Lung Cancer Update, Issue 4

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David S Ettinger, MD

Tracks 1-7

Track 1	Histology and treatment decision-making in lung cancer
Track 2	Implication of the FLEX data for bevacizumab-ineligible patients with previously untreated advanced NSCLC
Track 3	Ramping up biomarker assessment and personalized medicine in NSCLC

Track 4	Clinical trials evaluating chemoradiation therapy and cetuximab for locally advanced NSCLC
Track 5	Role of maintenance therapy in Stage III NSCLC
Track 6	Development of the novel anthracycline amrubicin in SCLC
Track 7	“Rule out five” approach for carcinoma of unknown primary

Select Excerpts from the Interview

Track 1

DR LOVE: Would you comment on tumor tissue type and treatment selection in NSCLC?

DR ETTINGER: Practice-changing data have emerged regarding the use of histology to predict the effectiveness of different therapeutic agents.

Dr Scagliotti recently published data in the Journal of Clinical Oncology from a study of gemcitabine/cisplatin versus pemetrexed/cisplatin in chemotherapy-naïve patients with advanced stage NSCLC, which demonstrated that patients with squamous cell histology had better outcomes with gemcitabine/cisplatin and those with adenocarcinoma fared better with pemetrexed/cisplatin (Scagliotti 2008; [4.1]).

As another example, Karp and colleagues presented a study at ASCO evaluating paclitaxel and carboplatin with CP-751,871 — a monoclonal antibody against insulin-like growth factor type 1 receptor (IGF-IR) — in patients with advanced, treatment-naïve NSCLC (Karp 2008). The highest levels of IGF1 occur in squamous cell NSCLC. In patients with squamous cell tumors, 11 out of 14 patients responded, or 78 percent, whereas 57 percent of patients with adenocarcinomas demonstrated responses.

4.1

Track 3

DR LOVE: What are your thoughts about ECOG-E1505 and the incorporation of bevacizumab in the adjuvant setting?

DR ETTINGER: ECOG-E1505 is a great study because we haven’t seen advances in adjuvant therapy for a while. In fact, at ASCO this year, Le Chevalier presented the eight-year follow-up data for the IALT study and showed that the survival advantage was no longer evident for chemotherapy (Le Chevalier 2008; [4.2]). Interestingly, ERCC1 status remained predictive for survival benefit from adjuvant chemotherapy (4.2).

DR LOVE: How do you approach selection of adjuvant chemotherapy off study?

4.2

DR ETTINGER: I use cisplatin paired with gemcitabine. If patients are intolerant of cisplatin, I use carboplatin. The bigger issue is where pemetrexed will fit in when it’s approved, especially for patients with adenocarcinomas.

Tracks 4-5

DR LOVE: Can you discuss new research approaches to locally advanced disease, particularly chemoradiation therapy and maintenance therapy?

4.3 DR ETTINGER: A study presented by Blumenschein and colleagues at ASCO revealed a median survival of 22.7 months with concurrent chemoradiation therapy and cetuximab, which is the longest survival observed in RTOG trials with Stage III NSCLC (Blumenschein 2008; [4.3]). Sequential chemoradiation therapy is associated with a 14-month median survival, and with concurrent chemoradiation therapy it’s about 17 months.

The Intergroup study (RTOG-0617) of concurrent chemoradiation therapy, comparing two different doses of radiation therapy — 74 and 60 Gray — has added cetuximab. Based on our experience with cetuximab and chemotherapy (Vermorken 2008) combined with radiation therapy (Bonner 2006) in head and neck malignancies, we expect that cetuximab will be effective.

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EDITOR
Neil Love, MD

INTERVIEWS

David Jablons, MD
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Gregory J Riely, MD, PhD
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Alan B Sandler, MD
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David S Ettinger, MD
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