Testing for Tumor Mutations: Liquid Biopsy Versus Traditional Biopsy


Liquid biopsies, virtually unknown even a year or two ago, are becoming common tools in precision diagnostics for cancer. Here, I will try to explain some of the more important differences between liquid and “traditional” tumor biopsies.

Biopsies of solid tumors (e.g., lung, breast, or brain tumors) involve surgically removing a small part of a tumor and sending it to pathology lab. In the last few years, doctors have also started to send some tumor samples to special service labs that analyze tumor DNA for the presence of cancer-related mutations.

By definition, regular biopsies can be intrusive and are sometimes associated with side effects, such as bleeding or infection. However, they provide some really essential information; i.e., the histology and grade of the tumor and other tumor characteristics necessary to determine the best choice of treatment. For lung cancer, for example, a biopsy determines the type of tumor—adenocarcinoma, squamous cancer, small-cell lung cancer, or another, less common type. For breast cancer, a routine test will determine if the tumor expresses estrogen, progesterone receptors, and a protein called HER2. These tests are critically important in guiding treatment choices. If mutational analysis of cancer-related genes is also performed (which doesn’t always happen, unfortunately), it may guide treatment with targeted drugs. Continue reading…


War of the Checkpoint Inhibitors: Anti-PD-1 Drugs Move into First-Line Treatment in NSCLC


Last year, the U.S. Food and Drug Administration (FDA) approved two anti-PD-1 checkpoint inhibitors, a type of immunotherapy, for treatment of non-small cell lung cancer (NSCLC) in patients whose cancer has progressed after first-line treatment with chemotherapy. Now, the manufacturers of both drugs, pembrolizumab (made by Merck) and nivolumab (made by Bristol-Myers Squibb; BMS) are intent on expanding the indications for use of their drugs. To this end, they have conducted clinical trials testing each as a first-line treatment (i.e., in previously untreated patients), comparing them to standard chemotherapy. Continue reading…


Super ASK Patient: Dyanne and Lars Push Far Beyond Standard Lung Cancer Treatment

In March of 2015, Dyanne Søraas was diagnosed with stage IV non-small cell lung cancer (NSCLC). She was 30 years old and otherwise healthy. Dyanne and her husband, Lars, began to research potential treatment options. Standard treatment seemed to provide little hope, and they gradually decided they would need to think outside the box in order to maximize the time their family would have together. Continue reading…


Lung Cancer Highlights from ASCO 2016


This year, the Annual Meeting of the American Society of Clinical Oncology (ASCO) did not produce any truly groundbreaking revelations about new treatments for lung cancer. However, researchers did report quite a few positive findings, and some disappointing ones. I have summarized some of the more prominent presentations below. Continue reading…


Super ASK Patient: Community Kindness Helps a Family Face Lung Cancer


Update:  We are deeply saddened to report that Michael passed away on July 20, 2016. It is a privilege to continue to share his story and keep his memory alive.

In October of 2014, Michael Hrabal’s wife Hazel urged him to go to the doctor for a small but persistent cough. The doctor prescribed cough medicine, but it didn’t help, and by the end of the month Michael had been diagnosed with stage IV non-small cell lung cancer.

“It was kind of shocking that this little cough turned out to be cancer,” says Michael, who was 57 years old at the time and living north of New York City with Hazel and their son Andrew. This was actually his second time facing cancer; he’d been treated for kidney cancer 15 years earlier, but had remained cancer-free until the new diagnosis. Continue reading…


Clinical Trial Versus Standard Protocol: Why and How to Enroll in a Trial


My job at Cancer Commons is to help cancer patients better understand and make decisions about their treatment. Through our Ask Cancer Commons service, I also strive to inform patients about new drugs in trials that they can discuss with their oncologists. Sometimes, I explain the rationale behind a patient’s current or upcoming treatment, and sometimes I try to convince patients to actually get treated, rather than hope that a vegetarian diet and herbal supplements will cure their metastatic disease. Continue reading…


New Insights on Lung Cancer in Younger Patients


Lung cancer in young people—in particular, non-small cell lung cancer (NSCLC)—is a topic of great interest. It has been made even more so by the recent publication of a study in The Journal of the American Medical Association (JAMA) that analyzed over 2,000 NSCLC patients of all ages and resulted in two major conclusions: First, that younger patients (less than 40 years old) have a higher frequency of targetable mutations. Second, that they have relatively poor survival when compared to older patients, except those older than 70 years. Continue reading…


Super Patient: Diane Milne Gives Other Cancer Patients the Tools that Helped Her Survive


June 14, 2014 started out like any other day for Diane Milne. But then, just before the two-hour Zumba exercise class she took almost every morning, she suddenly couldn’t breathe. “I had an overwhelming sense of doom,” recalls Diane, a 68-year-old retired nurse. “I was home alone and I thought I was going to die.” Continue reading…


New Promising Drugs for Small Cell Lung Cancer


Any type of advanced lung cancer is bad news, but a diagnosis of small cell lung cancer (SCLC) is a particularly grim one to receive. About 30 years have passed since any new treatments for SCLC were developed, and patients’ responses to standard chemotherapy with etoposide and cisplatin are short-lived. Hopefully, this will change soon.

We begin this post with the immune checkpoint inhibitors, a type of immunotherapy that is explored in seemingly every type of cancer, including SCLC. Reports from two clinical trials of these drugs were recently made available at two meetings on lung cancer treatment. Continue reading…