Clinical lung cancer最新文献

Introduction: Despite curative surgery for lung cancer, 30% to 55% of patients experience recurrence or death, which highlights the importance of adjuvant treatment. Adjuvant osimertinib therapy effectively prolongs disease-free and overall survival in patients with lung cancer harboring common epidermal growth factor receptor (EGFR) mutations. To identify potential candidates for adjuvant osimertinib, it is crucial to understand the rates and identify risk factors of recurrence.

Methods: This multicenter, retrospective cohort study was conducted in the Republic of Korea and enrolled patients who, between 2010 and 2017, underwent resection of stages I-III adenocarcinomas, with common EGFR mutations. The primary outcomes comprised the rate and risk factors of postoperative recurrence.

Results: Among the 759 participants, the overall recurrence rate and median recurrence-free survival were 39.1% and 59.8 (interquartile range [IQR], 26.3-84.2) months, respectively, during a median follow-up of 73.0 (IQR, 55.4-95.0) months. The recurrence rates for stages IA, IB, IIA, IIB, IIIA, and IIIB were 14.7%, 45.5%, 53.8%, 72.5%, 80.3%, and 93.3%, respectively. Multivariate analysis revealed that age ≥ 65 years, body mass index < 18.5 kg/m², the Del19 subtype of EGFR mutation, tumor size ≥ 2.3 cm, N1 involvement, N2 involvement, predominantly micropapillary or solid pattern, and the presence of visceral pleural invasion were independently associated with recurrence.

Conclusion: This multicenter cohort study demonstrated that stages I-III EGFR-mutated adenocarcinoma has a postoperative recurrence rate of 39.1%, and identified 7 independent risk factors for recurrence.

Background: Pembrolizumab alone is a first-line therapeutic option for patients with metastatic non-small cell lung cancer (NSCLC) with ≥ 50% PD-L1 expression, but few data are available for elderly patients, specifically octogenarians.

Methods: This retrospective, multicenter study included all consecutive patients with metastatic NSCLC PD-L1 ≥ 50% treated with first-line pembrolizumab monotherapy between May 2017 and November 2019. Information was collected from medical files with local evaluation of therapeutic response and progression-free survival (PFS).

Results: Among the 844 patients included, 73 (8.4%) were ≥ 80 (median: 82) years old, 74% men, 23.3% with ECOG-PS ≥ 2, 26% had ≥ 5% weight loss, PD-L1 50%-75%/≥ 75%: 45.2%/46.6%, respectively, with significantly more nonsmokers and (17.4% vs. 5.6%, P = .0002) and fewer adenocarcinomas (57.5% vs. 70.8%, P = .0217) than those < 80 years. After median follow-up of 45.7 (95% CI: 43.0-49.1) months, respective median overall survival (OS) for octogenarians versus younger patients lasted 12.0 (95% CI: 7.7-16.2) versus 23.9 (95% CI: 19.5-27.4) months (P = .0002), and median PFS for 5.0 (95% CI: 2.8-9.2) versus 8.3 (95% CI: 7.2-9.8) months (P = .039). Their respective objective response rates did not differ significantly: 42% (95% CI: 24-60) vs. 49% (95% CI: 43-54).

Conclusions: Based on the results of this large multicenter population, first-line pembrolizumab efficacy against NSCLCs expressing ≥ 50% PD-L1 in octogenarians seems inferior to that obtained in younger patients. The higher percentage of nonsmokers and fewer adenocarcinomas could partially explain that finding.

Small cell lung cancer (SCLC) is a highly aggressive malignancy and an exceptionally lethal disease; most patients present with extensive stage (ES) disease at diagnosis. Very little had changed in the treatment of ES-SCLC for decades until immune checkpoint inhibitor (ICI) therapy combined with chemotherapy followed by ICI maintenance monotherapy was added to standard treatment paradigms in 2019. Despite this important advance, high rates of relapse are still observed in patients with ES-SCLC and long-term survival rates remain low, with approximately 40% of patients proceeding to receive second-line treatment. There is an urgent need for novel treatment strategies to improve patient outcomes. In this review, we describe the rationale for maintenance therapy approaches in ES-SCLC and summarize the existing data on chemotherapy, ICIs, and other agents in the first-line maintenance setting. Predictive biomarkers, SCLC subtypes, and new therapeutics in development are discussed including lurbinectedin, antibody-drug conjugates, and T-cell engager molecules.

Background: Lung cancer (LC) is traditionally perceived as a disease primarily affecting the elderly. However, individuals under the age of 40 represent a rare subset, accounting for up to 6% of all LC cases. There is limited information about demographic, clinical, pathological, and molecular features and treatment outcomes of young-onset LC.

Methods: In this study, we have analyzed the clinical, pathological, molecular, treatment, and survival outcome data of non-small-cell lung cancer patients δ 40 years of age treated at a tertiary care center in India. Additionally, we compared the in-house genomic data of young-onset LC and late-onset LC tested on a common targeted next-generation sequencing (NGS) panel.

Results: A total of 133 patients were included, with a median age of 36 years (21-40 years). Females constituted 40.6% of total, and 79% were never smokers. Adenocarcinoma was the most common histology (85.7%), and oncogene fusions were common (ALK fusion in 34% and ROS1 in 7%). After a median follow-up of 39.2 months (95% CI 20.3-49.86), median overall survival was 26 months (95% CI 15.56-32.43) and median progression-free survival (of patients with stage 4 disease) was 6.53 months (95% CI 5.03-8.4). In-house NGS data reveals a striking enrichment of fusions (ALK and RET) in young-onset LC.

Conclusion: Young-onset LC is a unique entity with a higher prevalence of targetable genomic alterations, especially oncogene fusions. All efforts should be made to identify the targetable alterations in this enriched population and implement targeted therapy.

Background: Definitive concurrent chemoradiotherapy (CRT) is the primary curative-intent treatment option for unresectable locally advanced nonsmall-cell lung cancer (NSCLC). Completion of CRT is generally required for eligibility for consolidation durvalumab, which significantly improves survival. We sought to establish CRT completion rates at a comprehensive cancer center.

Patients and methods: 265 patients were treated with concurrent CRT over the decade 2012-2022, during which durvalumab became available. 63% were male, median age was 67, and 91% had performance status 0-1. All patients were recruited into the AURORA prospective cohort study which captured baseline demographics and comorbidities, and prospectively updated treatment and outcome data at subsequent hospital visits. Data were analyzed retrospectively to evaluate CRT completion rates, reasons for noncompletion, and survival outcomes. Survival was also analyzed based on durvalumab availability and administration.

Results: CRT was completed as planned by 246/265 (93%) patients. Reasons for noncompletion included treatment related toxicity (n = 6/19), unrelated illnesses (n = 7/19), local disease progression (n = 2/19), and distant progression (n = 4/19). Median overall survival (OS) was 2.2 years (95% CI, 1.7-2.8) for the entire cohort and 1.0 years (95% CI, 0.2-1.5) for those who ceased CRT early. No specific baseline characteristics predicted noncompletion of CRT. Consolidation durvalumab was associated with improved OS (HR 0.39; 95% CI, 0.21-0.72, P = .002).

Conclusion: With appropriate supportive care, most patients initially considered suitable for CRT could complete it and access consolidation durvalumab. Consolidation durvalumab was associated with improved survival in this "real-world" stage III NSCLC cohort.

Purpose: This study aimed to investigate the risk factors for severe radiation pneumonitis (RP) after thoracic radiotherapy (RT) in patients with locally advanced non-small cell lung cancer (NSCLC), develop a prediction model to identify high-risk groups, and investigate the impact of severe RP on overall survival (OS).

Methods: We retrospectively collected clinical, dosimetric, and hematological factors of patients with stage III NSCLC receiving thoracic RT without immunotherapy. The primary and secondary end points were severe RP and OS, respectively. Fine-Gray competing risk regression analyses were used to identify the risk factors for severe RP. The patients were randomly divided into training and validation cohorts at a ratio of 6:4. The model was evaluated using receiver operating characteristic (ROC) and calibration curves, and decision curve analysis (DCA). The OS of patients in the RP vs. non-RP and mild RP vs. severe RP groups was analyzed using the Kaplan-Meier method.

Results: A total of 305 patients were enrolled in the analysis, and 32 (10.5%) developed severe RP. Interstitial lung disease (ILD) (P = .013), percentage of ipsilateral lung volume receiving ≥ 20 Gy (ipsilateral V₂₀) (P = .029), pre-RT derived neutrophil lymphocyte ratio (dNLR) (P = .026), and post-RT systemic inflammation response index (SIRI) (P = .010) were independent predictors of severe RP, and were used to establish the nomogram based on a training cohort. The ROC area under the curve (AUC) of the nomogram was 0.804. Calibration curves and DCA showed favorable consistency and positive net benefits in both training and validation cohorts. Cases who developed severe RP had a shorter OS than those who developed mild RP (P = .027).

Conclusion: ILD, ipsilateral V₂₀, pre-RT dNLR, and post-RT SIRI could predict severe RP in patients with locally advanced NSCLC receiving thoracic RT. By combining these indicators, a nomogram was constructed and validated, demonstrating its potential value in clinical practice.

Background: Black patients present with non-small-cell lung cancer (NSCLC) at younger ages, and Black race is a poor prognostic factor. We aimed to identify specific socioeconomic factors that may contribute to these disparities.

Methods: The National Cancer Database (NCDB) was queried for NSCLC cases (2000-2020). Patients were grouped into 3 categories: 18 to 44(A), 45 to 49(B) and 50 to 90 years(C). Demographics, tumor characteristics, survival, insurance status, distance from the treating hospital, median household income, and proportion of residents without a high school diploma (HSD) were compared.

Results: There were 1,703,062 patients, 77,107 of whom were under 50-years-old. Compared to White patients, more Black patients in A and B presented at stage IV (A: 39.7% vs. 35%; B: 40.9% vs. 35%), had higher 90-day mortality (A: 2.7% vs. 2.2%; B: 4% vs. 2.7%) and were uninsured (A: 14.2% vs. 9.6%; B: 14.8% vs. 10.2%). Additionally, more Black patients in A (38.2% vs. 18.2%) and B (42% vs. 18%) were from regions with fewer high school graduates and where the median income was in the lowest quartile (A: 45.2% vs. 18.3%; B: 48.8% vs. 19.4%). Black patients lived closer to treating hospitals and were more often seen at academic centers. Despite this, Black patients under 50 years presented more frequently with stage IV disease and were commonly from disadvantaged settings compared to White patients.

Conclusions: Interventions on social determinants such as education and income might address some of the disparities surrounding NSCLC in young Black patients.