Limits...
Optimizing the management of advanced non-small-cell lung cancer: a personal view.

Vincent MD - Curr Oncol (2009)

Bottom Line: In addition, molecular markers and traditional parameters can now be combined to provide a framework of knowledge that will guide the application of not just the new therapies, but also the older ones that remain effective.As a result, substantial investment on the part of payers, which may or may not be possible, will be required.Responsive clinicians face difficult tradeoffs as they try to balance the pros and cons of early adoption versus excessive conservatism.The present article is my personal view of how to navigate these waters, and although it is written especially for patients who like to be the captain of their own ship, there is good reason to believe that all patients will eventually be managed by similar, if not identical, means.

View Article: PubMed Central - PubMed

Affiliation: Medical Oncology, London Regional Cancer Program, London, ON. mark.vincent@lhsc.on.ca

ABSTRACT
The management of advanced non-small-cell lung cancer (a-nsclc) is currently undergoing one of its rare paradigm shifts. Just as the nihilism of the 1970s gave way to the empiricism of the 1980s and 1990s, so the current decade has seen the first truly rational therapies based on informed design. In addition, molecular markers and traditional parameters can now be combined to provide a framework of knowledge that will guide the application of not just the new therapies, but also the older ones that remain effective. This framework-as important a component of the rational paradigm as the new drugs themselves are-is necessary to decide who should and, crucially, who should not receive the various components of this rapidly expanding armamentarium. Here, I have provided a historical overview of the drug treatment of a-nsclc, a mini-review of important new data, and an integrative approach that tries to ensure that patients receive the optimal treatment choice at the appropriate time.The speed at which new knowledge now arrives, coupled with the persistent high level of unmet medical need, suggests that the traditional pace of evidence-based review needs to be accelerated. Indeed, the increased scope for personalized management constitutes something of a challenge to "business as usual" evidence-based medicine. As a result, substantial investment on the part of payers, which may or may not be possible, will be required. In the meantime, some patients may wish and may be financially able to take advantage of modern developments before they have been fully digested by the public-payer system. Responsive clinicians face difficult tradeoffs as they try to balance the pros and cons of early adoption versus excessive conservatism.The present article is my personal view of how to navigate these waters, and although it is written especially for patients who like to be the captain of their own ship, there is good reason to believe that all patients will eventually be managed by similar, if not identical, means. Nonetheless, the recommendations herein should not be construed as appropriately reviewed provincial or national guidelines. Finally, if appropriate, a clinical trial should always be offered.

No MeSH data available.


Related in: MedlinePlus

Suggested management of large-cell carcinoma of the lung. egfr = epidermal growth factor receptor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2722061&req=5

f3-co16-4-9: Suggested management of large-cell carcinoma of the lung. egfr = epidermal growth factor receptor.

Mentions: Large-cell carcinoma patients (Figure 3) seem to benefit a great deal from pemetrexed-based chemotherapy, as in the first-line jmdb trial (hr:0.67; p = 0.03). In the jmen trial (pemetrexed maintenance), the number of large-cell cases was small, but pemetrexed should be considered if the first-line experience was good. Use of bevacizumab did not yield a survival benefit in the subgroup analysis of E4599, and its use might be justified only to enhance response in the first line. In the second line, erlotinib might be justifiable (unless the tumour is mutated-type KRAS or egfr fish-negative, or both), but data are scanty. Biomarker triage is not emphasized here, because information is scarce. The saturn study has not yet separately reported maintenance data for erlotinib in large-cell disease.


Optimizing the management of advanced non-small-cell lung cancer: a personal view.

Vincent MD - Curr Oncol (2009)

Suggested management of large-cell carcinoma of the lung. egfr = epidermal growth factor receptor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2722061&req=5

f3-co16-4-9: Suggested management of large-cell carcinoma of the lung. egfr = epidermal growth factor receptor.
Mentions: Large-cell carcinoma patients (Figure 3) seem to benefit a great deal from pemetrexed-based chemotherapy, as in the first-line jmdb trial (hr:0.67; p = 0.03). In the jmen trial (pemetrexed maintenance), the number of large-cell cases was small, but pemetrexed should be considered if the first-line experience was good. Use of bevacizumab did not yield a survival benefit in the subgroup analysis of E4599, and its use might be justified only to enhance response in the first line. In the second line, erlotinib might be justifiable (unless the tumour is mutated-type KRAS or egfr fish-negative, or both), but data are scanty. Biomarker triage is not emphasized here, because information is scarce. The saturn study has not yet separately reported maintenance data for erlotinib in large-cell disease.

Bottom Line: In addition, molecular markers and traditional parameters can now be combined to provide a framework of knowledge that will guide the application of not just the new therapies, but also the older ones that remain effective.As a result, substantial investment on the part of payers, which may or may not be possible, will be required.Responsive clinicians face difficult tradeoffs as they try to balance the pros and cons of early adoption versus excessive conservatism.The present article is my personal view of how to navigate these waters, and although it is written especially for patients who like to be the captain of their own ship, there is good reason to believe that all patients will eventually be managed by similar, if not identical, means.

View Article: PubMed Central - PubMed

Affiliation: Medical Oncology, London Regional Cancer Program, London, ON. mark.vincent@lhsc.on.ca

ABSTRACT
The management of advanced non-small-cell lung cancer (a-nsclc) is currently undergoing one of its rare paradigm shifts. Just as the nihilism of the 1970s gave way to the empiricism of the 1980s and 1990s, so the current decade has seen the first truly rational therapies based on informed design. In addition, molecular markers and traditional parameters can now be combined to provide a framework of knowledge that will guide the application of not just the new therapies, but also the older ones that remain effective. This framework-as important a component of the rational paradigm as the new drugs themselves are-is necessary to decide who should and, crucially, who should not receive the various components of this rapidly expanding armamentarium. Here, I have provided a historical overview of the drug treatment of a-nsclc, a mini-review of important new data, and an integrative approach that tries to ensure that patients receive the optimal treatment choice at the appropriate time.The speed at which new knowledge now arrives, coupled with the persistent high level of unmet medical need, suggests that the traditional pace of evidence-based review needs to be accelerated. Indeed, the increased scope for personalized management constitutes something of a challenge to "business as usual" evidence-based medicine. As a result, substantial investment on the part of payers, which may or may not be possible, will be required. In the meantime, some patients may wish and may be financially able to take advantage of modern developments before they have been fully digested by the public-payer system. Responsive clinicians face difficult tradeoffs as they try to balance the pros and cons of early adoption versus excessive conservatism.The present article is my personal view of how to navigate these waters, and although it is written especially for patients who like to be the captain of their own ship, there is good reason to believe that all patients will eventually be managed by similar, if not identical, means. Nonetheless, the recommendations herein should not be construed as appropriately reviewed provincial or national guidelines. Finally, if appropriate, a clinical trial should always be offered.

No MeSH data available.


Related in: MedlinePlus