericarditis (rare) - Radiation pneumonitis (usually 6-8 weeks, but can be up to one year), presents with cough, shortness of breath; likelihood of this is dependent on duration of treatment, dose of radiation, location A special thank you to our guest, Evan Osmundson, MD, PhD, Associate Professor in the Department of Radiation Oncology and serves as the Medical Director of Radiation Oncology at Vanderbilt University Medical Center in Nashville, TN!Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast
Lung cancer does not just happen to people who smoke.Meet Jill Atcheson, a healthy, vibrant young mom who was diagnosed with Stage 4 lung cancer at the age of 37. And guess what? She NEVER smoked a cigarette in her life. Her story is a profound example of what can happen when you partner conventional medicine with a holistic approach. Jill has a phenomenal outlook and that also plays into her health and well-being. Listen in today as I talk with her about that diagnosis, her treatment choices and the biggest surprise of all while she was on this journey!Connect with Jill at Luv Your Life Naturally:https://luvyourlifenaturally.com/Suggested Resource Links:Luv Your Life NaturallyBOOK: Metabolic Approach to Cancer
Proceedings from a daylong multitumor educational symposium in partnership with the American Oncology Network, featuring perspectives from Drs Ibiayi Dagogo-Jack and Suresh Ramalingam on recent advances and real-world implications in lung cancer. CME information and select publications
Proceedings from a daylong multitumor educational symposium in partnership with the American Oncology Network, including key clinical presentations and papers in breast cancer, chronic lymphocytic leukemia and lymphomas, gastrointestinal cancers, genitourinary cancers, lung cancer and multiple myeloma. Featuring perspectives from Drs Neeraj Agarwal, Harold Burstein, Ibiayi Dagogo-Jack, Rafael Fonseca, Brad Kahl, Rutika Mehta, Craig Moskowitz, Joyce O'Shaughnessy, Krina Patel, Philip Philip, Suresh Ramalingam and Sandy Srinvas, moderated by Dr Neil Love.
Featuring a discussion on the most exciting updates in the management of lung cancer from the 2022 ASCO annual meeting with Dr Joshua Sabari, moderated by Dr Neil Love.
How do we think about treatment of lung cancer? Recap on staging (see Episode 025) * Pro-tip: Highly recommend that you “forget” about the actual staging and focus more on the individual T, N, and M status * Tumor size:**T1a
Tanya Doan, 45, lung cancer, Braintree, with husband, Mark Rudolph, daughter, Rebecca, and Dr. David Jackman, Medical Director for Clinical Pathways, Dana-Farber ● Tanya was diagnosed with 4 EGFR adenocarcinoma of the lower lobe of right lung atthe beginning of 2021. After experiencing migraines, Tanya had an MRI and CT scanwhich showed the cancer.● Her father had been diagnosed with the same cancer the previous year.● EGFR lung cancer commonly affects non-smoking young Asians.● Tanya had surgery to remove two tumors, followed by radiation and immunotherapy.She is still on the immunotherapy and gets an infusion every three months for herbone metastases.● Tanya enjoys reading, exercising with her Peloton, cooking, travelling, and raising herHavanese puppy. She loves spending time with her family, including daughtersRebecca and Zoe.● Tanya feels Dana-Farber is special because every single person who works there --from the people who work in the coffee shop to the radiology techs, MAs and RNs --are kind and friendly.● She says that the physicians, PAs and NPs are phenomenal and that the nutritionistsand social workers have been especially helpful. For her, Dana Farber has become ahome away from home. ● She likes knowing her treatment is on the cutting edge and not having to worryabout researching treatment on her own. Lung cancer facts● Lung cancer is the uncontrolled growth of abnormal cells in one or both lungs.● These abnormal cells do not carry out the functions of normal lung cells and do notdevelop into healthy lung tissue. As they grow, the abnormal cells can form tumorsand interfere with the functioning of the lung, which provides oxygen to the body viathe blood.● Lung cancer is the second most common cancer (not counting skin cancer) in bothmen and women.● According to the American Cancer Society, there will be an estimated 236,740 newcases of lung cancer in the United States for 2022.● Lung cancer is the leading cause of cancer death in the United States, among bothmen and women. Lung cancer claims more lives each year than do colon, prostate,ovarian and breast cancers combined.● Overall, the chance that a man will develop lung cancer in his lifetime is about 1 in15; for a woman, the risk is about 1 in 1.7● People who smoke have the greatest risk of lung cancer, and about 80% of lungcancer deaths are thought to result from smoking, though lung cancer can also occurin people who have never smoked. The risk of lung cancer increases with the lengthof time and number of cigarettes you've smoked.● Lung cancer is divided into primary or secondary lung cancer.-Primary lung cancer starts in the lungs. The cancer cells are abnormal lung cells.-Secondary lung cancer is when people who have cancer travel from another part oftheir body or metastasize to their lungs. This is called secondary lung cancer because thelungs are a secondary site compared to the original primary location of the cancer.Dr. David Jackman● Dr. Jackman is a Senior Physician in the Thoracic Oncology Program at Dana-Farber,where he cares for patients with lung cancer, mesothelioma, and thymoma. He also serves as the Medical Director for Clinical Pathways, helping to create and oversee aweb-based platform in which doctors across the country and the world, can seekcare recommendations for their patients based on the expertise of Dana-Farber'sphysicians and researchers, extending the expertise of Dana-Farber physicians.
Featuring a slide presentation and related discussion from Dr Joshua Sabari, including the following topics: Recent updates from ASCO 2022 in the use of EGFR- and MET-targeted therapies (0:00) Targeting HER3 in patients with advanced non-small cell lung cancer (NSCLC) with and without EGFR mutations (16:04) Recent updates in therapy for patients with EGFR exon 20 insertion mutations (21:47) DESTINY-Lung04 trial: Trastuzumab deruxtecan for patients with HER2 exon 19 or 20 mutations (2921) Using mutational status in predicting patient benefit from chemoimmunotherapy (34:51) Immune checkpoint inhibition for patients with NSCLC with EGFR mutations (38:41) Combining novel agents with immune checkpoint inhibitors for patients with NSCLC and high PD-L1 expression (47:36) CME information and select publications
Featuring an interview with Dr Joshua Sabari, including the following topics: Updates in the use of adjuvant targeted therapy for localized and metastatic non-small cell lung cancer (NSCLC); impact of the ADAURA trial (0:00) Factors in the selection of second-line therapy for patients with and without driver mutations (10:30) Role of immunotherapy for patients with driver mutations (14:26) Recent updates in the use of antibody-drug conjugates for NSCLC (17:01) Combining VEGF inhibition with other therapies for previously treated NSCLC (20:10) Factors affecting response to immunotherapy in patients with lung cancer (23:19) CME information and select publications
Dr Joshua Sabari from the Perlmutter Cancer Center in New York discusses key presentations in lung cancer from the 2022 ASCO annual meeting. CME information and select publications here (http://www.researchtopractice.com/OncologyTodayPostASCOLung22).
On August 1st, Oncology Data Advisor hosted a live panel discussion in honor of World Lung Cancer Day, featuring Beth Sandy, MSN, CRNP, and Corey Langer, MD, both of the University of Pennsylvania Abramson Cancer Center. Ms. Sandy and Dr. Langer discussed the improvements in survival that have occurred in recent years due to the development of novel therapies, groundbreaking developments in the fields of immunotherapy and targeted therapy, and exciting advances that lay on the horizon for patients with lung cancer in the coming years.
Each year, lung cancer kills more Americans than any other cancer. But hope is on the horizon. Advanced, low-dose CT screenings are saving lives by detecting those cancers early while they're still treatable. Dr. Sharp Malak, Radiologist with St. Bernards Imaging Center, explains how the screenings work and who might benefit from them.
Lung cancer specialized testing in NSCLC: What do we do if we biopsy a suspected metastatic lesion?* Immunohistochemistry (IHC): **Confirm if it is metastatic NSCLC **Confirms the histology of the NSCLC (such as adenocarcinoma vs. squamous cell)**Used to determine the type of chemotherapy that can be administered for treatment *PDL1 testing: **PDL1 is a protein expressed by certain cancer cells allowing them to evade the immune system (“fake mustache analogy”).**Also confirmed by IHC**This protein is targetable!**Often measured as:***Total protein expression (TPS): The number of positive tumor cells divided by the total number of viable tumor cells multiplied by 100%***Composite protein expression (CPS): The number of positive tumor cells, lymphocytes and macrophages, divided by the total number of viable tumor cells multiplied by 100%*Molecular testing: **We discuss this in detail in Episode 005**Genetic information from the tissue sample**Always better to get sample from soft tissue than from bone**Why is this important?***To be able to identify “driver mutations”****What is it? Important mutations that may be “driving” oncogenesis****Many of these have drugs that directly target these mutationsPrognostic vs. predictive biomarkers:*Prognostic biomarkers: Mutations or changes that give information about the cancer's overall outcome regardless of therapy*Predictive biomarkers: Mutations that provide information about how a cancer may respond to a particular drug Cell-free DNA (AKA “liquid biopsy”):*Special tests that can detect microscopic amounts of cancer cell DNA within the patient's blood which may also be used to find prognostic/predictive biomarkers*Ongoing studies to see if this can be used to find relapse of diseasePlease visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast
Here are the links for everything discussed in Episode 76. Times are also below so feel free to skip around and get to the updates that interest you. (1:32) FDA issues EUA for JYNNEOS vaccine (5:05) FDA approves Enhertu for NSCLC w/ HER2 expression Other FDA approvals: (8:13) - Myfembree (8:43) - Nubeqa (9:08) - Calquence (9:36) - Xofluza CDC website for COVID information - get boosted!FDA monkeypox response websiteConnect with The Rx Daily Dose:Twitter Instagram YouTube Linkedin WebsiteEmail: firstname.lastname@example.orgConnect with Ian Parnigoni PharmD. on social media:Twitter Instagram Linkedin ★ Support this podcast on Patreon ★
Episode 4 discusses the benefits of smoking cessation after a diagnosis of lung cancer.Mahdi Sheikh, Anush Mukeriya, Oxana Shangina, et al. Postdiagnosis Smoking Cessation and Reduced Risk for Lung Cancer Progression and Mortality: A Prospective Cohort Study. Ann Intern Med.2021;174:1232-1239. [Epub 27 July 2021].We also talk about whether or not increased buprenorphine prescribing will lead patients to be placed on it inappropriately, and some of the hurdles faced when trying to prescribe medications for opioid use disorder in the hospital.To make sure you're prescribing buprenorphine correctly, read SAMHSA's Practical Tools for Prescribing and Promoting Buprenorphine in Primary Care Settings.Take a look at the article A Call to Action: Hospitalists' Role in Addressing Substance Use Disorder.This is Addiction Medicine Journal Club with Dr. Sonya Del Tredici and Dr. John Keenan. We practice addiction medicine and primary care, and we believe that addiction is a disease that can be treated. This podcast reviews current articles to help you stay up to date with research that you can use in your addiction medicine practice. The best part of any journal club is the conversation, and we want to hear what you have to say. To have your opinions about the articles included in a future episode, you can email us at email@example.com or talk to us on Twitter @AddictionMedJC. If you want to hear your comment in your own voice on the air, you can record a voice memo on your phone and email it to us.Credits:Original theme music: composed and performed by Benjamin KennedyAudio production: Angela OhlfestAddiction Medicine Journal Club is intended for educational purposes only, and should not be considered medical advice. The views expressed here are our own, and do not necessarily reflect those of our employers or the authors of the articles we review. All patient information has been modified to protect their identities.
There is so much hope in lung cancer today. But lung cancer is also inherently very complicated. And the process of getting to a treatment plan takes a lot of expertise, different members of a medical team, and lots of tests. And one way to make this process easier on patients and more efficient for doctors who are making those treatment plans is to use an expert called a patient or nurse navigator. Guests Charity Holien, RN, a patient navigator with the University of Colorado Cancer Center Ross Camidge, MD, PhD, Director of the Thoracic Oncology Clinical and Clinical Research Programs at University of Colorado Cancer Center Video Podcast on YouTube | Transcription Resources A Lung Cancer Diagnosis: What's Next The First 7 Days podcast series What Do I Need to Know About Biomarker Testing? LCFA is a nonprofit dedicated to improving the survivorship of lung cancer patients by funding lung cancer research. Visit lcfamerica.org.
Lung Cancer Histology and Staging*Workup for a nodule that is concerning: **Ensure there is a dedicated CT scan of the chest to evaluate **Try to obtain old imaging; the rate of change is important **Can get PET, but even if a lesion if not FDG-avid, but growing quickly we should consider biopsy anyway**Referral to pulmonary medicine, who can assist with biopsy and also regional lymph node evaluation (important – more below)**PFTs are often ordered because it provides information about lung function in anticipation of possible surgery for treatment Lung Cancer Histology: *Non-small cell lung cancer (NSCLC)**Umbrella term for a variety of cancers**Increased risk in smokers**More common types: ***Adenocarcinoma (~50% of all lung cancers)****Most common overall; cancer of the mucus producing cells****IHC: TTF-1, NapsinA, CK7 positive***Squamous Cell Carcinoma (22.7%)****More often seen in patients with a smoking history ****IHC: p63 positive and cytokeratin pearls***Remaining ~15% are the other types of lung cancer / mixed histologies**Small cell lung cancer (SCLC)***Neuroendocrine tumor with very different pathology***Much more aggressive than NSCLC***Oncologic emergency***IHC: Chromogranin and synaptophysin positive IHC pearls: TTF-1 usually means lung cancer (but can be negative in squamous cell lung cancer). This will be important in the future (we promise :])*Staging for NSCLC:**Nodal evaluation: lymph node evaluation is part of the workup for NSCLC**Single digit = central/mediastinal nodes (higher risk)**Double digit = peripheral/hilar/intrapulmonary lymph nodes (lower risk)**“R” vs. “L” is direction *Pearl: Why is this important? If there is nodal involvement, systemic therapy is going to be necessary *Putting it all together: **T: Tumor size: T1-4**N: Nodal involvement***N0: no nodal involvement ***N1: Nodes closest to the primary tumor (double digits)****Ipsilateral peribronchial, hilar, intrapulmonary ***N2: Further away (single digit)****Ipsilateral mediastinal and/or subcarinal LN***N3: Contralateral any node or supraclavicular LN **M: Metastasis – in lung cancer, patients with certain patterns of metastatic disease are still curable! ***M0: no mets***M1a: Contralateral lobe, pleural effusion or pericardial effusion à these are generally still curable!***M1b: single site of metastatic disease à these are generally still curable!***M1c: multiple sites of metastatic disease à these are generally not curable*Staging for SCLC: **Limited stage - meaning it can fit in “one radiation field”**Extensive stage - does not fit in “one radiation field”*Once lung cancer is diagnosed:**Go to NCCN to learn the flow of ongoing management**Complete staging (if not already done):***CT C/A/P (don't necessarily need if a PET scan is done)***PET Scan***MRI brain à in general this is needed, but there are some exception to this (see NCCN)**Referral to pulmonary for nodal evaluationReferences: NCCN.orghttps://doi-org.proxy.library.vanderbilt.edu/10.1016/j.semcancer.2017.11.019-Article about IHC markers for lung cancer Please visit our website (TheFellowOnCall.com) for more information Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast
We've approached a remarkable close to the last day of the IASLC 2022 World Conference on Lung Cancer in Vienna, Austria. Lung Cancer Considered hosts Dr. Stephen Liu and Dr. Narjust Florez interview Dr. Belinda King Kallimanis, Dr. Charles Rudin and Dr. Solange Peters about patient-centric clinical trial consent forms, an update on the Keynote 604 trial, the importance of women's sexual health and new data on a combination of therapies for patients with KRAS mutations.
A VIDEO RECORDING OF THIS INTERVIEW IS AVAILABLE HERE. Interim results on overall survival in phase 3 of the IMpower010 trial were presented at this year's meeting of the International Assosciation for the Study of Lung Cancer (IASLC). As part of the NEJM Group's coverage of the conference, Christine Sadlowski interviewed the presenter, Dr. Enriqueta Felip. […] The post Podcast 299: Lung cancer and atezolizumab — results from the IMpower010 trial first appeared on Clinical Conversations.
It's Day 3 at the IASLC 2022 World Conference on Lung Cancer! Dr. Narjust Florez hosts pivotal researchers Dr. Enriqueta Felip, Dr. Mariano Provencio, and Dr. Rachael Murray to discuss their top-rated studies. IASLC President Dr. Heather Wakelee also joins in to give insight on how the committee selected these high-ranked abstracts for this year's Presidential Symposium.
Lung cancer is the leading cause of cancer deaths. We will be live with a patient about to receive one of the most advanced screenings available for this deadly disease. Our doctors explain the advancements giving patients the power of hope.
In this special edition of Lung Cancer Considered recorded at the IASLC 2022 World Conference on Lung Cancer, hosts Dr. Narjust Florez and Dr. Stephen Liu interview researchers Dr. Chi-Fu Jeffrey Yang, Dr. Jarushka Naidoo and Mr. Koen de Nijs, PhD student, to discuss their recent findings from the significant studies presented today.
Today's podcast originates from the IASLC World Conference on Lung Cancer in Vienna. Hosts Dr. Stephen Liu and Dr. Narjust Florez interview IASLC WCLC 2022 Honorary Chair Dr. Robert Pirker and Chair Dr. Silvia Novello at the meeting. Dr. Pirker and Dr. Novello provide an overview of the meeting and give podcast listeners a glimpse of what to expect at the IASLC WCLC 2022.
Director of the Lung Cancer Medical Oncology Program at Cleveland Clinic Taussig Cancer Institute, Nathan A. Pennell, MD, PhD joins the Cancer Advances podcast to discuss the KRYSTAL-1 trial, a new treatment option for patients with advanced non-small-cell lung cancer with KRASG12C mutation. Listen as Dr. Pennell explains the trial and findings that were presented at the American Society of Clinical Oncology (ASCO) 2022 annual meeting.
Lung cancer is one of the most commonly diagnosed type of cancer and so it is fitting that we start the first of our disease-specific oncology series with this diagnosis. This week, we sit down with guest pulmonologist Dr. Greta Dahlberg to discuss how she thinks about and works up lung nodules concerning for malignancy.Lung nodules: * For discussions about incidental lung nodules and lung cancer screening, check out Episode 197 from our friends, The Curbsiders (link: https://thecurbsiders.com/podcast/197) * Nodule vs. mass:** “Micronodule” is
On this episode, we're featuring discussions on lung cancer that took place at the 2022 ASCO Annual Meeting. They were led by Dr. Gilberto de Lima Lopes, Jr, of the Sylvester Comprehensive Cancer Center at the University of Miami. The first focuses on data from a study of a novel bispecific antibody in patients with non–small cell lung cancer that exhibits the MET exon 14 skipping mutation. The second focuses on an analysis of patients with lung cancer treated with chemoimmunotherapy regimens.To listen to more podcasts from ASCO, visit asco.org/podcasts.
Jarushka Naidoo, MBBCH, MD, Chair of the Thoracic Oncology Division, Beaumont RCSI Cancer Centre (Dublin, Ireland), and Stephen Liu, MD, Director of Thoracic Oncology and Director of Developmental Therapeutics, Lombardi Comprehensive Cancer Center of Georgetown University, join the show to preview all of the important and exciting advancements in thoracic oncology leading up to the IASLC 2022 World Conference on Lung Cancer. The trio cover early-stage lung cancer, pathologic response as a surrogate endpoint for new clinical trials, promising new agents in development and testing, sequencing with immunotherapy, updates in data and targeted therapy for EGFR mutations, and a round-up of other studies highlighting different disease histologies. Check out Chadi's website for all Healthcare Unfiltered episodes and other content. www.chadinabhan.com/ Watch all Healthcare Unfiltered episodes on Youtube. www.youtube.com/channel/UCjiJPTpIJdIiukcq0UaMFsA
Dr Jeffrey Bradley from the Emory University School of Medicine in Atlanta, Georgia, and Dr David Spigel from the Sarah Cannon Research Institute in Nashville, Tennessee, discuss the past, present and future management of unresectable Stage III non-small cell lung cancer. CME information and select publications here (http://www.researchtopractice.com/OncologyTodayStageIIINSCLC22).
Enjoy this fascinating interview with Chad Hodge on his incredible cancer story. CANCER RESEARCH LINK: https://bit.ly/3yWTP6e CANCER PROTOCOL LINK: https://bit.ly/3BloBJ9 Dr. Berg's Keto and IF Lab: https://www.facebook.com/groups/drbergslab/ How to Bulletproof your Immune System FREE Course: https://bit.ly/39Ry3s2 FREE MINI-COURSE ➜ ➜ Take Dr. Berg's Free Keto Mini-Course! ADD YOUR SUCCESS STORY HERE: https://bit.ly/3z9TviS Find Your Body Type: https://www.drberg.com/body-type-quiz Talk to a Product Advisor to find the best product for you! Call 1-540-299-1557 with your questions about Dr. Berg's products. Product Advisors are available Monday through Friday 8 am - 6 pm and Saturday 9 am - 5 pm EST. At this time, we no longer offer Keto Consulting and our Product Advisors will only be advising on which product is best for you and advise on how to take them. Dr. Eric Berg DC Bio: Dr. Berg, 51 years of age is a chiropractor who specializes in weight loss through nutritional & natural methods. His private practice is located in Alexandria, Virginia. His clients include senior officials in the U.S. government & the Justice Department, ambassadors, medical doctors, high-level executives of prominent corporations, scientists, engineers, professors, and other clients from all walks of life. He is the author of The 7 Principles of Fat Burning. Dr. Berg's Website: http://bit.ly/37AV0fk Dr. Berg's Recipe Ideas: http://bit.ly/37FF6QR Dr. Berg's Reviews: http://bit.ly/3hkIvbb Dr. Berg's Shop: http://bit.ly/3mJcLxg Dr. Berg's Bio: http://bit.ly/3as2cfE Dr. Berg's Health Coach Training: http://bit.ly/3as2p2q Facebook: https://www.facebook.com/drericberg Messenger: https://www.messenger.com/t/drericberg Instagram: https://www.instagram.com/drericberg/ YouTube: http://bit.ly/37DXt8C Pinterest: https://www.pinterest.com/drericberg/
We reflect on the Supreme Court term as a whole, and the direction and politics of the Court. We focus on West Virginia v. EPA, which canonized the "major questions" doctrine, and the upcoming case of Moore v. Harper, which confronts the "independent state legislature doctrine."
Show Summary: “You will not heal until your mind aligns with your healing. You can only heal if you stop what's causing your pain in the first place. Never give up hope; you are your best healer.”**********Trigger warning: Cancer story and suicide ideation.**********It's been a year since Tristin's passing, and Juanique is here with us today to share her journey that spans over five years.It all started when she was 28 years old and 20 weeks into her pregnancy when the world seemed to have stopped revolving the moment they found out that her husband was diagnosed with stage 4 Lung Cancer. Throughout those years, she has been nothing but a solid support system for Tristin, her children, and her friends. She carried all the emotional and psychological weight of the situation while refusing to show vulnerability. Not for selfish reasons, but to continue taking care of everyone around her. As a trauma response, Juanique buried herself in tons of work and advocacies in helping others on their healing journey. That is until her own body showed signs of many unusual neurological symptoms lately. It even came to a point where she just wanted it to end. Her mind and body shut down which made her stop and slow down. As if her body's telling her that she has taken care of everybody enough, and now is the time to take care of herself too.Here in the Gutsy Health Podcast, we always aim to share with you the many ways we can heal ourselves in a holistic way. And Juanique, as brave as she is, stands to be an example that no matter how hard we repress all our pain, we can still recover and create a healing space - not just for everyone that we care about, but for ourselves too. After all, the healing journey begins with us, and only us. We hope that by listening to this special podcast episode, you'll pick up a thing or two and go about your day feeling like you've gained optimism and strength to know that no matter how hard your situation is right now, there is always hope. And there is always help along the way. Exceptional Highlights:Our body will start to process all the fear, emotions, and things we've held on to for so long when it feels safe to do it.Our disease and dis-ease are our internal mirror of the imbalance within our mind, body, and soul.If we can create disease, we can create health. If we can create darkness, we can create light.Show Highlights:About repressed emotions for the past six yearsJuanique 5:55Because I was trying to protect everyone and make them feel comfortable, there was no space for me to feel my emotions. And as I've been going back to work, for the first time I felt sadness for myself.Trauma response and survivalGina 12:46You lived in your mind for survival. If you didn't disconnect from your emotions and physical exhaustion at the time, you wouldn't be able to survive and take care of your kids and Tristin.Realizations while meditating, doing EDMR, and Ketamine TherapyJuanique 13:43By pushing all my emotions down, that's where I dishonored myself. That's where I lost myself and safety in this life.Important Links:Juanique Roney InstagramProvo HealthInsight TimerHeadspaceGutsy Health Podcast Instagram