Clinical lung cancer最新文献_第10页

Clinical Outcomes of Patients With Advanced ALK-Rearranged Lung Squamous Cell Carcinoma Treated With ALK Tyrosine Kinase Inhibitors ALK酪氨酸激酶抑制剂治疗晚期ALK重排肺鳞状细胞癌的临床疗效

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-07-19 DOI: 10.1016/j.cllc.2025.07.011

Yuanze Sun , Dan Yang , Zhe Huang , Huan Yan , Liang Zeng , Qinqin Xu , Lianxi Song , Chunhua Zhou , Ling Peng , Jiwen Xiao , Shaoding Lin , Zhiqing Zhou , Siqi Xiang , Zhaohui Ruan , Nong Yang , Yongchang Zhang

Background

DNA-based next-generation sequencing (NGS) has identified ALK rearrangements in lung squamous cell carcinoma (LUSC), a subset of nonsmall cell lung cancer traditionally lacking effective targeted therapies. While ALK tyrosine kinase inhibitors (TKIs) like crizotinib and alectinib are effective in ALK-rearranged lung adenocarcinoma, their efficacy in LUSC remains poorly defined due to limited subtype-specific data.

Methods

We presented a case of ALK-rearranged LUSC and established a patient-derived xenograft (PDX) model to validate the tumor-inhibitory effects of various ALK-TKIs on ALK-positive LUSC. Additionally, we conducted a retrospective study that included 28 patients diagnosed with stage IIIC-IV LUSC who received treatment at Hunan Cancer Hospital between June 2014 and May 2024 to evaluate the clinical characteristics and therapeutic outcomes of ALK-rearranged LUSC in a real-world cohort.

Results

We report a patient with LUSC harboring a novel CSNK1G3-ALK fusion, who demonstrated treatment response and durable disease control with first-line alectinib for over 30 months. PDX-based in vivo studies demonstrated significant tumor shrinkage with crizotinib, alectinib, and lorlatinib compared to vehicle control. In the retrospective cohort (n = 28), first-line ALK-TKI treatment was associated with improved progression-free survival (median PFS: 16.0 months vs. 3.0 months, P < .01), overall survival (median OS: 30.0 months vs. 18.5 months, P = .039), and objective response rates (ORR: 75% vs. 25%, P = .021), compared to first-line chemotherapy.

Conclusions

This study provides real-world evidence supporting the therapeutic benefit of ALK-TKIs in ALK-rearranged LUSC, highlighting their potential as a viable therapeutic strategy for this rare nonsmall cell lung cancer subtype.

背景：基于dna的新一代测序（NGS）已经在肺鳞状细胞癌（LUSC）中发现了ALK重排，LUSC是传统上缺乏有效靶向治疗的非小细胞肺癌的一个亚群。虽然ALK酪氨酸激酶抑制剂（TKIs）如克里唑替尼和阿勒替尼对ALK重排肺腺癌有效，但由于亚型特异性数据有限，它们对LUSC的疗效仍不明确。方法：我们提出了一例alk重排LUSC，并建立了患者来源的异种移植（PDX）模型，以验证各种ALK-TKIs对alk阳性LUSC的肿瘤抑制作用。此外，我们进行了一项回顾性研究，纳入了2014年6月至2024年5月在湖南省肿瘤医院接受治疗的28例IIIC-IV期LUSC患者，以评估真实世界队列中alk重排LUSC的临床特征和治疗结果。结果：我们报告了一名具有新型CSNK1G3-ALK融合的LUSC患者，该患者在一线alectinib治疗反应和持久的疾病控制超过30个月。基于pdx的体内研究表明，与对照相比，克唑替尼、阿勒替尼和氯拉替尼的肿瘤缩小显著。在回顾性队列（n = 28）中，与一线化疗相比，一线ALK-TKI治疗改善了无进展生存期（中位PFS: 16.0个月vs. 3.0个月，P < 0.01）、总生存期（中位OS: 30.0个月vs. 18.5个月，P = 0.039）和客观缓解率（ORR: 75% vs. 25%, P = 0.021）。结论：本研究提供了真实世界的证据，支持ALK-TKIs在alk重排LUSC中的治疗益处，突出了它们作为这种罕见的非小细胞肺癌亚型的可行治疗策略的潜力。

{"title":"Clinical Outcomes of Patients With Advanced ALK-Rearranged Lung Squamous Cell Carcinoma Treated With ALK Tyrosine Kinase Inhibitors","authors":"Yuanze Sun , Dan Yang , Zhe Huang , Huan Yan , Liang Zeng , Qinqin Xu , Lianxi Song , Chunhua Zhou , Ling Peng , Jiwen Xiao , Shaoding Lin , Zhiqing Zhou , Siqi Xiang , Zhaohui Ruan , Nong Yang , Yongchang Zhang","doi":"10.1016/j.cllc.2025.07.011","DOIUrl":"10.1016/j.cllc.2025.07.011","url":null,"abstract":"<div><h3>Background</h3><div>DNA-based next-generation sequencing (NGS) has identified <em>ALK</em> rearrangements in lung squamous cell carcinoma (LUSC), a subset of nonsmall cell lung cancer traditionally lacking effective targeted therapies. While ALK tyrosine kinase inhibitors (TKIs) like crizotinib and alectinib are effective in <em>ALK</em>-rearranged lung adenocarcinoma, their efficacy in LUSC remains poorly defined due to limited subtype-specific data.</div></div><div><h3>Methods</h3><div>We presented a case of <em>ALK</em>-rearranged LUSC and established a patient-derived xenograft (PDX) model to validate the tumor-inhibitory effects of various ALK-TKIs on ALK-positive LUSC. Additionally, we conducted a retrospective study that included 28 patients diagnosed with stage IIIC-IV LUSC who received treatment at Hunan Cancer Hospital between June 2014 and May 2024 to evaluate the clinical characteristics and therapeutic outcomes of <em>ALK</em>-rearranged LUSC in a real-world cohort.</div></div><div><h3>Results</h3><div>We report a patient with LUSC harboring a novel <em>CSNK1G3-ALK</em> fusion, who demonstrated treatment response and durable disease control with first-line alectinib for over 30 months. PDX-based <em>in vivo</em> studies demonstrated significant tumor shrinkage with crizotinib, alectinib, and lorlatinib compared to vehicle control. In the retrospective cohort (<em>n</em> = 28), first-line ALK-TKI treatment was associated with improved progression-free survival (median PFS: 16.0 months vs. 3.0 months, <em>P</em> < .01), overall survival (median OS: 30.0 months vs. 18.5 months, <em>P</em> = .039), and objective response rates (ORR: 75% vs. 25%, <em>P</em> = .021), compared to first-line chemotherapy.</div></div><div><h3>Conclusions</h3><div>This study provides real-world evidence supporting the therapeutic benefit of ALK-TKIs in <em>ALK</em>-rearranged LUSC, highlighting their potential as a viable therapeutic strategy for this rare nonsmall cell lung cancer subtype.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 8","pages":"Pages 617-625.e6"},"PeriodicalIF":3.3,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144811893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

First-Line Osimertinib in a Patient Having NSCLC With a Rare Duplication Mutation in the EGFR Exon 19 Region (NM_005228.5:c.2214_2231dup p.(Ile740_Lys745dup)) 一线奥西替尼治疗EGFR外显子19区罕见重复突变的非小细胞肺癌（NM_005228.5:c）2214 _2231dup p。(Ile740_Lys745dup))。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-07-18 DOI: 10.1016/j.cllc.2025.07.013

Mikel Portu , Sergio Martinez-Recio , Andres Barba , Alan Gonzalez , Laura López , Lluis Catasús , Margarita Majem

•
EGFR Mutation Subtyping:○ While exon 19 deletions and L858R mutations dominate, uncommon EGFR variants (∼ 15%) like exon 19 duplications can show distinct responses to TKIs.○ Accurate NGS-based molecular profiling is essential to detect these rare variants.
•
Osimertinib is active in patients EGFR Exon 19 Region (NM_005228.5:c.2214_2231dup p.(Ile740_Lys745dup)):○ This finding aligns with 2 previously reported cases showing early favorable responses.
•
Need for Expanded Real-World Data:○ Due to their extreme rarity, these mutations are unlikely to be studied in large RCTs.
•
Clinical Monitoring and Management:○ The patient experienced only mild toxicity (grade 1 rash), managed conservatively—indicating a favorable tolerability profile even in older patients.

•EGFR突变亚型：虽然外显子19缺失和L858R突变占主导地位，但不常见的EGFR变异（约15%）如外显子19重复可以对TKIs表现出不同的反应。〇准确的基于ngs的分子分析是检测这些罕见变异的关键。•奥西替尼在患者EGFR外显子19区有活性（NM_005228.5:c）。这一发现与先前报道的2例早期良好反应的病例一致。•扩大真实世界数据的需求：〇由于这些突变极其罕见，不太可能在大型随机对照试验中进行研究。•临床监测和管理：〇患者仅出现轻度毒性（1级皮疹），保守管理-表明即使在老年患者中也具有良好的耐受性。

{"title":"First-Line Osimertinib in a Patient Having NSCLC With a Rare Duplication Mutation in the EGFR Exon 19 Region (NM_005228.5:c.2214_2231dup p.(Ile740_Lys745dup))","authors":"Mikel Portu , Sergio Martinez-Recio , Andres Barba , Alan Gonzalez , Laura López , Lluis Catasús , Margarita Majem","doi":"10.1016/j.cllc.2025.07.013","DOIUrl":"10.1016/j.cllc.2025.07.013","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>EGFR Mutation Subtyping:○ While exon 19 deletions and L858R mutations dominate, <em>uncommon EGFR variants</em> (∼ 15%) like exon 19 duplications can show distinct responses to TKIs.○ Accurate NGS-based molecular profiling is essential to detect these rare variants.</div></span></li><li><span>•</span><span><div>Osimertinib is active in patients EGFR Exon 19 Region (NM_005228.5:c.2214_2231dup p.(Ile740_Lys745dup)):○ This finding aligns with 2 previously reported cases showing early favorable responses.</div></span></li><li><span>•</span><span><div>Need for Expanded Real-World Data:○ Due to their extreme rarity, these mutations are unlikely to be studied in large RCTs.</div></span></li><li><span>•</span><span><div>Clinical Monitoring and Management:○ The patient experienced only mild toxicity (grade 1 rash), managed conservatively—indicating a favorable tolerability profile even in older patients.</div></span></li></ul></div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e620-e622"},"PeriodicalIF":3.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144798366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Coexistence of a Novel BABAM2-ALK and EML4-ALK Double-Fusion in a Lung Adenocarcinoma Patient and Response to Alectinib: The First Case Report 一种新的BABAM2-ALK和EML4-ALK双融合在肺腺癌患者中的共存和对阿勒替尼的反应：第一例报告

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-07-18 DOI: 10.1016/j.cllc.2025.07.012

MingHui Lin , XuYu Chen , Fan Lin , YanBo Yang

•
First reported case of NSCLC with a novel dual ALK fusion (BABAM2-ALK and EML4-ALK).
•
Exceptional sensitivity to first-line alectinib, achieving significant tumor regression and pathological response.
•
Comprehensive genomic profiling identified the dual fusion, emphasizing its role in guiding personalized therapy.
•
Postoperative pathological assessment confirmed complete response in lymph nodes and residual tumor in the primary lesion.

•首次报道新型双ALK融合（BABAM2-ALK和EML4-ALK）的非小细胞肺癌病例。•对一线alectinib异常敏感，实现显著的肿瘤消退和病理反应。•全面的基因组分析确定了双重融合，强调其在指导个性化治疗中的作用。•术后病理评估证实淋巴结完全缓解，原发病变残存肿瘤。

引用次数: 0

Real World Effectiveness of Durvalumab in Stage III Unresectable Non-small Cell Lung Cancer: What is the Role of PD-L1 Expression? 杜伐单抗在III期不可切除非小细胞肺癌中的实际疗效：PD-L1表达的作用是什么？

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-07-17 DOI: 10.1016/j.cllc.2025.07.009

Hanieh Abedian Kalkhoran , Marjon V. Verschueren , Bas J.M. Peters , Ewoudt M.W. van de Garde , Egbert F. Smit , Stefan Bohringer , Danielle Cohen , Judith L. Gulikers , Henk Codrington , Henk-Jan Guchelaar , Loes E. Visser , Juliëtte Zwaveling

Purpose

Although the European Medicines Agency approved durvalumab post-chemoradiation (CRT) only for stage III unresectable non-small cell lung cancer (UR-NSCLC) patients with PD-L1 tumor proportion scores (TPS) ≥ 1%, the Netherlands offers reimbursement irrespective of PD-L1 status. This real-world study compares survival between durvalumab-treated patients with PD-L1 TPS < 1% vs. ≥ 1%, and also evaluates its effectiveness against a historic-cohort.

Patients and Methods

This multicenter retrospective study included 2 patient cohorts with stage III UR-NSCLC: a durvalumab cohort and a historic CRT-only cohort. The durvalumab cohort was divided into PD-L1 TPS subgroups: < 1%, ≥ 1%, and unknown. Overall survival (OS) and progression-free survival (PFS) were compared between (1) durvalumab-treated patients with PD-L1 TPS < 1% vs. ≥ 1%, and (2) durvalumab cohort (including PD-L1 subgroups) vs. historic-cohort.

Results

229 and 339 patients were included in the durvalumab- and historic-cohorts, respectively. Although not statistically significant, durvalumab-treated patients with PD-L1 TPS ≥ 1% experienced a modestly greater benefit in OS (2-year OS 74.3% vs. 66.5%) and PFS (2-year PFS 55.5% vs. 36.2%) compared to those with PD-L1 TPS < 1%. Survival outcomes favored durvalumab over the historic cohort across PD-L1 subgroups, though PFS improvement was not statistically significant for PD-L1 TPS < 1%.

Conclusions

Given these findings, patients with PD-L1 TPS < 1% may also benefit from durvalumab treatment in stage III UR-NSCLC.

目的：尽管欧洲药品管理局批准durvalumab放化疗后（CRT）仅用于PD-L1肿瘤比例评分(TPS)≥1%的III期不可切除非小细胞肺癌（UR-NSCLC）患者，但荷兰提供报销，无论PD-L1状态如何。这项现实世界的研究比较了durvalumab治疗PD-L1 TPS < 1%和≥1%的患者的生存率，并评估了其对历史队列的有效性。患者和方法：这项多中心回顾性研究包括2个III期UR-NSCLC患者队列：durvalumab队列和历史上仅使用crt的队列。durvalumab队列分为PD-L1 TPS亚组：< 1%，≥1%和未知。比较(1)杜伐单抗治疗的PD-L1 TPS < 1%和≥1%的患者的总生存期（OS）和无进展生存期（PFS），以及(2)杜伐单抗队列（包括PD-L1亚组）和历史队列。结果：durvalumab组和病史组分别纳入229和339例患者。虽然没有统计学意义，但与PD-L1 TPS < 1%的患者相比，durvalumab治疗的PD-L1 TPS≥1%的患者在OS（2年OS 74.3% vs. 66.5%）和PFS（2年PFS 55.5% vs. 36.2%）方面的获益略有增加。在PD-L1亚组中，durvalumab的生存结果优于历史队列，尽管PD-L1 TPS < 1%时PFS改善无统计学意义。结论：鉴于这些发现，PD-L1 TPS < 1%的III期UR-NSCLC患者也可能受益于durvalumab治疗。

{"title":"Real World Effectiveness of Durvalumab in Stage III Unresectable Non-small Cell Lung Cancer: What is the Role of PD-L1 Expression?","authors":"Hanieh Abedian Kalkhoran , Marjon V. Verschueren , Bas J.M. Peters , Ewoudt M.W. van de Garde , Egbert F. Smit , Stefan Bohringer , Danielle Cohen , Judith L. Gulikers , Henk Codrington , Henk-Jan Guchelaar , Loes E. Visser , Juliëtte Zwaveling","doi":"10.1016/j.cllc.2025.07.009","DOIUrl":"10.1016/j.cllc.2025.07.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Although the European Medicines Agency approved durvalumab post-chemoradiation (CRT) only for stage III unresectable non-small cell lung cancer (UR-NSCLC) patients with PD-L1 tumor proportion scores (TPS) ≥ 1%, the Netherlands offers reimbursement irrespective of PD-L1 status. This real-world study compares survival between durvalumab-treated patients with PD-L1 TPS < 1% vs. ≥ 1%, and also evaluates its effectiveness against a historic-cohort.</div></div><div><h3>Patients and Methods</h3><div>This multicenter retrospective study included 2 patient cohorts with stage III UR-NSCLC: a durvalumab cohort and a historic CRT-only cohort. The durvalumab cohort was divided into PD-L1 TPS subgroups: < 1%, ≥ 1%, and unknown. Overall survival (OS) and progression-free survival (PFS) were compared between (<span><span>1</span></span>) durvalumab-treated patients with PD-L1 TPS < 1% vs. ≥ 1%, and (<span><span>2</span></span>) durvalumab cohort (including PD-L1 subgroups) vs. historic-cohort.</div></div><div><h3>Results</h3><div>229 and 339 patients were included in the durvalumab- and historic-cohorts, respectively. Although not statistically significant, durvalumab-treated patients with PD-L1 TPS ≥ 1% experienced a modestly greater benefit in OS (2-year OS 74.3% vs. 66.5%) and PFS (2-year PFS 55.5% vs. 36.2%) compared to those with PD-L1 TPS < 1%. Survival outcomes favored durvalumab over the historic cohort across PD-L1 subgroups, though PFS improvement was not statistically significant for PD-L1 TPS < 1%.</div></div><div><h3>Conclusions</h3><div>Given these findings, patients with PD-L1 TPS < 1% may also benefit from durvalumab treatment in stage III UR-NSCLC.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e599-e608.e2"},"PeriodicalIF":3.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144793641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

AFSOS-SFRO Guidelines on Radiation-Induced Lung Injury AFSOS-SFRO放射性肺损伤指南。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-07-17 DOI: 10.1016/j.cllc.2025.07.008

O. Cravereau MD , V. Bourbonne , L. Vaugier , F. Lucia , F. Le Tinier , J. Cadranel , B. Duchemann , P. Habert , N. Martz , W. Gehin , M. Bruand , A. Stefani , J. Marcel , I. Trampetti , C. Clement-Duchene , D. Lerouge , A. Laville , K. Cao , N. Pourel , A. Zaccariotto , JC. Faivre

Radiation-induced lung injury (RILI) remains a significant complication of thoracic radiotherapy, with clinical presentations ranging from asymptomatic radiological changes to life-threatening pneumonitis and long-term fibrosis. Given the increasing use of thoracic irradiation and the growing complexity of combined modality treatments, including immunotherapy, a multidisciplinary and standardized approach to the clinical management of RILI is essential. This article presents expert recommendations jointly developed by the French Society of Radiation Oncology (SFRO) and the French Association for Supportive Care in Oncology (AFSOS), with the aim of guiding clinicians in the diagnosis, grading, and supportive management of RILI. Key topics addressed include clinical risk factors, differential diagnosis, therapeutic strategies based on toxicity grade, the role of corticosteroids and supportive treatments, follow-up recommendations, and preventive measures. These consensus guidelines are intended to improve the quality and consistency of care for patients at risk of or experiencing RILI.

放射性肺损伤（RILI）仍然是胸部放疗的一个重要并发症，其临床表现从无症状的放射学改变到危及生命的肺炎和长期纤维化。鉴于越来越多地使用胸部放射治疗和包括免疫治疗在内的联合治疗方式日益复杂，对RILI的临床管理采取多学科和标准化的方法至关重要。本文提出了由法国放射肿瘤学会（SFRO）和法国肿瘤支持护理协会（AFSOS）联合制定的专家建议，旨在指导临床医生对RILI的诊断、分级和支持管理。主要议题包括临床危险因素、鉴别诊断、基于毒性等级的治疗策略、皮质类固醇的作用和支持性治疗、随访建议和预防措施。这些共识指南的目的是提高对有RILI风险或正在经历RILI的患者的护理质量和一致性。

{"title":"AFSOS-SFRO Guidelines on Radiation-Induced Lung Injury","authors":"O. Cravereau MD , V. Bourbonne , L. Vaugier , F. Lucia , F. Le Tinier , J. Cadranel , B. Duchemann , P. Habert , N. Martz , W. Gehin , M. Bruand , A. Stefani , J. Marcel , I. Trampetti , C. Clement-Duchene , D. Lerouge , A. Laville , K. Cao , N. Pourel , A. Zaccariotto , JC. Faivre","doi":"10.1016/j.cllc.2025.07.008","DOIUrl":"10.1016/j.cllc.2025.07.008","url":null,"abstract":"<div><div>Radiation-induced lung injury (RILI) remains a significant complication of thoracic radiotherapy, with clinical presentations ranging from asymptomatic radiological changes to life-threatening pneumonitis and long-term fibrosis. Given the increasing use of thoracic irradiation and the growing complexity of combined modality treatments, including immunotherapy, a multidisciplinary and standardized approach to the clinical management of RILI is essential. This article presents expert recommendations jointly developed by the French Society of Radiation Oncology (SFRO) and the French Association for Supportive Care in Oncology (AFSOS), with the aim of guiding clinicians in the diagnosis, grading, and supportive management of RILI. Key topics addressed include clinical risk factors, differential diagnosis, therapeutic strategies based on toxicity grade, the role of corticosteroids and supportive treatments, follow-up recommendations, and preventive measures. These consensus guidelines are intended to improve the quality and consistency of care for patients at risk of or experiencing RILI.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages 527-540"},"PeriodicalIF":3.3,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Rationale and Design of the AUSTRAL trial: An Open-Label, Multicenter, Phase II Study Evaluating Radiotherapy Followed by Durvalumab (MEDI4736) and Ceralasertib (AZD6738) in Stage III NSCLC Patients With Thoracic Relapses and/or Oligometastases After the PACIFIC Regimen AUSTRAL试验的基本原理和设计：一项开放标签，多中心，II期研究，评估放疗后Durvalumab （MEDI4736）和Ceralasertib （AZD6738）治疗太平洋方案后胸部复发和/或寡转移的III期NSCLC患者。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-07-12 DOI: 10.1016/j.cllc.2025.07.006

Andrea Riccardo Filippi , Eliana Rulli , Diego Signorelli , Jonas Willmann , Andrè Durham , Irene De Simone , Anna Santoni , Francesca Galli , Luciano Carlucci , Valter Torri , Giuseppe Lo Russo , Alfredo Addeo , Matthias Guckenberger

Non–small-cell lung cancer (NSCLC) is a leading cause of death for cancer worldwide. Standard treatment for patients for whom surgical resection is not feasible is concurrent (PACIFIC regimen) or sequential (PACIFIC-like regimen) chemoradiotherapy with platinum-based doublet chemotherapy followed by durvalumab maintenance. The progression-free survival (PFS) rate after the PACIFIC regimen was 55.3% at 12 months, with the primary site of recurrence being intrathoracic. In retrospective studies, a relevant proportion of patients presented a combination of intrathoracic failure and limited extra-thoracic metastatic disease. For patients with local progression only, or with loco-regional progression and limited metastatic burden, the use of chemotherapy or other agents without the addition of a local therapy may represent a missed opportunity for a second curative intent treatment approach. The AUSTRAL trial, a phase II, interventional, multicenter, single-arm, study (ClinicalTrials.gov identifier, NCT06680050) aims to investigate the combination of thoracic irradiation ± Stereotactic Body Radiation Therapy (SBRT) to oligometastatic sites followed, after 2 to 4 weeks, by durvalumab and ceralasertib, administered until progression or severe toxicity. The study population will include 21 stage III NSCLC patients with loco-regional relapse after >12 months from the end of CRT ± ≤3 metastatic lesions following PACIFIC/PACIFIC-like regimens. The study will last approximately 40 months and involve 7 Italian and 2 Swiss sites. Primary hierarchical endpoints are safety, assessed by the continuous toxicity monitoring approach, and efficacy, assessed by PFS. Secondary endpoints are objective response rate (ORR), 6- and 12-month PFS and OS rate.

非小细胞肺癌（NSCLC）是世界范围内癌症死亡的主要原因。手术切除不可行的患者的标准治疗是同步（PACIFIC方案）或顺序（PACIFIC-样方案）放化疗，以铂为基础的双重化疗，然后进行杜伐单抗维持。PACIFIC方案12个月后的无进展生存率（PFS）为55.3%，主要复发部位为胸内。在回顾性研究中，相当比例的患者出现胸内衰竭和有限的胸外转移性疾病。对于仅局部进展或局部-区域进展和有限转移负担的患者，使用化疗或其他药物而不添加局部治疗可能意味着错过了第二次治疗意图治疗方法的机会。AUSTRAL试验是一项II期、介入、多中心、单组研究（ClinicalTrials.gov标识号，NCT06680050），旨在研究胸部放射±立体定向全身放射治疗（SBRT）对低转移部位的联合治疗，在2至4周后，使用durvalumab和ceralasertib，直至进展或严重毒性。研究人群将包括21例III期NSCLC患者，这些患者在接受PACIFIC/PACIFIC-样方案治疗后，在CRT结束后12个月内局部-区域复发±≤3个转移灶。这项研究将持续大约40个月，涉及7个意大利和2个瑞士的地点。主要分级终点是安全性（通过持续毒性监测方法评估）和有效性（通过PFS评估）。次要终点是客观缓解率（ORR）， 6个月和12个月PFS和OS率。

{"title":"Rationale and Design of the AUSTRAL trial: An Open-Label, Multicenter, Phase II Study Evaluating Radiotherapy Followed by Durvalumab (MEDI4736) and Ceralasertib (AZD6738) in Stage III NSCLC Patients With Thoracic Relapses and/or Oligometastases After the PACIFIC Regimen","authors":"Andrea Riccardo Filippi , Eliana Rulli , Diego Signorelli , Jonas Willmann , Andrè Durham , Irene De Simone , Anna Santoni , Francesca Galli , Luciano Carlucci , Valter Torri , Giuseppe Lo Russo , Alfredo Addeo , Matthias Guckenberger","doi":"10.1016/j.cllc.2025.07.006","DOIUrl":"10.1016/j.cllc.2025.07.006","url":null,"abstract":"<div><div>Non–small-cell lung cancer (NSCLC) is a leading cause of death for cancer worldwide. Standard treatment for patients for whom surgical resection is not feasible is concurrent (PACIFIC regimen) or sequential (PACIFIC-like regimen) chemoradiotherapy with platinum-based doublet chemotherapy followed by durvalumab maintenance. The progression-free survival (PFS) rate after the PACIFIC regimen was 55.3% at 12 months, with the primary site of recurrence being intrathoracic. In retrospective studies, a relevant proportion of patients presented a combination of intrathoracic failure and limited extra-thoracic metastatic disease. For patients with local progression only, or with loco-regional progression and limited metastatic burden, the use of chemotherapy or other agents without the addition of a local therapy may represent a missed opportunity for a second curative intent treatment approach. The AUSTRAL trial, a phase II, interventional, multicenter, single-arm, study (ClinicalTrials.gov identifier, NCT06680050) aims to investigate the combination of thoracic irradiation ± Stereotactic Body Radiation Therapy (SBRT) to oligometastatic sites followed, after 2 to 4 weeks, by durvalumab and ceralasertib, administered until progression or severe toxicity. The study population will include 21 stage III NSCLC patients with loco-regional relapse after >12 months from the end of CRT ± ≤3 metastatic lesions following PACIFIC/PACIFIC-like regimens. The study will last approximately 40 months and involve 7 Italian and 2 Swiss sites. Primary hierarchical endpoints are safety, assessed by the continuous toxicity monitoring approach, and efficacy, assessed by PFS. Secondary endpoints are objective response rate (ORR), 6- and 12-month PFS and OS rate.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 8","pages":"Pages e633-e638"},"PeriodicalIF":3.3,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Italian Mauris Phase IIIb Trial of Atezolizumab Plus Carboplatin and Etoposide for Patients With Newly Diagnosed Extensive-Stage Small Cell Lung Cancer: 3-Year End-of-Study Results 意大利Mauris iii期ib试验Atezolizumab联合卡铂和依托泊苷治疗新诊断的广泛期小细胞肺癌患者：3年研究结束结果

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-07-09 DOI: 10.1016/j.cllc.2025.07.003

Floriana Morgillo , Ester Del Signore , Emilio Bria , Filippo de Marinis , Fortunato Ciardiello , Marina Chiara Garassino , Alessio Stefani , Francesco Verderame , Alessandro Morabito , Andrea Sbrana , Giuseppe Tonini , Marina Gilli , Rossana Berardi , Paola Adriana Taveggia , Alessandra Bearz , Angelo Delmonte , Maria Rita Migliorino , Cesare Gridelli , Giovanni Maria Fadda , Manuela Iero , Andrea Ardizzoni

Background

Atezolizumab combined to carboplatin and etoposide prolonged survival in the IMpower133 trial of untreated extensive-stage small-cell lung cancer (ES-SCLC). Aim of this analysis is to provide end-of-study results from the phase IIIb MAURIS study on the efficacy and safety of atezolizumab plus chemotherapy in the same disease setting, in a patient population with broader inclusion criteria.

Materials and Methods

MAURIS is a multicentric, open-label, single-arm study conducted between 2019 and 2023 in 25 Italian study centres. A total of 155 patients with untreated ES-SCLC were enrolled. Treatment was based on atezolizumab 1200 mg + carboplatin + etoposide every 21 days, for 4 to 6 cycles, during the induction phase, and atezolizumab every 3 weeks during the maintenance phase. Safety, overall survival (OS) and progression-free survival (PFS) were among study endpoints.

Results

The median OS at end of study was 10.6 months, with OS rates of 45.5% at 1 year, 31.0% at 1.5 years, 17.1% at 2 years and 14.5% at 3 years. The median PFS was 5.5 months. Serious adverse events (AEs) occurred in 38.3% of patients, treatment-related serious AEs in 21.4%, and immuno-mediated treatment-emergent AEs in 26.6% of patients. Immune-mediated grade 3 to 4 AEs were inversely related with mortality (hazard ratio, HR = 0.36; 95% confidence interval, CI: 0.13-0.97) in a multivariate analysis.

Conclusion

This study showed consistent findings with the IMpower133 trial on the safety and efficacy of atezolizumab plus chemotherapy in first-line treatment of ES-SCLC. Long-term survival of a subgroup of patients was also confirmed.

背景：在IMpower133试验中，Atezolizumab联合卡铂和依托泊苷延长了未经治疗的广泛期小细胞肺癌（ES-SCLC）的生存期。本分析的目的是提供IIIb期MAURIS研究的研究结束结果，该研究在具有更广泛纳入标准的患者群体中，对atezolizumab加化疗在相同疾病环境下的疗效和安全性进行了研究。材料和方法：MAURIS是一项多中心、开放标签、单臂研究，于2019年至2023年在25个意大利研究中心进行。共有155名未经治疗的ES-SCLC患者入组。在诱导期，每21天使用atezolizumab 1200mg +卡铂+依托泊苷治疗4 - 6个周期，在维持期每3周使用atezolizumab治疗。研究终点包括安全性、总生存期（OS）和无进展生存期（PFS）。结果：研究结束时中位OS为10.6个月，1年OS率为45.5%，1.5年OS率为31.0%，2年OS率为17.1%，3年OS率为14.5%。中位PFS为5.5个月。38.3%的患者发生严重不良事件（ae）， 21.4%的患者发生与治疗相关的严重ae， 26.6%的患者发生免疫介导的治疗突发ae。免疫介导的3 ~ 4级ae与死亡率呈负相关(风险比，HR = 0.36；95%可信区间（CI: 0.13-0.97）。结论：本研究与IMpower133试验在atezolizumab联合化疗一线治疗ES-SCLC的安全性和有效性方面的结果一致。一个亚组患者的长期生存也得到了证实。

{"title":"The Italian Mauris Phase IIIb Trial of Atezolizumab Plus Carboplatin and Etoposide for Patients With Newly Diagnosed Extensive-Stage Small Cell Lung Cancer: 3-Year End-of-Study Results","authors":"Floriana Morgillo , Ester Del Signore , Emilio Bria , Filippo de Marinis , Fortunato Ciardiello , Marina Chiara Garassino , Alessio Stefani , Francesco Verderame , Alessandro Morabito , Andrea Sbrana , Giuseppe Tonini , Marina Gilli , Rossana Berardi , Paola Adriana Taveggia , Alessandra Bearz , Angelo Delmonte , Maria Rita Migliorino , Cesare Gridelli , Giovanni Maria Fadda , Manuela Iero , Andrea Ardizzoni","doi":"10.1016/j.cllc.2025.07.003","DOIUrl":"10.1016/j.cllc.2025.07.003","url":null,"abstract":"<div><h3>Background</h3><div>Atezolizumab combined to carboplatin and etoposide prolonged survival in the IMpower133 trial of untreated extensive-stage small-cell lung cancer (ES-SCLC). Aim of this analysis is to provide end-of-study results from the phase IIIb MAURIS study on the efficacy and safety of atezolizumab plus chemotherapy in the same disease setting, in a patient population with broader inclusion criteria.</div></div><div><h3>Materials and Methods</h3><div>MAURIS is a multicentric, open-label, single-arm study conducted between 2019 and 2023 in 25 Italian study centres. A total of 155 patients with untreated ES-SCLC were enrolled. Treatment was based on atezolizumab 1200 mg + carboplatin + etoposide every 21 days, for 4 to 6 cycles, during the induction phase, and atezolizumab every 3 weeks during the maintenance phase. Safety, overall survival (OS) and progression-free survival (PFS) were among study endpoints.</div></div><div><h3>Results</h3><div>The median OS at end of study was 10.6 months, with OS rates of 45.5% at 1 year, 31.0% at 1.5 years, 17.1% at 2 years and 14.5% at 3 years. The median PFS was 5.5 months. Serious adverse events (AEs) occurred in 38.3% of patients, treatment-related serious AEs in 21.4%, and immuno-mediated treatment-emergent AEs in 26.6% of patients. Immune-mediated grade 3 to 4 AEs were inversely related with mortality (hazard ratio, HR = 0.36; 95% confidence interval, CI: 0.13-0.97) in a multivariate analysis.</div></div><div><h3>Conclusion</h3><div>This study showed consistent findings with the IMpower133 trial on the safety and efficacy of atezolizumab plus chemotherapy in first-line treatment of ES-SCLC. Long-term survival of a subgroup of patients was also confirmed.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages 541-551"},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144752620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The Effect of Exercise on Quality of Life in Patients With Advanced Lung Cancer: A Secondary Analysis of a Randomized Controlled Trial 运动对晚期肺癌患者生活质量的影响：一项随机对照试验的二次分析

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-07-09 DOI: 10.1016/j.cllc.2025.07.005

Zina Bloch , Sandra Jensen , Victor Sørensen , Seppo W. Langer , Morten Quist

Background

Chemotherapy is the primary treatment for lung cancer; however, it often leads to adverse side effects such as nausea, fatigue, and neuropathy, potentially compromising treatment adherence and patient quality of life. Exercise has emerged as a promising therapy, with evidence suggesting that physical activity during chemotherapy can mitigate symptoms and enhance overall well-being. This exploratory analysis investigates the efficacy of a 12-week exercise intervention on health-related quality of life (HRQoL) in patients with advanced lung cancer undergoing chemotherapy.

Methods

218 participants with advanced lung cancer were randomized to either a 12-week exercise intervention or usual care. HRQoL was assessed at baseline and after 12 weeks using the European Organization for Research and Treatment of Cancer (EORTC) core Quality of Life Questionnaire (QLQ-C30) and the EORTC lung cancer-specific Quality of Life Questionnaire (QLQ-LC13).

Results

Peripheral neuropathy remained unchanged in the intervention group (95% CI, -8.5-3.3, P = .39), but increased with 6.2 (95% CI, 1.3-11.1, P = .02) in the control group, resulting in a between group difference of -8.8 (95% CI, -16.4 to -1.1, P = .03). Moreover, the intervention group demonstrated a decrease in pain other of -7.4 (95% CI, -14.1 to -0.8, P = .03), where the control group remained unchanged (95% CI, -4.5-11.3 P = .40), resulting in a between group difference of –10.8 (95% CI, -21.1 to -0.6, P = .04).

Conclusion

This study demonstrates that a 12-week exercise intervention mitigates worsening of peripheral neuropathy and reduces pain in patients with advanced lung cancer, supporting exercise as a beneficial complementary strategy during chemotherapy.

背景：化疗是肺癌的主要治疗方法；然而，它经常导致不良副作用，如恶心、疲劳和神经病变，潜在地影响治疗依从性和患者的生活质量。运动已经成为一种很有前景的治疗方法，有证据表明，化疗期间的体育活动可以减轻症状，提高整体健康水平。本探索性分析探讨了12周运动干预对晚期肺癌化疗患者健康相关生活质量（HRQoL）的影响。方法：218名晚期肺癌患者随机分为12周运动干预组和常规护理组。HRQoL在基线和12周后使用欧洲癌症研究与治疗组织（EORTC）核心生活质量问卷（QLQ-C30）和EORTC肺癌特异性生活质量问卷（QLQ-LC13）进行评估。结果：干预组周围神经病变发生率无变化（95% CI, -8.5 ~ 3.3, P = 0.39），对照组周围神经病变发生率增加6.2 (95% CI, 1.3 ~ 11.1, P = 0.02)，组间差异为-8.8 （95% CI, -16.4 ~ -1.1, P = 0.03）。此外，干预组的疼痛减少了-7.4 (95% CI, -14.1至-0.8,P = 0.03)，而对照组保持不变（95% CI, -4.5-11.3 P = 0.40），导致组间差异为-10.8 （95% CI, -21.1至-0.6,P = 0.04）。结论：本研究表明，12周的运动干预可以缓解晚期肺癌患者周围神经病变的恶化，减轻疼痛，支持运动作为化疗期间有益的补充策略。

{"title":"The Effect of Exercise on Quality of Life in Patients With Advanced Lung Cancer: A Secondary Analysis of a Randomized Controlled Trial","authors":"Zina Bloch , Sandra Jensen , Victor Sørensen , Seppo W. Langer , Morten Quist","doi":"10.1016/j.cllc.2025.07.005","DOIUrl":"10.1016/j.cllc.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Chemotherapy is the primary treatment for lung cancer; however, it often leads to adverse side effects such as nausea, fatigue, and neuropathy, potentially compromising treatment adherence and patient quality of life. Exercise has emerged as a promising therapy, with evidence suggesting that physical activity during chemotherapy can mitigate symptoms and enhance overall well-being. This exploratory analysis investigates the efficacy of a 12-week exercise intervention on health-related quality of life (HRQoL) in patients with advanced lung cancer undergoing chemotherapy.</div></div><div><h3>Methods</h3><div>218 participants with advanced lung cancer were randomized to either a 12-week exercise intervention or usual care. HRQoL was assessed at baseline and after 12 weeks using the European Organization for Research and Treatment of Cancer (EORTC) core Quality of Life Questionnaire (QLQ-C30) and the EORTC lung cancer-specific Quality of Life Questionnaire (QLQ-LC13).</div></div><div><h3>Results</h3><div>Peripheral neuropathy remained unchanged in the intervention group (95% CI, -8.5-3.3, <em>P</em> = .39), but increased with 6.2 (95% CI, 1.3-11.1, <em>P</em> = .02) in the control group, resulting in a between group difference of -8.8 (95% CI, -16.4 to -1.1, <em>P</em> = .03). Moreover, the intervention group demonstrated a decrease in pain other of -7.4 (95% CI, -14.1 to -0.8, <em>P</em> = .03), where the control group remained unchanged (95% CI, -4.5-11.3 <em>P</em> = .40), resulting in a between group difference of –10.8 (95% CI, -21.1 to -0.6, <em>P</em> = .04).</div></div><div><h3>Conclusion</h3><div>This study demonstrates that a 12-week exercise intervention mitigates worsening of peripheral neuropathy and reduces pain in patients with advanced lung cancer, supporting exercise as a beneficial complementary strategy during chemotherapy.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e582-e590"},"PeriodicalIF":3.3,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors Associated With Local Control and Toxicity of Hypofractionated Radiotherapy for Early and Late-Stage Ultracentral Lung Tumors 早期和晚期超中央肺肿瘤低分割放疗局部控制和毒性的相关因素。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-07-08 DOI: 10.1016/j.cllc.2025.07.004

Wai Lone Jonathan Ho , Silpa Karipineni , Jason C. Ye

Background

Treating ultracentral tumors near critical mediastinal structures is challenging due to severe toxicity risks. This retrospective study evaluates the safety and efficacy of hypofractionated body radiotherapy (HFRT) for ultracentral tumors at a single institution.

Methods

Ultracentral tumors were defined as those invading, abutting, or having an overlapping planning target volume with the proximal bronchial tree (PBT), heart, great vessels, or esophagus. Patients with primary lung cancer or metastases from nonlung primaries, and received HFRT (6-15 fractions) or stereotactic body radiotherapy (SBRT, ≤5 fractions) were included. Radiation-associated toxicities were recorded. Outcomes included overall survival (OS), progression-free survival (PFS), and local control (LC). Prognostic factors were analyzed using Cox regression analysis.

Results

Eighty-six patients with ultracentral tumors underwent 94 treatment courses (69 SBRT, 25 HFRT) between 2014 and 2023. Radiation pneumonitis (RP), pneumonia, and cardiotoxicities developed in 39.3%, 13.9%, and 9.6% of treatments, respectively. One patient experienced grade 3 pulmonary hemorrhage, with no cases of airway fistula or necrosis. Median follow-up was 17.9 months with 1-year and 2-year OS rates of 78.7% and 65.6%, and LC rates of 93.5% and 84.0%, respectively. BED₁₀ ≥100 Gy was associated with improved OS on multivariable Cox regression analysis. RP of any grade was a risk factor for local failure (HR 4.63, 95% CI, 1.22-17.48).

Conclusions

HFRT can be safely administered to ultracentral tumors with excellent local control and low toxicity. Further research is needed to optimize treatment strategies and investigate associations between RP and increased local failure.

背景：由于严重的毒性风险，治疗靠近重要纵隔结构的超中央肿瘤具有挑战性。本回顾性研究评估了在单一机构使用低分割体放疗（HFRT）治疗超中心肿瘤的安全性和有效性。方法：超中心肿瘤定义为侵犯、邻近或与近端支气管树（PBT）、心脏、大血管或食管有重叠规划靶体积的肿瘤。纳入了接受HFRT（6-15分）或立体定向体放疗（SBRT，≤5分）的原发性肺癌或非肺原发转移患者。记录辐射相关的毒性。结果包括总生存期（OS）、无进展生存期（PFS）和局部控制期（LC）。预后因素采用Cox回归分析。结果：2014年至2023年，86例超中央肿瘤患者共接受94个疗程（SBRT 69例，HFRT 25例）。放射性肺炎（RP）、肺炎和心脏毒性分别在39.3%、13.9%和9.6%的治疗中发生。1例患者出现3级肺出血，无气道瘘或气道坏死病例。中位随访时间为17.9个月，1年和2年OS率分别为78.7%和65.6%，LC率分别为93.5%和84.0%。多变量Cox回归分析显示，BED10≥100 Gy与OS改善相关。任何级别的RP都是局部失败的危险因素（HR 4.63, 95% CI, 1.22-17.48）。结论：HFRT可安全用于超中央肿瘤，局部控制性好，毒性低。需要进一步的研究来优化治疗策略，并调查RP与局部衰竭增加之间的关系。

{"title":"Factors Associated With Local Control and Toxicity of Hypofractionated Radiotherapy for Early and Late-Stage Ultracentral Lung Tumors","authors":"Wai Lone Jonathan Ho , Silpa Karipineni , Jason C. Ye","doi":"10.1016/j.cllc.2025.07.004","DOIUrl":"10.1016/j.cllc.2025.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Treating ultracentral tumors near critical mediastinal structures is challenging due to severe toxicity risks. This retrospective study evaluates the safety and efficacy of hypofractionated body radiotherapy (HFRT) for ultracentral tumors at a single institution.</div></div><div><h3>Methods</h3><div>Ultracentral tumors were defined as those invading, abutting, or having an overlapping planning target volume with the proximal bronchial tree (PBT), heart, great vessels, or esophagus. Patients with primary lung cancer or metastases from nonlung primaries, and received HFRT (6-15 fractions) or stereotactic body radiotherapy (SBRT, ≤5 fractions) were included. Radiation-associated toxicities were recorded. Outcomes included overall survival (OS), progression-free survival (PFS), and local control (LC). Prognostic factors were analyzed using Cox regression analysis.</div></div><div><h3>Results</h3><div>Eighty-six patients with ultracentral tumors underwent 94 treatment courses (69 SBRT, 25 HFRT) between 2014 and 2023. Radiation pneumonitis (RP), pneumonia, and cardiotoxicities developed in 39.3%, 13.9%, and 9.6% of treatments, respectively. One patient experienced grade 3 pulmonary hemorrhage, with no cases of airway fistula or necrosis. Median follow-up was 17.9 months with 1-year and 2-year OS rates of 78.7% and 65.6%, and LC rates of 93.5% and 84.0%, respectively. BED<sub>10</sub> ≥100 Gy was associated with improved OS on multivariable Cox regression analysis. RP of any grade was a risk factor for local failure (HR 4.63, 95% CI, 1.22-17.48).</div></div><div><h3>Conclusions</h3><div>HFRT can be safely administered to ultracentral tumors with excellent local control and low toxicity. Further research is needed to optimize treatment strategies and investigate associations between RP and increased local failure.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e572-e581"},"PeriodicalIF":3.3,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Brief Report: Central Nervous System Metastases After Chemoradiation Followed by Durvalumab for Unresectable Locally Advanced Nonsmall Cell Lung Cancer 摘要报告：局部晚期非小细胞肺癌，在放化疗后使用Durvalumab治疗中枢神经系统转移。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2025-07-05 DOI: 10.1016/j.cllc.2025.07.002

John Sharp , Philip Young , Songzhu Zhao , Lai Wei , Sandip H. Patel , Mingjia Li , Jeremy Brownstein , Karl Haglund , Joshua Palmer , Raju Raval , Sasha Beyer , Logan Roof , Peter Shields , Kai He , Jacob Kaufman , Regan M. Memmott , Asrar Alahmadi , David P Carbone , Gregory A Otterson , Carolyn J Presley , Dwight H. Owen

•
In this multi-center study of patients with unresectable locally advanced non-small cell lung cancer undergoing concurrent chemoradiation followed by durvalumab, central nervous system (CNS) metastases developed in 16.6% of patients, higher than previously reported in the literature.
•
Higher baseline stage (IIIB/C vs. IIIA) and an interval of >3 months from staging brain MRI to initiation of durvalumab were associated with an increased risk of developing CNS metastases.
•
Overall survival was shorter for patients who developed CNS metastases. Patients with synchronous systemic and CNS metastases had a particularly short overall survival.

•在这项多中心研究中，不可切除的局部晚期非小细胞肺癌患者同时接受化疗和杜伐单抗治疗，中枢神经系统（CNS）转移发生在16.6%的患者中，高于先前文献报道。•较高的基线分期（IIIB/C vs IIIA）和从分期脑MRI到开始使用durvalumab的间隔时间为3个月与发生中枢神经系统转移的风险增加相关。•发生中枢神经系统转移的患者总生存期较短。伴有全身和中枢神经系统同步转移的患者总生存期特别短。

{"title":"Brief Report: Central Nervous System Metastases After Chemoradiation Followed by Durvalumab for Unresectable Locally Advanced Nonsmall Cell Lung Cancer","authors":"John Sharp , Philip Young , Songzhu Zhao , Lai Wei , Sandip H. Patel , Mingjia Li , Jeremy Brownstein , Karl Haglund , Joshua Palmer , Raju Raval , Sasha Beyer , Logan Roof , Peter Shields , Kai He , Jacob Kaufman , Regan M. Memmott , Asrar Alahmadi , David P Carbone , Gregory A Otterson , Carolyn J Presley , Dwight H. Owen","doi":"10.1016/j.cllc.2025.07.002","DOIUrl":"10.1016/j.cllc.2025.07.002","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>In this multi-center study of patients with unresectable locally advanced non-small cell lung cancer undergoing concurrent chemoradiation followed by durvalumab, central nervous system (CNS) metastases developed in 16.6% of patients, higher than previously reported in the literature.</div></span></li><li><span>•</span><span><div>Higher baseline stage (IIIB/C vs. IIIA) and an interval of >3 months from staging brain MRI to initiation of durvalumab were associated with an increased risk of developing CNS metastases.</div></span></li><li><span>•</span><span><div>Overall survival was shorter for patients who developed CNS metastases. Patients with synchronous systemic and CNS metastases had a particularly short overall survival.</div></span></li></ul></div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e566-e571.e2"},"PeriodicalIF":3.3,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144728454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0