Since I started OncTalk, I’ve worked to post new information several times per week, and I don’t like to go for more than a day or two without adding more.  I just wanted to let people know that today and tomorrow I’m chairing a national lung cancer meeting called the (Third Annual) Multidisciplinary Interactive Thoracic Oncology Conference here in Seattle, so if it takes me a day or two to respond to e-mail and discussion threads, and/or if I don’t get to post anything new for another day or two, I haven’t forgotten and closed down.  Let me tell you a bit about the meeting:

 (click to enlarge - yes, Seattle is always this pretty, and it never rains)

  Several years ago, my surgical friend and colleague Eric Vallieres were discussing how much we’d enjoy being part of a different kind of lung cancer meeting than the standard ones we speak at, in which the format has traditionally been lecture after lecture, followed by a few minutes of discussion/Q&A if people haven’t run overtime.  It’s a big download of information and isn’t interactive, and the information tends to highlight the textbook type of cases.  Instead, we thought it would be great to focus on real life, messy scenarios for which we don’t have clear answers and we all have to try to make tough decisions without the benefit of big trials or standard guidelines to tell us what to do.  We wanted to have a format that was case-based, using our real patient scans and treatments (removing all of the identifying information, of course), and to have the core of the meeting be the discussion among a group of experts, coming from all different disciplines, including medical oncology, radiation oncology, surgery, pulmonology, and pathology and radiology there too.  Basically, the idea was to develop a “dream team” tumor board, the meeting that many hospitals have among their various disciplines to discuss what to do with lung cancer cases as a group.  More and more people with lung cancer are needing treatment from multiple specialties, and we wanted to bring in several national experts to debate the options for the tough cases.  So we set out several years ago to build the kind of meeting we’d enjoy most, and we found that the faculty and audience of primarily Pacific Northwest regional physicians and nurses really enjoyed the format and learned a lot.  We included lots of “how would you treat this patient now?” multiple choice questions using a remote control audience response system, and we found that, as we expected, there is a lot of variability on how different people approach the same problem.  And we also found, not surprisingly, that even the experts with access to the same evidence had differing approaches.  Audience members told us that they found it encouraging to see the national experts debating back and forth and not emerging with clear answers for many cases, just the way they debate at their own tumor boards at home.  The way they do things at Memorial Sloan Kettering may be different from the way they do things at MD Anderson or Vanderbilt or my own center, Swedish Cancer Institute, even with good expertise at all of these places.  

   In past years, we’ve had so many challenging cases to discuss that we haven’t had enough time to discuss the details as long as we’d like.  In response, this year we cut back on the number of cases, and we also pruned down the number of faculty members (although still including stars from Memorial, MD Anderson, Stanford, Vanderbilt, Univ. of North Carolina, Mayo, Yale, and other places), so that we can get the most out of the people we have participating.  Here are some of the situations we’ll present and debate in detail:

• The NSCLC tumor that is at the border of resectability based on possible involvement of the spine: Consider surgery or focus on chemo/radiation?
• A slowly growing ground glass opacity in an elderly patient: how aggressively should we chase it down, and what surgical interventions should we pursue, if any?
• A patient with 1-2 areas of NSCLC in the chest months after completing chemo/radiation with curative intent: is this still curable, and what are the most promising treatment options?
• After responding well for months on EGFR inhibitor therapy, a patient with a lung adenocarcinoma develops mild and asymptomatic progression: should they increase dose,  continue EGFR therapy and add another agent, or switch to a completely different treatment plan?
• Non-bulky stage IIIA NSCLC in a fit patient: what are the range of management options, and what should be done if there is residual mediastinal lymph node involvement found after surgery?
• A never-smoking patient undergoes surgery for a stage IB lung adenocarcinoma: what is the evidence for and against treating them with adjuvant chemo, and would physicians be inclined to consider newer targeted therapies such as tarceva, or possibly avastin?
• Other topics we’ll discuss will include treatment options for recurrent SCLC, management options for recurrent SCLC, newer radiation techniques, optimizing pulmonary function to prepare patients for surgery, the potential value of smaller surgical resections (less than a lobectomy — when is that appropriate, if ever?), and optimal use of anti-angiogenic drugs like Avastin.

I’ve touched on several of these issues in my posts and replies to questions over the last several months, and I’ll cover the highlights of our discussions of these cases in the next few weeks and months.  Each of these topics includes lots of side roads to discuss.  I expect it to be a great, enjoyable, and educational meeting.  At this point, the discussion is really aimed at a medical audience, but perhaps in future years we can consider hosting a meeting to cover information directed for patients and family members and allow them to have direct access to a group of lung cancer experts from multiple disciplines to discuss management of real life scenarios at a level that is interesting and valuable for the general population.

Anyway, I’ll add more as soon as I can.  It’ll be a busy few days.