Treatment of patients with inoperable locally advanced non-small cell lung cancer (NSCLC), defined as lymph node-positive (N+) non-metastatic (M0), has improved tremendously since the first trial comparing radiation monotherapy (RTmono) to placebo [1]. Randomized trials established concurrent chemoradiation (CRT) as the standard of care for non-operable N + M0 NSCLC [2–4]. However, in practice patients are excluded from this regimen because of a poor performance status, limited social support system,...
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Antibodies targeting the programmed cell death-1 (PD-1)/programmed cell death ligand-1 (PD-L1) pathway have improved outcomes for patients with advanced non-small-cell lung cancer (NSCLC), and are now approved in several countries [1 –7]. As improved clinical outcomes with these antibodies are often associated with higher tumor PD-L1 expression levels in NSCLC [1,3,7,8], different PD-L1 expression cutoffs have been investigated in clinical trials and as part of the co-development of immunohistochemistry...
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In patients with non-small cell lung cancer (NSCLC), accurate mediastinal lymph node of staging becomes crucial to determine the prognosis of the disease and the choice of treatment (1). Computerized tomography (CT) and Positron Emission Tomography CT (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) are usually the initial non-invasive staging techniques, followed by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), a minimally invasive procedure with great diagnostic accuracy...
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Personalized, or precision, medicine has transformed medical oncology for lung cancer patients. Personalized medicine involves the molecular characterization of a patient ’s tumor by targeted next-generation sequencing (NGS) to direct treatment options that will provide the best outcome for the patient[1]. NGS sequencing for advanced lung cancer is now standard in clinics, and various commercial vendors provide clinical multiplexed NGS services. Clinical trials hav e shown the survival benefits of...
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Lung cancer is the leading cause of cancer-related deaths worldwide [1]. A significant proportion of patients with non-small cell lung cancer (NSCLC), particularly those with adenocarcinoma histology, carry EGFR mutations, with about 15% in Caucasian adenocarcinoma and 50% in Asian adenocarcinoma are EGFR mutants [1 –3]. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have been established as the standard therapy in the first-line treatment of advanced NSCLC with EGFR mutations....
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The importance of hospital volume on the impact of surgery in patients with lung cancer has been observed in several studies. Higher volumes appear to be protective with suggested benefits including the higher use of surgical resection, higher rates of surgery in older patients, improved surgical technique, shorter hospital length of stay, lower readmission rates, fewer perioperative complications and improved survival [1 –6]. Hence, the assessment of the impact of hospital volume on cancer outcomes...
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Systematic review of early and late survival in SCLCCauses of 30-day mortality following chemotherapy are exploredBetter survival following chemotherapy for Asian individuals with SCLCEarly thoracic radiotherapy and PCI augment survival for LD-SCLC but not ED-SCLC (Source: Lung Cancer)
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Non-small cell lung cancer (NSCLC) accounts for about 85% of all lung cancers [1], which are the leading cause of cancer-related morbidity and mortality worldwide [2]. With the use of Tyrosine kinase inhibitors (TKI) in NSCLC patients with epidermal growth factor receptor (EGFR) mutations, the survival of lung cancer patients with EGFR mutation has significantly improved [3]. However, 40% patients develop brain metastases (BM) during the disease and the risk of BM is higher in NSCLC patients with...
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Lung cancer is a leading cause of cancer-related death worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately 85 % of all cases of lung cancer. Among all cases of NSCLC, about two-thirds are already advanced and inoperable at the time of diagnosis. Concurrent chemoradiotherapy is the standard treatment for patients with unresectable locally advanced NSCLC. Chemotherapy at full systemic doses combined with thoracic radiotherapy (TRT) is employed to control the micro-metastases in...
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Driver oncogenic mutations in genes such as EGFR and ALK are currently considered important therapeutic targets in non-small cell lung cancer (NSCLC)[1,2]. Although driver-specific inhibitors have marked treatment effects on tumors with these driver alterations, tumors often develop resistance[3] and thus become difficult to treat. Recent research on immune-checkpoint inhibitor (ICI) immunotherapy has shed light on intractable cases, and ICI therapy has become one of the first-line treatment options...
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COPD and lung cancer incidence in the Women ’s Health Initiative Observational Study: A brief report
Lung cancer is the leading cause of cancer mortality in both men and women in the United States, with an estimated 154,050 deaths expected to occur in 2018 [1]. Cigarette smoking has been linked to the development of lung cancer and chronic obstructive pulmonary disease (COPD) [2] and COPD has been found to be independently associated with an increased risk of developing lung cancer. A pooled analysis of 17 epidemiologic studies reported a 2.4-fold increase in risk of lung cancer associated with...
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Lung cancer ranks among the most common cancers worldwide with approximately 1.8 million patients in 2012 [1,2]. Non small cell lung cancer (NSCLC) represents 75 –85% of all lung cancers. 2/3 of these patients are in non-curable stage III and IV at the time of diagnosis, and are usually treated systemically [3]. The current management of non-curable NSCLC has become more and more individualized and is based on immunohistochemical and molecular tumor charac terization [4]. In this context, EGFR mutation...
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The importance of hospital volume on the impact of surgery in patients with lung cancer has been observed in several studies. Higher volumes appear to be protective with suggested benefits including the higher use of surgical resection, higher rates of surgery in older patients, improved surgical technique, shorter hospital length of stay, lower readmission rates, fewer perioperative complications and improved survival (1 –6). Hence, the assessment of the impact of hospital volume on cancer outcomes...
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Neutropenia is a serious chemotherapy-induced hematologic toxicity in cancer patients. It is associated with both the risk of life-threatening infections and also chemotherapy dose reductions and delays that may compromise treatment outcomes [1]. In addition, studies have shown that health related quality of life is reduced in patients who develop neutropenia, especially those needing hospitalization [2,3]. Hence, it is important to try and estimate the risk of development of neutropenia in an attempt...
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Treatment of stage IV Non Small Cell Lung Cancer (NSCLC) is rapidly evolving. Systemic chemotherapy, targeted therapy or immunotherapy represent the standard of care, depending on both disease biology and patient ’s characteristics. Results in terms of progression free survival (PFS) and overall survival (OS) range between 3-13 months and 5-25 months, respectively. [1–12] (Source: Lung Cancer)
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The development of targeted therapies has revolutionized the treatment of patients with lung cancer, especially non-small-cell lung cancer (NSCLC). Anaplastic lymphoma kinase (ALK) is a research hotspot of molecular targeted therapy for lung cancer. ALK tyrosine kinase inhibitors (TKIs) are highly effective for ALK-rearranged NSCLC-positive patients. These targeted therapies have significant clinical effects; however, they inevitably lead to acquired resistance. In previous studies, the histological...
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Nivolumab is now a reference treatment for patients with advanced non-small cell lung cancer (NSCLC) after failure of prior platinum-based chemotherapy. Little data are available on treatment approaches following discontinuation of nivolumab and on the interest of a second course of immunotherapy after nivolumab discontinuation. The aims of this study were to describe treatment pathways following nivolumab discontinuation and to describe survival following retreatment with immunotherapy. (Source:...
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Systemic chemotherapy remains the mainstay of treatment for patients with unresectable malignant pleural mesothelioma (MPM). In 2003, the EMPHACIS trial established cisplatin and pemetrexed as the standard of care for first-line treatment of advanced mesothelioma [1]. More recently, the MAPS trial provided the first randomised demonstration of efficacy of a targeted therapy in mesothelioma, with the addition of bevacizumab to cisplatin and pemetrexed chemotherapy providing a small incremental survival...
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The presence of epidermal growth factor receptor (EGFR) sensitizing mutations predicts suitability for first line EGFR tyrosine kinase inhibitor (TKI) treatment in non-small cell lung cancer (NSCLC). [1 –8] The recommended source for detection of EGFR mutations is a tumour biopsy, but mutations detected in circulating tumour DNA (ctDNA) in the bloodstream can also be used for patient selection [9]. Several methods, with various benefits and disadvantages, exist for the detection of ctDNA [10,11]....
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Insight into the therapeutic results of checkpoint inhibitors are obtained from randomized trials and careful observations in population studies [1 –4] Phase III studies answer specific questions in selected patient groups with strict inclusion criteria. Patients participating in trials may show favorable outcome compared to patients not participating because of selection bias. When medical practice evolves, physicians will have a broader sel ection scope of patients and new questions will emerge...
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