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LUNGevity Caregiver Award Winner Charlie Keene January 23rd, 2013 - by Katie Brown http://blog.lungevity.org/2013/01/23/lu ... lie-keene/ In November, during Lung Cancer Awareness Month, we announced LUNGevity’s Third Annual Lung Cancer Caregiver Contest. We were looking to honor a spectacular individual who has provided exceptional care to a lung cancer patient. Nominations came in from all over the country, and if we could have, we would have awarded every caregiver a prize. Their stories of sacrifice and loving care moved us to tears. These caregivers are unsung heroes and rarely get recognized. It was our honor to recognize them and to award a prize to one exceptional caregiver that surpassed the criteria set before our judges: someone who advocated for their loved one’s medical needs, who is supportive and helpful with their loved one’s emotional needs, and someone who recognizes their own limitations and seeks support as needed in order to be the best caregiver possible. We’re happy to announce this year’s winner is Mr. Charles Keene. “Big Charlie” as he is lovingly called by his family members was nominated by his daughter in law, Margo, for providing unwavering and exceptional care of his wife, Becky, who has lung cancer. Excerpts of Margo’s nomination are below. “…he accompanies her to every doctor’s visit…he stays by her side at home after every treatment…he supports her unconditionally and without a doubt is in this fight too.” “Big Charlie has never wavered in his role as partner in sickness and in health and I know will stand by her side for infinity doing anything in his power to make Becky comfortable, happy and keep that bright smile on her beautiful face…” The prize is a one-week stay at Cricket House in the historic Gettysburg area of Pennsylvania, and includes round-trip airline tickets for two. The weeklong getaway is donated by the owner of Cricket House, Debi Gemmell. Gemmell had been a caregiver for her husband, Chris, who passed away from lung cancer. When we notified Charles “Big Charlie” Keene that he had been nominated for being an exceptional caregiver and had won, the soft spoken county commissioner was speechless. He is humble and no doubt does not need recognition for something he does naturally. His wife Becky, who’s living with lung cancer, calls Big Charlie her best friend of 38 years. “I can thank him every day, but it means SO much when others recognize and thank him!” If you are a lung cancer caregiver and you need support or information, please visit our online lung cancer Caregiver Resource Center.

LUNGevity's Hope Summit, May 2012 Tracy Anderson and her mother, Barb Miller, both stage IIIB lung cancer survivors, joined us for last year's annual Hope Summit. Here they talk about the importance of raising awareness, hope for the future and funding for early detection & new treatments.

Nashville, TN Resident Named Winner of LUNGevity's Third Annual Caregiver Contest for Exceptional Support of Wife with Lung Cancer http://events.lungevity.org/site/PageNa ... 12313.html FOR IMMEDIATE RELEASE Media Contact: Victoria Shapiro vshapiro@susandavis.com (202) 414-0774 Nation’s largest lung cancer-focused nonprofit encourages lung cancer survivors to participate WASHINGTON (January 23, 2013) – LUNGevity Foundation is pleased to announce Charles Keene of Nashville, TN as the winner of its Annual Caregiver Contest, recognizing a special individual who has provided exceptional care to a lung cancer patient. Charlie was nominated for the award by his family for the care of his wife Becky, a lung cancer survivor who is still in active treatments. Over the course of their lives, one in 14 Americans is affected by lung cancer. Lung cancer caregivers are mothers, fathers, sons, daughters, neighbors and family friends of all ages. In most cases, they have no medical background, yet they play a crucial role in helping lung cancer survivors manage their disease, often coordinating medical care and providing emotional and physical support, in addition to tending to household and professional needs. LUNGevity Foundation recognizes the vital role these caregivers play in the fight against the nation’s number one cancer killer and honors their commitment and love with its Annual Caregiver Contest. During the month of November, Lung Cancer Awareness Month, LUNGevity asked the public to submit nominations for an incredible caregiver. Many dedicated men and women were nominated, including husbands, wives, daughters, sons-in-laws, sisters, mothers, fathers, and friends. Charlie Keene was ultimately chosen by an independent panel of judges, based on specific criteria of caregiving: Being an advocate for their loved one’s medical needs Being supportive and helpful with their loved one’s emotional needs Successfully creating a support network around their patient "Big Charlie," as he is lovingly called by his family members, was nominated by his daughter in law, Margo, for providing unwavering and exceptional care of his wife, Becky, who has lung cancer. Margo stated in her nomination. "He (Charlie) accompanies her to every doctor's visit. He stays by her side at home after every treatment. He supports her unconditionally and without a doubt is in this fight too. Big Charlie has never wavered in his role as partner in sickness and in health and I know he will stand by her side for infinity doing anything in his power to make Becky comfortable, happy and keep that bright smile on her beautiful face." The winner of LUNGevity’s caregiver contest wins travel and a one-week stay for two at Cricket House in historic Gettysburg, PA. Cricket House is owned by Debi Gemmell, who was also a caregiver for her husband, Chris. “LUNGevity recognizes the difficulty and hardships that lung cancer caregivers sometimes face and are thrilled to be able to partner with Debi to offer this prize to one incredible caregiver. We wish we could give every one of these hard-working and deserving caregivers and their loved ones a prize,” stated Katie Brown, Director of Support and Advocacy for LUNGevity Foundation. LUNGevity Foundation has the largest grants award program for lung cancer research among lung cancer nonprofit organizations in the United States. As a thought leader and community hub, LUNGevity provides many resources to the lung cancer community, including the Lung Cancer Support Community, the largest dedicated social network providing support to anyone touched by lung cancer. As part of the online resources it offers, the Foundation created the Caregiver Resource Center, at www.lungevity.org/caregiver, which offers emotional support, practical advice and patient advocacy advice, and other services for caregivers. It is the first online resource wholly devoted to lung cancer caregivers. About Cricket House Cricket House is an award-winning historical property located in the heart of downtown Gettysburg, PA, and consisting of two charming historic buildings, the Cricket Guest House and the Main House, which has recently opened the Cricket House Spa. For more information, please visit www.crickethousegettysburg.com. About LUNGevity Foundation The mission of LUNGevity Foundation is to have a meaningful impact on improving lung cancer survival rates, ensure a higher quality of life for lung cancer patients and provide a community for those impacted by lung cancer. It does so by supporting critical research into the early detection and successful treatment of lung cancer, as well as by providing information, resources and a support community to patients and caregivers. LUNGevity seeks to inspire the nation to commit to ending lung cancer. For more information about the grants or LUNGevity Foundation, please visit www.lungevity.org. About Lung Cancer 1 in 14 Americans is diagnosed with lung cancer in their lifetime Lung cancer is the leading cause of cancer death, regardless of gender or ethnicity Lung cancer kills almost twice as many women as breast cancer and more than three times as many men as prostate cancer About 55% of all new lung cancer diagnoses are among people who have never smoked or are former smokers Only 16% of all people diagnosed with lung cancer will survive 5 years or more, BUT if it’s caught before it spreads, the chance for 5-year survival improves dramatically

Challenges Abound, Yet We Remain Strong January 14th, 2013 - by Juhi Kunde http://blog.lungevity.org/2013/01/14/ch ... in-strong/ As we are starting a fresh year, it is natural to take a step back and survey the scene – past and present. How was last year? What chaos and wonders will this year bring? As always, I look on the past year with a general sense of bewilderment and awe. We lost Whitney Houston, Andy Griffith and Ravi Shankar. And who could have imagined the horrible tragedy in Newtown, Connecticut? The year is never what we expect it to be. But last year, even in the middle of all that uncertainty, we found happiness, courage and hope. I would have never thought that the San Francisco Giants would win another World Series so soon. We saw a magnificent display of talent at the London Olympics and we held another peaceful (and tight) presidential election. This year, I see the challenges piling as high as the Rocky Mountains. We have healthcare worries, economic concerns and of course, a royal baby to worry about. Plus we all have our unique personal challenges looming ahead of us. In my family, we are expecting our own baby in April and we are helping a beloved family member fight cancer. Despite my concerns for the coming year, I am filled with feelings of hope, confidence and determination because the people around me are not drowning in their worries. They are embracing the future and facing their challenges by taking steps to alleviate problems and improve their situations. People in their fifties are going back to school, parents are homeschooling their children, and a few families have joined health clubs while cancelling cable subscriptions. For lung cancer survivors and caregivers, similar patterns are emerging. People are listening to scientific webinars, reading about clinical trials and taking charge of their treatment plans. They are stepping forward to become their own health care advocates and to raise lung cancer awareness. Plus, with the help of determined volunteers, passionate supporters and skilled scientists, the lung cancer movement continues to gain momentum and brings us closer to major breakthroughs in early detection and treatment. By continuing to actively participate in our lives, we are all facing the challenges that lie before us.Let’s rely on our communities, be resilient and not let our worries drown us. By working cooperatively we may just succeed in beating the odds. Let’s all try to make 2013 the year we hope it’ll be.

“Mixed Response” in Lung Cancer: What Should We Do, and What’s Happening Biologically? January 11th, 2013 - by Dr. Jack West http://blog.lungevity.org/2013/01/11/mixe/ The topic of “mixed response” to treatment for lung cancer comes up as a rather common question. I tried to cover this in two brief videos. The first explains we mean when we refer to a mixed response, and then how we might approach this issue in the clinic. The second video continues on that theme and covers the question of what is happening biologically when we see a mixed response, which brings up the question of whether we should do multiple biopsies, looking specifically at the areas that are progressing, and whether we should repeat biopsies at multiple intervals over the course of a patient’s disease. This isn’t the current standard, but might we learn far more about cancer biology if we were to do this? If you or someone you care about demonstrated a mixed response while on treatment for lung cancer, would you be inclined to undergo a repeat biopsy, even if there were a good chance it wouldn’t reveal a result that changes management? And if yes, if an insurer said that it wouldn’t be covered, would you want to pay for the cost of the biopsy and testing for various molecular markers? These are the kinds of questions we faced in the times of transition in how we practice — in this case, moving into a new era of molecular oncology.

How should we use serum tumor markers, if ever, in managing lung cancer? January 4th, 2013 - by Dr. Jack West http://blog.lungevity.org/2013/01/04/se ... -lc-video/ A common question that comes up in managing lung cancer is how, and perhaps even whether, we should use blood tests to make clinical decisions in the management of lung cancer? Here’s a video in which I discuss this issue of serum tumor marker testing for lung cancer, a question without a clear right answer, but perhaps some wrong ones. What are your experiences with it? I’d underscore that if your oncologist isn’t checking for these, this isn’t a wrong answer, but do you feel that you’re missing out without it? Would you be tempted to use (and perhaps overinterpret) this information if you had it?

Lahey Clinic Offering Free Lung Cancer Screening for Veterans Burlington's Director of Veteran Affairs Robert Hogan says veterans are at higher risk for lung cancer, so the screening is available for early detection. http://burlington.patch.com/articles/la ... s-8084c82b January 7, 2013 The following is a release from Burlington's Director of Veteran Affairs Robert Hogan: The Burlington Office of Veterans Services wants to inform Burlington veterans that the Lahey Clinic is offering Free Lung Cancer CT Screenings to eligible, qualified veterans. Why? Because the incidence of lung cancer is higher among veterans, and the survival rate among veterans is lower than the civilian population. Studies indicate that mortality rate is higher for veterans. Two million World War-2 and Korean War veterans died an average 11.1 years sooner than their civilian counterparts. When you add in Agent Orange for Vietnam veterans and the uranium related issues for Gulf War veterans, it is clear that early screening and detection is necessary in order to catch the disease early, and treat it successfully. According to Lahey Clinic, studies clearly show that for veterans who are high risk for lung cancer, early detection with low-dose CT lung screening can save lives. If you are a veteran, between the ages of 50 and 75, and a smoker or have quit in the past 10-15 years, or have smoked a pack a day for 20 or more years, you may be eligible for a Free Lung Cancer CT Screening. You can contact Lahey Clinic at 1-855-CT-CHEST (282-4378), or www.Lahey.org/FreeLungScreening, for more information. The goal of low-dose CT lung screenings is to save lives. Without these CT lung screenings, lung cancer is usually not found until a person develops symptoms. At that time, the cancer is much harder to treat. The exam is easy. No medication is given, no needles are used. You can eat before and after the CT scan and it only takes a few seconds to complete. As veterans we all know that for decades through the end of the Vietnam War, cigarettes were routinely included in K-rations and C-rations and were sold at discounted prices at military exchanges and commissaries. Here is an opportunity to get checked out and find out if you need treatment for a cancer you did not know you had. If you tried to quit smoking, keep trying. Millions of people have quit, so can you. If not, and you are a veteran and between the ages of 50 and 75, and were a smoker, call Lahey Clinic, you may be eligible to make an appointment for one of the Free CT Lung Cancer Screenings.

It’s what we do next that matters January 3rd, 2013 - by G. Alan Rader http://blog.lungevity.org/2013/01/03/it ... t-matters/ My name is Alan Rader. I live in the country about 15 miles northwest of Harrisburg, Pennsylvania. I was diagnosed with stage 3 lung cancer at the age of 59. Like many survivors I’ve come to know, I was misdiagnosed for a few months before the pieces were put together. The results of a CT scan showed a mass at the peak of my right lung. The primary care dr. set up an appointment for me to see a surgeon who could see me in a month. I have to say that I wasn’t surprised about possibly having lung cancer. I was emotionally numb about it. I went to work the next day, I had to finish a job I was doing. All I knew about lung cancer was that it would kill me. I lost an aunt to lung cancer and it happened fast. I lost my father in law to lung cancer and happened slowly and painfully. We weren’t about to wait a month to see a surgeon and lose even more time. My wife Susan spent part of that day researching what we could do now. She found Cancer Treatment Centers of Americas’ website during her search and called the 800 number. She talked to a guy who said they could see us on Monday. They recognized our sense of urgency. That got our attention and we went to Philadelphia to see what they could do. It turned out to be a great decision. My cancer was inoperable; it had worked its way into my spine and a rib. They called it stage 4 because it invaded a vertebral body. Others called it stage 3 because it was one tumor. I went through 30 radiation treatments and 20 chemotherapy sessions. A month after the treatments were complete they did another PET/CT to see where we were. Surgery was still out of the question, the proximity to the spinal cord made it too dangerous. I probably would be paralyzed. Cyberknife and 6 more chemo sessions finished it off. January 2010 it was NED and has been to this day. During treatment I really had no significant painful side effects. I had no nausea. I did get fatigued and I did get dehydrated and I lost all my hair, the usual things I was told to expect. The doctors and nurses all did a great job, they seemed to have all the bases covered and made me extremely confident about the care I was getting. They did offer physical therapy and I strongly recommend doing that during treatment. It kept me in good shape; I learned breathing techniques and the importance of maintaining strength. They also offered acupuncture which they did often and sometimes during my chemo sessions. The only real challenge I have since is dealing with a severely damaged ulnar nerve. I am right handed so I’ve had to learn to live with that small inconvenience. The cancer had eaten almost 43% of the T1 vertibra. I learned so much about lung cancer through all of this, things I never would have known. I was a smoker but I had quit almost 5 years prior to my diagnosis. The industry I was part of also wasn’t conducive to great health either. I saw many of the guys I worked with pass on not long after their retirement from one lung disease or another. That’s why my diagnosis wasn’t a shock to me. What got me through the initial part of it was remembering that it’s what I do next that matters. The other stuff is history. During Lawrence Taylors’ acceptance speech at the pro football hall of fame, he said that a champion is determined by not how many times he’s knocked down, but how many times he gets back up. I heard that many years before I got cancer, but I drew inspiration from it. I also was inspired by Jimmy Valvano’s speech at the ESPY awards long before I was diagnosed. It is available on YouTube or Google it, it’s a must-see speech. People I meet sometimes start out with the smoking question. I’m not disturbed by it at all. I understand the stigma associated with lung cancer and its connection to tobacco use. I use it as an opportunity to educate that person about the fact that almost 60% of new cases are nonsmokers and people who quit many years ago. Sometimes they are interested and sometimes I feel like I’m talking to the wall. Like I said before, it’s what we do next that matters. I do wish that everyone understood how many people are lost to lung cancer and how underfunded the research is. Perhaps it takes a loved one being diagnosed to raise awareness. The fact is that 1 in 14 people will be diagnosed with lung cancer. That is one reason I work to inform people about this disease, to increase funding for research and treatment. Cancer Treatment Center of America has kept me involved in survivorship programs. I sometimes meet with new patients at the Philadelphia hospital. I’ve been part of their Patient Advisory Council. We are a group of survivors from their different hospitals. We meet in those cities, tour the hospital, talk to patients there and find ways to make the patient experience as good as it can be. We have made a difference and examples can be found all over the place. It is a hard job as everything is covered very well already. Our group has visited 3 of the hospitals with 2 to go. This torch will be handed over to a new group and the task will continue. They asked me to be in one of their commercials which I did gladly. It is airing all over the country and has achieved results. I have met people in Philadelphia who told me they saw it and made the call. That’s what we did and I’m a survivor. They do really great things there and I’m proud to be a part of their efforts in the fight against cancer. I also take part in a program called the Patient to Patient Network. A new patient is offered an opportunity to speak with a survivor who has “been there, done that”. It’s very rewarding when I find out that someone I spoke with, sometimes for hours, made a decision to come to CTCA and is doing well. I’ve talked with well over a hundred cancer patients and look forward to seeing them in Philadelphia when our paths cross. These things keep me focused; I want all cancer patients to have good results. They do try to forward lung cancer patients to lung cancer survivors but we do speak with patients with other types from time to time. We aren’t giving medical advice or solutions, we’re trying to help them understand the treatment model and how their initial visit will happen. It helps ease their anxiety about traveling and those things. It has been very rewarding. I read a full page ad about LUNGevity in the spring issue of Cancer Fighters Thrive magazine one day in the spring of 2011. I checked out the website and joined immediately. The support group has been wonderful there. I posted my news now and then and I’m sure I ruffled a few feathers from time to time. I did get responses from survivors who had the same type of tumor that I did. Donna from the Minneapolis area was the first to answer and Kasey from very near my home came along too. Donna was a 14 year survivor and Kasey, 7 years. They both gave me so much hope and inspiration. I found out that the type of cancer we share is less than 3% of all lung cancer types. I’ve never met in person another case like ours. I have talked to some newly diagnosed people with it and I always tell them about these 2 ladies. (No, I don’t use your names). Last May, I had a chance to attend the Hope Summit in Washington D.C. There were almost 50 lung cancer survivors in one room. It was a very powerful thing. We were from every corner of the country and I don’t think any 2 of us were treated at the same place. There is great care all over this country and this was one happy group. We listened to speakers, shared stories, meals, laughter and even some tears. “That’s a full day.” We have lost a few of these wonderful people since then and we all know that this is the nature of the beast. I know these souls are still with us and the legacy they left will live forever in the hearts of those touched by them. Sometimes I think getting cancer was the best thing that ever happened to me. The people I’ve met have inspired me beyond imagination. I’ve met runners, cyclists, swimmers, “gymmers”, hikers, writers, workers, and we’re all husbands, wives, fathers, mothers, sisters, brothers, advocates and many more all with this commonality. I’ve learned what things in life are important and the things that don’t matter at all. I wonder if these thoughts would be at the front of my brain if I didn’t get cancer. I know I’d still be working, I loved my little business. I wasn’t through, I had projects unfinished and more to do. It was as if the rug got pulled out from under me. I got back up, got in a fight and so far, I’m winning it. I might get knocked down again, I understand that, and I will get back up again. My wish is that everyone everywhere would pay attention to what their body is telling them. Persistent coughing, pains that won’t go away, anything that seems out of the ordinary, go talk to your doctor. Go to as many as it takes until you are satisfied with the answers. Don’t worry about hurting doctors feelings by going elsewhere for another opinion. Don’t panic if it is a cancer diagnosis. Find out exactly what type it is before reading the entire internet. Ignore the statistics, we are people not numbers. Don’t be afraid to travel to a reputable treatment facility where ever it might be. Make sure you are fully confident in the team you select. A huge weight will be lifted from you with that faith. If you are in an occupation that puts you at a higher risk, demand tests for early detection. Lung cancer is usually advanced by the time of diagnosis. Listen to your body. Get it checked. At first, I assumed that lung cancer was a death sentence. I quickly learned that it didn’t have to be. I was offered hope and I was inspired by the many survivors I met along the way. Hope, inspiration, faith, a positive outlook, family, friends and oh yeah, never underestimate the power of prayer. You can do it!

A Life Worth Living, Still January 3rd, 2013 - by Kenneth Lourie http://blog.lungevity.org/2013/01/03/a- ... ing-still/ It might be my age (as in getting older), or it might be the fact that I have cancer (you think?), but my brain and the related physical and mental tasks it coordinates are not exactly working at peak efficiency. Don’t get me wrong, I’m not exactly “Forrest, Forrest Gump,” but plans are not easily made and when they are made, not so easily or successfully carried out. Whether it’s a drive to an unfamiliar destination, time spent with semi-unsuspecting (about me) acquaintances, or overnighting away from home (and out of my routine: alkaline water, pills, asparagus, baking soda, apple cider vinegar, etc.) as a few examples, what once seemed like ordinary and manageable acts of everyday-type life now present previously unfamiliar hurdles. Talk about making something out of nothing. Everything is something, even if it’s nothing. And that’s a change – for the worse. Unfortunately, knowing this – and accepting it, hasn’t lessened the burden and inevitability of living with it. I’m always relieved when whatever, wherever, however, we (meaning me) finish what we’re doing: get to where we’re going/solve the problem we’re needing to solve/arrange the schedule we’re attempting to arrange, and complete our miscellaneous activities. I can then settle back into what’s familiar and relatively uncomplicated. If I’ve been there and am accustomed to doing it, it gets done, without much ado. However, if I haven’t been there – literally and figuratively, getting there – and back, becomes increasingly more difficult. I don’t necessarily want to blame this behavior on my age or my underlying problem (“NSCLC”), but at least if I blame it on something that makes sense – to me, I can live with the consequences of this preferred inaction. And the more I understand the reasons for certain “inaction,” the less stress I’ll feel. And the less stress I feel, the better off I’ll be; as a cancer patient, first, and as a reasonably intelligent adult second (no comments from the peanut gallery, please). I guess what I’m trying to do is what Jerry, Elaine, George and Kramer were competing to do years ago on a particularly memorable “Seinfeld” episode: master my own domain; trying to control the uncontrollable. However, if any set of circumstances is likely uncontrollable, it is the physical, mental, emotional and spiritual effects one experiences after receiving a terminal diagnosis. You’re either ready for its demands or you’re not. It’s not like – at least for me, there was really any preparation or expectation that your life – as you knew it, was over. I suppose there’s a handbook somewhere. (Maybe there’s even some training or a class – Cancer 101, you can attend.) And though I can certainly appreciate the benefit and power of the written – and read word, a terminal diagnosis with a “13-month to two-year” prognosis requires – in my opinion, a more personal touch, one with a one-to-one/face-to-face-type connection. When the diagnosis is stage IV-serious, it’s best to leave nothing to chance and/or misinterpretation. As much as you – as the patient/”diagnosee” think you’re hearing and/or reading what’s being said or handed to you concerning the facts of your case, the shock of what you’re learning will not only cloud your judgment, but rewire your brain, emotionally speaking. It’s hardly another day at the office. In fact, it’s like no other day you’ve ever had at your office or any other office. The assimilation – or rather the attempted assimilation of your diagnosis, prognosis, treatment options, schedule of diagnostic scans and doctor appointments, best and worst case scenarios, will forever change the way you process information and plan your future. What I’m finding out is, the longer I survive, it’s the emotions I feel about having cancer more than the facts of having cancer that are causing me the most problems. One I can live with, the other is living with me. And it’s not of my own choosing, either. Share your thoughts with us below. How do you live with the emotions that accompany being a cancer survivor? ____________________________________________________________ “This column is my life as one of the fortunate few; a lung cancer anomaly: a stage IV lung cancer patient who has outlived his doctor’s original prognosis; and I’m glad to share it. It seems to help me cope writing about it. Perhaps it will help you relate reading about it.” Mr. Lourie’s columns can be found at http://www.connectionnewspapers.com. (key word, Lourie)

My evolving views on molecular testing in advanced NSCLC December 28th, 2012 - by Dr. Jack West http://blog.lungevity.org/2012/12/28/my ... ced-nsclc/ Here’s a video I just did that describes my changing perspective on molecular testing for markers such as EGFR and KRAS mutations and ALK rearrangements. In it, I describe how I’ve been struck by a higher yield for molecular testing in my own clinic patients over the past couple of months than I’ve expected to see, including my finding some “actionable” markers that have led to important treatment shifts in some patients I might have considered to be relatively unlikely to harbor a mutation. Although it would be nice to be able to define a clear, knowable rule for who to test and what to expect, the reality is that we’re learning so much, so quickly, that I feel it’s most appropriate to acknowledge that our early conclusions are based on limited information, and that we’re gaining new insights based on an ever-growing body of evidence as we test and treat more and more patients with molecularly targeted agents. And this should lead us to be inclined to review what we think we know, assess whether the new information supports or refutes our current perspective, and potentially change that view to better accommodate what we’re learning in real time. I hope this is helpful and interesting. I hope it’s NOT just unsettling to get a glimpse that betrays that even specialists can have changing approaches over time. The truth is that when we’re still learning a lot, we should all recognize that nobody should offer dogmatic answers, and we should be eager to both learn more and incorporate that new evidence into evolving practices. It’s wonderful to be living through such dynamic times in molecular oncology, where new markers are being detected and new treatments being tested all the time, but it also means that the ground is always shifting below us. Because of that, we need to be nimble and not too entrenched where we are.

Is there an age cap for chemo? December 21st, 2012 - by Dr. Jack West One important question that comes up frequently is whether someone with lung cancer is too old to consider chemo. While that’s an understandable concern, the actual evidence shows that patients in their 70s, and even in the range of 70-90, not only benefit from chemotherapy but generally get the same magnitude of benefit as younger patients. Here’s a brief video of the topic, done through my hospital’s website, that covers the question a bit more. http://blog.lungevity.org/2012/12/21/is ... for-chemo/

A Stack of Forgotten Papers December 17th, 2012 - by Juhi Kunde http://blog.lungevity.org/2012/12/17/a- ... en-papers/ Usually, my holidays are full of fun. My favorite part of the season is wrapping the presents my husband and I buy together. But this year, I have to do the shopping while my husband is away on business. That means I am faced with the daunting task of managing coupons – by myself. During the rest of year, I am not that good at keeping track of coupons anyway, but during the holidays there are even more ways to save and it drives me crazy. Yesterday, I was in line at Target and I managed to use two coupons I clipped from a mailer plus I got 5% off for using my Target Red Card. Of course, I was also hitting the store’s sale racks and I had even used a couple of digital coupons from my phone. But I still left the store disappointed in myself and wishing my husband had been there to help. You see, I had forgotten a stack of manufacturer coupons on my kitchen counter. So there I was, digging through my purse looking for them when the cashier started looking pointedly at the line growing behind me. Eventually, I gave in to the pressure and signed for my purchases. It is a lot of work to make sure that you have the right pieces of paper, the right technology and the right date, time and location to optimize a shopping expedition. In fact, when you are trying to optimize anything, it is a lot work to have every single duck lined up. And just one wayward duck can leave you feeling ineffective and exhausted. Of course, saving 50 cents on frosting is nothing compared to the stress of optimizing a visit to the oncologist. No one wants to be sitting in the doctor’s office when they realize they forgot important paperwork. Being diagnosed with lung cancer can be overwhelming in itself but then adding the daunting tasks of tracking appointments, organizing medical records and timing medications could make anyone want to hide under the covers. That is why I am grateful to the wonderful caregivers – our husbands and wives, our friends and children – who help us manage it all. To all those strong people who keep us organized, focused and moving forward – I offer a heartfelt “thank you!!” Do you have a special person who helps you keep it all straight? Leave a comment telling us about them or nominate them for LUNGevity’s Lung Cancer Caregiver Contest!

Why Don’t We Routinely Use Two Drug Combinations for Previously Treated Advanced NSCLC? December 16th, 2012 - by Dr. Jack West http://blog.lungevity.org/2012/12/16/wh ... ced-nsclc/ Here’s a brief video presentation I just did, which appears on my hospital’s website/blog, discussing why we routinely give single agent treatments rather than doublet combinations to patients who have already received first line therapy for advanced NSCLC. The basic idea is that as treatment continues for patients on therapy for advanced NSCLC, it becomes only more and more important to balance the anticipated side effects of treatments against the incremental benefit of a more aggressive treatment. Overall, the majority of patients with advanced NSCLC can do well with a combination approach for first line (with the exception of patients with a “driver mutation”, for whom an EGFR or ALK inhibitor alone will generally be quite effective), but after that, we find that combinations confer greater side effects without any accompanying significant improvement in overall survival. The leading alternative is sequential single agent approaches, which may lead to further tumor shrinkage in some patients, and either a minor response or prolonged stable disease in many others; these results often lead to an improvement in survival with minimal cost in terms of side effects. I hope this video and discussion are helpful for many of you. I’ll be posting more short videos, which I hope will be both educational and engaging, very soon.

Dr. Aisner’s Glimpse into the Future of Molecular Marker Testing December 14th, 2012 - by Dr. Jack West http://blog.lungevity.org/2012/12/14/dr ... r-testing/ The close of Dr. Aisner’s presentation on pathology and molecular testing included a projection of what we can hope to see in the future for molecular oncology. How will we improve the efficiency and maybe even lower costs as molecular testing becomes more routine and the battery of tests we do for various cancers broadens? Here’s Dr. Aisner’s perspective on the transitions we’re experiencing. Below are the video and audio versions of the podcasts, as well as the associated transcript and figures for the program. (Click link above to view video and audio versions of the podcasts.) Aisner Path and Mol Path Pt 3 Future of Marker Testing Video Podcast Aisner Path and Mol Path Pt 3 Future of Marker Testing Audio Podcast Aisner Path and Mol Path Pt 3 Future of Marker Testing Transcript Aisner Path and Mol Path Pt 3 Future of Marker Testing Figures Dr. Aisner was a wonderful guest participant, and I think it’ll be very helpful to keep her as a friendly and accessible resource for more of our molecular oncology questions in the future. I hope you found her as informative as I did.

Dr. Dara Aisner Introducing Molecular Pathology & Challenges of Molecular Testing December 7th, 2012 - by Dr. Jack West http://blog.lungevity.org/2012/12/07/dr ... r-testing/ As part of our ongoing partnership to improve lung cancer education and patient empowerment, LUNGevity Foundation and GRACE co-sponsored a live program recently with Dr. Dara Aisner, who is a pathologist and the Co-Director of the Molecular Correlates Lab at the University of Colorado. I was very happy to have the opportunity to do this in the form of a back and forth discussion/Q&A session with Dr. Aisner, especially since she’s a great communicator about topics that are very timely but can also be very complex. In the first part of the discussion, which went off into mini-presentations on the questions we covered, she introduces basic concepts of what a pathologist does and what the new field of molecular pathology actually entails. Here’s the first part, including the video and audio versions of the podcast, as well as the transcript and figures. (Click on the link above to view the video and audio links.) Aisner Pathol and Mol Path Pt 1 Defining Terms Video Podcast Aisner Pathol and Mol Path Pt 1 Defining Terms Audio Podcast Aisner Pathol and Mol Path Pt 1 Defining Terms Transcript Aisner Pathol and Mol Path Pt 1 Defining Terms Figures The second portion of our discussion covered the practical challenges of molecular testing on certain tissues, where to obtain biopsies from, and other current issues that we encounter in real clinical management as we struggle to make molecular testing more routine. Again, here’s the video and audio versions of the podcast, along with the associated transcript and figures. Aisner Pathol and Mol Path Pt 2 Practical Challenges Video Podcast Aisner Pathol and Mol Path Pt 2 Practical Challenges Audio Podcast Aisner Pathol and Mol Path Pt 2 Practical Challenges Transcript Aisner Pathol and Mol Path Pt 2 Practical Challenges Figures We’ll finish with a glimpse of the future of molecular testing. That podcast will be posted here very soon. I hope you find this both interesting and helpful!

Nurse Navigator Tammy Allred December 6th, 2012 - by admin http://blog.lungevity.org/2012/12/06/nu ... my-allred/ Tammy Allred knew the moment she began working with oncology patients that she had found her calling. The North Carolina native, originally from Chapel Hill, has been working in oncology for 29 years and loving it. Her official title is Sarcoma and Thoracic Oncology Nurse Navigator. She is one of two lung cancer nurse navigators at the UNC Cancer Center and she is the first person a patient sees. Allred works to provide educational materials to help patients understand their disease. She supports and educates them during their treatments and helps them avoid all obstacles that they may face during their treatments. She facilitates their appointments and maintains contact to make sure they don’t get lost in the care continuum. She also makes referrals they may need to obtain medications and makes sure their insurance needs are met. If patients are not insured or have special needs, she makes sure they are referred appropriately to get the help they need. We asked Allred what recommendations she would give to someone who’s just been diagnosed with lung cancer. Her reply: “Do NOT Google anything about lung cancer! There is too much inaccurate information out there. Go to a medical oncologist who is experienced in lung cancer. Get a second opinion if you do not feel comfortable with what you are hearing. Do not listen to old wives tales or compare your lung cancer to other types of cancers. All cancers are not treated the same. All cancers have different outcomes. To sum it up, be a self-advocate. Lung cancer has changed so much over the past several years and continues to change in a positive manner. There IS hope.” There are also many misconceptions when it comes to lung cancer. We asked Allred what she thought the biggest misconceptions the public may have about lung cancer. “The biggest misconceptions are that lung cancer is a smoker’s disease and that there is no hope if you are diagnosed. It IS NOT A SMOKERS DISEASE. Lung cancer can happen to anyone with lungs. And there IS hope. Things are changing every day to improve the quality of life for people with lung cancer and treatments are getting better. No one deserves lung cancer and patients should not be blamed or feel guilt for having lung cancer.” Allred has worked in different aspects of nursing from the med/surg floor, giving chemotherapy, hospice, clinical trials, and now with lung cancer patients. She says she’s finally doing what she loves, combining all her experience in all these areas and navigating patients thru all the phases of their lung cancer experience. She’s been working with the North Carolina LC Partnership for the past 5 years and loves doing outreach and education and raising awareness about lung cancer and correcting the misconceptions and stigmas about the disease. She also mentors new navigators and shows them how to find resources that will help their patients. One thing is clear to us: Tammy Allred puts her patients first. She recently was nominated for Best Lung Cancer Healthcare Provider for the month of November on Facebook and won. LUNGevity is glad to honor and recognize her passion and dedication and care of those affected by lung cancer.

Buy Now, Pay Later December 3rd, 2012 - by Kenneth Lourie http://blog.lungevity.org/2012/12/03/buy-now-pay-later/ Buy Now, Pay Later. Meaning: If I’m terminal, why deprive myself because of cost? If, in fact, I’m only living once – as the old saying goes, and somewhat less of a life than I had anticipated, shouldn’t I, at the very least, “Pull my pants down and slide on the ice,” as prescribed by Dr. Sidney Freedman in an episode of M*A*S*H, way back when? I mean, what am I waiting for? Godot? It seems fairly clear, after having received the diagnosis: stage IV non-small cell lung cancer, and the prognosis: “13 months to two years” back in late February, 2009, that time was not exactly on my side. Nevertheless, I’ve tried to live my life like I wasn’t dying (to bastardize Chris Allen’s debut single). However, doing so is sort of like serving two masters. I can’t live today like there’s no tomorrow if a part of me is living as normally as I can today as a strategy for there being a tomorrow. It’s somewhere between taking one step forward and then two steps backward and/or doing the Hokey Pokey. You’re getting nowhere fast, but at least you’re getting somewhere. Huh? I can’t tell you, although I attempt to every week in these cancer columns, how confusing the uncertainty of being a terminal cancer patient can be. I want to believe the means that I’m employing to survive is not simply a fool’s errand/alternative to the same fate that awaits us all. Moreover, I want to act responsibly and prudently in the face of this killer disease. But sacrificing today for tomorrow, a tomorrow that 44 months ago lost its guarantee, seems counter-productive, almost counter-intuitive anymore. There are certain consequences to actions – or inactions quite frankly, that perhaps I don’t need to consider as I did when I was p.c. (pre-cancer). If I’m living on borrowed time, so to speak, I don’t need to pay the “vig” (vigorish). What’s the point of paying interest, metaphorically speaking? What interest I should be paying is for any and all things that bring me happiness now – while I’m alive and still kicking. Later, apparently, is being taken care of, or so I’ve been told by my oncologist – if you know what I mean? (One of his suggestions to me at the initial Team Lourie meeting was to: “Take that vacation I’ve always dreamed of,” as in: since you’re dying sooner rather than later, there’s no time like the present, literally). But I was always put off by that notion and the bucket with the lists. I never wanted to check off any lists. I simply wanted to live like I always had, hoping that the normalcy and familiarity of what I was doing would help sustain me through the inevitable dark days to follow. (Generally speaking, a cancer diagnosis doesn’t exactly spread joy in its wake.) I didn’t want to live like I was dying. I wanted to live like I was/had been living. (“Denial,” as they say, “is more than just a river in Egypt.”) The only problem: being diagnosed with a terminal disease is a hell of a thing. Change is coming: mentally, physically, emotionally, spiritually and everything in between and all around, too; and control of any and all of it becomes increasingly more difficult. I know what I want to do, but sometimes the cancer has other ideas. And even though some of these ideas are not mine, occasionally, they just might be for the best. Who knew? Live and learn. Thank God! ________________________________ Share your thoughts with us below. Do you have a bucket list? “This column is my life as one of the fortunate few; a lung cancer anomaly: a stage IV lung cancer patient who has outlived his doctor’s original prognosis; and I’m glad to share it. It seems to help me cope writing about it. Perhaps it will help you relate reading about it.” Mr. Lourie’s columns can be found at www.connectionnewspapers.com. (key word, Lourie) Read Kenneth Lourie’s 1st LUNGevity blog post & bio.

Dr. Mehta Podcasts on New Technologies on Radiation for Lung Cancer, and Applying It in Advanced Lung Cancer November 30th, 2012 - by Dr. Jack West http://blog.lungevity.org/2012/11/30/dr ... s-5-and-6/ Here are the final two parts of the program by Dr. Vivek Mehta, radiation oncologist at Swedish Cancer Institute in Seattle, WA, on Refining Radiation for Lung Cancer. This next podcast covers several new advances in the technologies now being incorporated into radiation therapy for lung cancer. Here are the video and audio versions of his podcast, along with the associated transcript and figures. Click the link above to view the video and audio links. Mehta Refining RT for LC Pt 5 New Technologies Video Podcast Mehta Refining RT for LC Pt 5 New Technologies Audio Podcast Mehta Refining RT for LC Pt 5 New Technologies Transcript Mehta Refining RT for LC Pt 5 New Technologies Figures Finally, his talk closes with a discussion of the open question of whether and how to integrate these new technologies into the management of advanced lung cancer. Again, here are the video and audio podcast versions of the program, along with the transcript and figures for it. Mehta Refining RT for LC Pt 6 Moving Developments into Metastatic LC Video Podcast Mehta Refining RT for LC Pt 6 Moving Developments into Metastatic LC Audio Podcast Mehta Refining RT for LC Pt 6 Moving Developments into Metastatic LC Transcript Mehta Refining RT for LC Pt 6 Moving Developments into Metastatic LC Figs This marks the end of this program, but we’ll have our next one posting very soon!

Deerfield High Schoolers fight against lung cancer BY HANNAH KOHUT | hkohut@pioneerlocal.com November 29, 2012 2:24PM http://deerfield.suntimes.com/news/scho ... ancer.html Focusing on a cause. That’s been the story of two Deerfield High School students’ lives for the past five months. Hundreds of e-mails; meetings with national non-profit organizers, coordinating a series of school and community events — and still keeping up with classwork and other activities. Sixteen-year-olds Samantha Gottstein and Graham Ambrose said they’ve been on a mission to bring awareness to and raise funds for a special cause – the LUNGevity Foundation. This year, the DHS student body voted to support LUNGevity for this year’s School Chest – the school’s annual fundraiser. Gottstein and Graham, who are co-chairs of this year’s School Chest, said they looked at 50 charities in all. “LUNGevity is a foundation that works to eradicate lung cancer,” Gottstein said. “They do it through a variety of ways, (mainly) through research.” “(School Chest) lasts for three weeks, between the breaks of Thanksgiving and winter vacation,” Graham said. “For those three weeks, we push fundraising throughout the school.” Gottstein said they’ve known about LUNGevity since April 2011, when the non-profit held a run/walk at the high school, called Breathe Deep, Deerfield. “When it came around to summer (of 2012), they gave us some information and submitted the proposal to be one of the School Chest candidates this year,” Gottstein said. “In August, they came and presented (their pitch) to the student council.” Once the student body voted, and LUNGevity was chosen as the 2012 School Chest beneficiary, all the hard work started, Graham said. “The number of e-mails Sam and I send out every day is amazing (to make this happen),” Graham said. “It’s a huge task and a huge responsibility, but the reward matches the greatness of the task.” Both Graham and Gottstein said, while neither of them have had loved ones affected by lung disease, their passion for the cause runs deep. “I have been totally missed by this very horrible disease, but that is such a positive for me, because I am absolutely devoted to this cause,” Graham said. “I love LUNGevity’s work.” “My family has been touched by cancer, but not lung cancer, so for me, when they presented it, it was a very fresh perspective on what the disease is and who it’s impacting,” Gottstein said. “The people that (LUNGevity) brought in to speak are parents of kids who I see everyday in the hallways. People in my own community will be directly benefiting from the funds we are raising in the school.” Graham said the campaign kicked off on Wednesday, Nov. 28 with a school assembly and plenty more activities to come, including a 5k run, dinner fundraiser, a DHS Idol contest and Mr. DHS beauty pageant. “If you can imagine a pageant for senior boys,” Graham said, with a laugh. “It’s a humorous take on something people all know about (the Miss America pageant). When the campaign is all said and done, Graham and Gottstein know one thing will be for sure. “The five months’ work is going to pay off,” Graham said. Graham said to make donations or for more information on this year’s events, e-mail SchoolChest@gmail.com, or visit www.LUNGevity.org/SchoolChest.

Lung cancer screenings offered to local residents who qualify 5:27 PM, Nov 28, 2012 http://www.thestarpress.com/article/201 ... ck_check=1 Q What is our local lung cancer burden? A. In a recent Community Health Needs Assessment, smoking and tobacco use were identified among the top 5 health concerns for our community. More than 20 percent of adults in Indiana smoke. In East Central Indiana, our current smoking rates are even higher. Smoking is identified as the biggest risk factor for lung cancer. In 2011, Indiana UniversityHealth Ball Memorial Cancer Center treated about 150 cases of lung cancer. Nearly 75 percent of those cases presented at stage 3 and 4 – meaning advanced disease. Q. What is a lung cancer screening and why offer one now? A. A lung cancer screening involves an assessment tool to determine eligibility and a CT scan of the lungs. It is a noninvasive procedure done in the radiology department at IU Health Ball Memorial Hospital. We believe it is important to offer this screening because lung cancer is the leading cause of cancer death for men and women not only in the United States, but here as well. Unfortunately lung cancer can be aggressive, and as a result it is not found until later stages when the cancer is much more difficult to treat. A lung cancer screening will hopefully allow us to find the cancer earlier, and achieve better outcomes. Recent national trials have shown a 20 percent reduction in mortality when long term smokers are screened for lung cancer with a lung CT scan. Q. Who should be screened? A. There are specific guidelines for who is eligible for lung cancer screening. These guidelines are set by the National Cancer Institute. All guidelines must be met to be eligible: 1. Between 55-74 years of age 2. Currently smoke or have quit in the last 15 years 3. Thirty pack year history of smoking (“pack year” is calculated by multiplying the number of packs of cigarettes smoked per day by the number of years spent smoking) 4. Symptom free 5. No CT scan of the chest within the past year If you are eligible, a screening involves a CT scan of your lungs and speaking with a healthcare professional about your lung cancer risk. The out-of-pocket expense is $49 to be paid at the time of screening. If you are not eligible, we encourage you to speak with your primary care doctor about your lung cancer risk. Q. What if I am interested in a lung cancer screening? A. Again, you must meet all the requirements mentioned earlier. If so, call Indiana University Health Ball Memorial Hospital at 751-2727 to schedule an appointment. You will be contacted by a navigator who will assist you through the screening process and accessing any follow up services that may be necessary. All current smokers are encouraged to quit. Smokers can obtain assistance by contacting the Indiana Tobacco Quit Line at (800) Quit Now (800 -784-8669). Joseph Spahr, MD, is a Board Certified Hematologist/Medical Oncologist at Indiana University Health Ball Memorial Oncology Physicians. For more information, call 281-2030 or go to, iuhealth.org.

Do you enjoy eating fruits and vegetables? Research indicates a colorful plate can help fight cancer. Thoughts? http://health.usnews.com/health-news/ne ... hting-diet Colorful Fruits, Vegetables May Be Key to Cancer-Fighting Diet Fall favorites -- apples, cranberries, sweet potatoes -- are beneficial all year long, expert says November 26, 2012 MONDAY, Nov. 26 (HealthDay News) -- Many cancer-fighting fruits and vegetables are at their nutritional peak in the fall, and it's a good time to incorporate them into your diet, a nutritional expert advises. For example, research suggests that eating an apple a day really may keep the doctor away, by helping to prevent throat, mouth, lung and possibly breast cancer, noted Stacy Kennedy, a senior nutritionist at the Dana-Farber Cancer Institute in Boston. Apples contain a nutrient called quercetin, which protects the cell's DNA from damage that could lead to cancer. "The key is to eat them raw and with the skin on. That's where many of the nutrients are found," Kennedy said in an institute news release. Cranberries, another healthy fall favorite, are in season and at their nutritional peak now. Kennedy suggested stocking up on bags of cranberries and freezing them for use throughout the year, because there is evidence that the benzoic acid found in these berries may inhibit lung and colon cancer, and some forms of leukemia. Among the brightly colored fresh vegetables that are available at this time of year are beets, carrots and parsnips. Kennedy suggests serving generous portions of these. "The brighter and richer the pigment, the higher the level of cancer-fighting nutrients," Kennedy said. Dark, leafy vegetables such as kale, broccoli, cabbage and Brussels sprouts are also important, she pointed out. People who eat plenty of these vegetables have lower rates of lung, prostate and stomach cancer. "Kale is a top choice because it's rich in phytonutrients called indoles, which stimulate liver detoxification and help fight cancer," Kennedy said. Orange vegetables such as carrots, sweet potatoes, squash and pumpkins are all packed with nutrients called carotenoids, which have been linked to the prevention of colon, prostate, breast and lung cancer, Kennedy said. Color is key to finding cancer-fighting foods in any season, Kennedy added. "Eating a plant-based diet is the best way to help lower your risk of cancer all year long," she said. More information The U.S. National Cancer Institute has more about cancer prevention. Copyright © 2012 HealthDay. All rights reserved.

The Critical Battleground Community ~ Young Voices November 19th, 2012 - by Jill Feldman http://blog.lungevity.org/2012/11/19/th ... ng-voices/ Leading up to the election and for a few days after I was obsessed with the absurd amount of time, energy and money spent on the presidential election. I just kept thinking, all that campaigning and now what? What if 1/4 of those resources were spent on raising awareness or money for lung cancer research? Do 1/4 of Americans even know that November is Lung Cancer Awareness month? Like most Americans, I followed the election the night of November 6th as different states were colored red or blue. I was particularly interested in the battleground states and the significance of winning those states for each candidate. It was also interesting how much emphasis was put on the importance of people getting to the polls and voting, especially for certain groups. The young voters, the future of our country, played a key role in the election. Lung cancer isn’t much different. The opposing candidates are Lung Cancer and Life, and there are various ‘battleground’ communities in this campaign including, government, general public, medical professionals, patients, and caregivers. Young voices also play a critical role in this campaign. The government has already shown us that lung cancer is not a priority, therefore, Lung Cancer wins that community. Lung Cancer wins the general public because just like those who choose not to vote, the majority of society, for various reasons, chooses not to take a stand against lung cancer. The medical community is split because there are still many medical professionals that perpetuate stigma and/or believe the disease represents nihilism. Life clearly wins the patient and caregiver community, although there are still patients and caregivers that feel shame or are too sick to advocate for themselves, their disease and change. That leaves the young voices — the critical battleground community that could compel others to rethink lung cancer. This is a community that can incite change by caring about the WHAT (what are we going to do) not the HOW or WHY (how or why someone gets lung cancer). There is an insightful group of teenagers in the young voices community who have chosen to vote Life and lead that campaign. Deerfield High School, in Chicago’s northern suburbs, organizes School Chest each year, a three-week-long charity drive that unites students, teachers and residents behind an organization with a cause they believe in and connections in the community. LUNGevity Foundation was chosen as the 2012 beneficiary. I can’t put into words the respect and admiration I have for these students. They recognize the impact and reality of lung cancer. They understand that we need to get past the blame game, and they know that anyone can get lung cancer. These teenagers are proud to stand up to lung cancer, and they do so with determination and conviction. They vote Life! As a lung cancer patient and Deerfield mom of four, I am touched and completely awed by the students of Deerfield High School. They will help give lung cancer a much needed voice, and theirs will be loud. There won’t be a stigma to erase if this community understands the REAL story. They will make a difference — and that gives me so much hope for the future – for Life! You can watch these amazing teenagers in action, and donate to their tireless efforts, by visiting www.lungevity.org/schoolchest & www.facebook.com/schoolchest2012lungevity.

Is Rash a Critical Predictor of Benefit with EGFR Inhibitors? Video on the TOPICAL Study November 25th, 2012 - by Dr. Jack West http://blog.lungevity.org/2012/11/25/to ... velopment/ Since the early studies of inhibitors of the epidermal growth factor receptor (EGFR) — both oral tyrosine kinase inhibitors (TKIs) and IV monoclonal antibodies — one retrospective finding in many studies has been that the patients who develop a rash do better than the patients who don’t, and this has been seen not only in trials of lung cancer, but in colon cancer as well. Nevertheless, I and most other experts have remained wary about using the development of rash in clinical decisions, such as to discontinue an EGFR inhibitor in someone who doesn’t develop a rash. Why? I have several reasons: 1) These are just a post-hoc subgroup analyses, which arguably shouldn’t be taken as being as important as prospectively defined questions. 2) Tarceva (erlotinib) is currently FDA approved for all previously treated patients with advanced NSCLC. To stop it in patients who don’t develop a rash is to cut a treatment with a proven value in a broader population of which these patients were still a part. 3) Patients need to have tried the drug if we might learn whether a patient will develop a rash on it. It’s hard to stop a treatment after just a few weeks, without getting additional feedback on its efficacy. 4) This correlation isn’t perfect. Some patients do extremely well with EGFR inhibitors despite not developing skin side effects. Despite these reservations, I must admit that I’ve been struck by the recent findings in the TOPICAL study, just published in the journal Lancet Oncology. Adding to the rather consistent finding that rash is clearly associated with better outcomes on an EGFR inhibitor like Tarceva (erlotinib), the study begs the question of whether rash development really should be a component of clinical decision making. Specifically, the results suggest that patients who don’t develop a rash in the first month on Tarceva do worse than the patients on placebo and actually may be harmed by it. Here’s a brief video that describes the study and the key results: [powerpress] Learning all of this, if you had lung cancer and were to try Tarceva but didn’t develop a rash, would you be inclined to stop it after a few weeks, or would you still want to continue it until a repeat CT scan clarifies whether there is progression or not? Do you accept the concept that the development of rash may distinguish between those helped and those potentially even harmed from an EGFR inhibitor? Though these results aren’t perfect, the consistency of the observation is leading me to revisit my views and consider whether rash development really might be an important factor in stratifying which patients are being helped by Tarceva and which ones might actually be harmed by it. Thoughts?

Is there an upper age cap on chemotherapy for lung cancer? November 21st, 2012 - by Dr. Jack West http://blog.lungevity.org/2012/11/21/is ... ng-cancer/ For those who are interested, I started doing some brief videos on various topics in lung cancer. Here’s one available through my institution, Swedish Medical Center, in Seattle, on the topic of whether chemotherapy is feasible for older patients with lung cancer: http://swedish.org/About/Blog/November- ... z2CsSvvUsx I hope you find it helpful and that this format of just speaking in front of a camera is engaging and an easy way to learn about a topic.

Here, There, and Everywhere November 20th, 2012 - by Kenneth Lourie http://blog.lungevity.org/2012/11/20/he ... verywhere/ The Beatles sang it on their “Revolver” album back in the mid 60s. My wife and I danced to it in the late 70s when we selected it as “first song as husband and wife” – in 1978. And recently we felt it, three years after my stage IV lung cancer diagnosis, as our reaction/assessment to the many similarly diagnosed individuals who’ve shared their lung cancer stories with us. Who knew? All of a sudden – or so it seems, people with whom we thought we had little in common – and even less of a connection, have selflessly offered up their lung cancer experiences, journeys, associations, etc. One-hundred, sixty-thousand deaths per year attributed to lung cancer, the leading cause of cancer-related deaths in this country – by far, is reason enough for what initially seemed like a random coincidence but now feels more like an inevitability. Apparently, where there are overwhelming numbers, so too is there an overwhelming capacity for empathy and understanding. Any lung cancer story I hear is more evidence and reinforcement to boost my own survival. Not that any experiences of what other cancer patients have endured/survived is necessarily related to my survival, still; it beats the alternative, as I like to say. Living is its own reward and surviving lung cancer is exponentially more rewarding than anything else I do. It’s the first thing I think of when I wake in the morning and the last thing I think before I fall asleep at night. And on those many nights when I’m unable to fall asleep, or sleep soundly – or enough, you can be sure the culprit is cancer. Certainly, I have physical challenges related to my diagnosis, but mostly the problem I face is mental: how do you not obsess on the thing that is most likely killing you and one for which you have minimal control or defense? My solution, or rather an attempt at a solution: I try to compartmentalize – and/or pretend, but cancer is insidious and tricky: an enemy of the people if there ever was one. More specifically, trying to make the best of a bad situation is what I do best. When you’re characterized as “terminal” at age 54 and a half – not even three months after you buried your widowed mother at age 86 – of a disease for which there was no immediate-family history, combined with the fact that you were a lifelong non-smoker (85 percent of lung cancer patients have been smokers), the breaks don’t exactly feel as if they’re going your way. Nevertheless, dwelling on that fact or feeling sorry for myself or “woeing” is me is not reflective of the positive mental attitude that my parents instilled in me. I saw how they lived their lives and more importantly, I observed their dignity and perseverance when their health deteriorated. Somehow, they never made it about them, it was more about others. Likewise, as I regularly receive communications from and occasionally meet other cancer survivors, I only hope that I am doing for them what they are doing for me. A cancer diagnosis was not exactly what I had anticipated hearing from my Internal Medicine doctor three years ago when he made “the call” to me. However, now that I’ve lived the cancer life for three-plus years and met the people I have and read the many stories sent to me, I feel privileged to be part of such a brave and courageous group. Thanks for reaching out to us. Because of you, we’ve never felt alone. _______________________________________________ Don’t be afraid to share your lung cancer story. Please leave your comments below. “This column is my life as one of the fortunate few; a lung cancer anomaly: a stage IV lung cancer patient who has outlived his doctor’s original prognosis; and I’m glad to share it. It seems to help me cope writing about it. Perhaps it will help you relate reading about it.” Mr. Lourie’s columns can be found at www.connectionnewspapers.com. (key word, Lourie)