Introduction Progress in therapy for thoracic malignancies has been increasing dramatically in recent years. We have known for some time that chemotherapy improves survival and quality of life compared with best supportive care for advanced-stage disease. 1 Guidelines pub- lished by the American Society of Clinical Oncology (ASCO) and the American College of Chest Physicians endorse either a platinum or nonplatinum doublet as initial therapy for patients with good performance status (PS) with newly diagnosed advanced-stage non– small-cell lung cancer (NSCLC). 2,3 For early-stage NSCLC that has been resected, both ASCO and the National Comprehensive Cancer Network endorse cisplatin-based adjuvant chemotherapy for resect- ed stage II and IIIA NSCLC, with controversy surrounding therapy of stage I disease and the use of postoperative radiation therapy. 4-6 For advanced-stage disease, efforts to add a third drug to the standard 2-drug doublet regimens had not met with success until recent trials that have included bevacizumab and cetuximab, both antibodies targeted to pathways now known to be important in NSCLC. 7-9 These pathways include the vascular endothelial growth factor (VEGF) pathway critical for angiogenesis targeted by bevacizumab and the epidermal growth factor receptor (EGFR) pathway targeted by cetuximab. The benefit of the addition of bevacizumab to chemotherapy was first demonstrated by E4599, a phase III trial led by one of the large cooperative oncology research 1 Department of Medicine, Division of Oncology 2 Division of Radiation Oncology Stanford University Cancer Center, CA 3 Thoracic Surgery, City of Hope, Duarte, CA 4 Department of Thoracic Surgery, Vanderbilt University, Nashville, TN 5 Department of Medicine, Division of Oncology, University of Maryland Greenebaum Cancer Center, Baltimore 6 Section of Hematology/Oncology, University of Chicago Medical Center, IL 7 Department of Medicine, Division of Oncology, The University of Texas Southwestern Medical Center, Dallas 8 Department of Thoracic Oncology, Netherlands Cancer Institute, Amsterdam 9 Medical Oncology Division, National Cancer Center Hospital, Chiba, Japan 10 Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 11 Department of Medicine, The Ottawa Hospital Cancer Centre, Ontario, Canada 12 Department of Radiation, The University of Texas Southwestern Medical Center, Dallas 13 Division of Hematology and Oncology, University of California Davis Cancer Center, Sacramento Submitted: Sep 4, 2009; Revised: Sep 26, 2009; Accepted: Sep 28, 2009 Address for correspondence: Heather Wakelee, MD, Department of Medicine, Division of Oncology, Stanford Cancer Center, 875 Blake Wilbur Dr, Stanford, CA 94305-5826 Fax: 650-724-3697; e-mail: hwakelee@stanford.edu This article might include the discussion of investigational and/or unlabeled uses of drugs and/or devices that might not be approved by the FDA. Electronic forwarding or copying is a violation of US and international copyright laws. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by CIG Media Group, LP, ISSN #1525-7304, provided the appropriate fee is paid directly to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923 USA. www.copyright.com 978-750-8400. Clinical Lung Cancer November 2009 | 395 Abstract Cooperative Group Research Efforts in Thoracic Malignancies 2009: A Review From the 10th Annual International Lung Cancer Congress Heather Wakelee, 1 Bill W. Loo, Jr., 2 Kemp H. Kernstine, 3 Joe Bill Putnam, Jr., 4 Martin J. Edelman, 5 Everett E. Vokes, 6 Joan H. Schiller, 7 Paul Baas, 8 Nagahiro Saijo, 9 Alex Adjei, 10 Glenwood Goss, 11 Hak Choy, 12 David R. Gandara 13 Critical advances in the treatment of patients with lung cancer have occurred in the past few years. The cooperative groups in North America and internationally have played crucial roles in these advances. The leaders of the groups meet on a regular basis to review the progress of their trials. However, they rarely have a chance to discuss all ongoing and planned trials, except at the annual Lung Cancer Congress held each June. This article captures this exchange from the 10th Annual Lung Cancer Congress held in June 2009. Exciting efforts are ongoing for all stages of non– small-cell lung cancer, small-cell lung cancer, and mesothelioma. A major focus of the groups at this time is a push toward more personalized medicine, as reflected in the selection criteria for many of the trials, along with planned correlates to better define populations most likely to benefit. Agents targeting the vascular endothelial growth factor (VEGF) pathway, including many tyrosine kinase inhibitors against the VEGF receptor, and those targeting the epider- mal growth factor receptor pathway, are under extensive development with many combination trials ongoing. Clinical Lung Cancer, Vol. 10, No. 6, 395-404, 2009; DOI: 10.3816/CLC.2009.n.075 Keywords: Bevacizumab, Cediranib, Cetuximab, EGFR mutational status, Mesothelioma, Sunitinib, Vinorelbine Comprehensive Review