Pub Date : 2025-11-01Epub Date: 2025-08-06DOI: 10.1016/j.cllc.2025.08.003
Rosalyn Marar , Claire Bai , Eric Hansen , Christina M. Zettler , Andrew J. Belli , Laura L. Fernandes , Ching-Kun Wang , Kaushal Parikh
Purpose
This study analyzed the comparative effectiveness of immune-checkpoint inhibitor (ICI) monotherapy versus ICI+chemotherapy (CIT) in the first-line (1L) setting among metastatic NSCLC (mNSCLC) patients with ≥ 50% programmed death-ligand 1 (PD-L1) expression, and without epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and c-ros oncogene 1 (ROS1) alterations.
Methods
Patients were identified from COTA’s real-world (rw) database meeting the criteria: aged ≥ 18 years at diagnosis with mNSCLC on or after January 1, 2017, ≥ 50% PD-L1 expression, negative for EGFR, ALK, and ROS1 mutations, and received 1L ICI monotherapy or CIT. Characteristics and treatment patterns were summarized overall and by treatment group. Rw time to next treatment (rwTTNT), progression-free survival (rwPFS), and overall survival (rwOS) were summarized using Kaplan-Meier methodology. The inverse probability of treatment weighting method was used to balance baseline characteristics for adjusted analyses.
Results
Of 311 patients, 178 received ICI monotherapy and 133 received CIT. Adjusted median rwTTNT was 11.31 months for the CIT group compared to 7.63 for the ICI group (HR: 0.68, 95% CI: 0.50, 0.93). Adjusted rwPFS for the CIT group vs. ICI group was 8.78 and 5.56 months, respectively (HR: 0.82, 95% CI: 0.61, 1.11), and adjusted median rwOS for CIT and ICI was 23.08 and 20.28 months, respectively (HR: 0.83, 95% CI: 0.59, 1.18).
Conclusions
Although adjusted rwTTNT differed by treatment group, this did not translate to a significant difference in survival. Among mNSCLC patients with high PD-L1 expression, the addition of chemotherapy to ICI did not improve survival.
{"title":"Treatment Patterns and Outcomes of Non-Small Cell Lung Cancer with High PD-L1 Expression using Real World Evidence","authors":"Rosalyn Marar , Claire Bai , Eric Hansen , Christina M. Zettler , Andrew J. Belli , Laura L. Fernandes , Ching-Kun Wang , Kaushal Parikh","doi":"10.1016/j.cllc.2025.08.003","DOIUrl":"10.1016/j.cllc.2025.08.003","url":null,"abstract":"<div><h3>Purpose</h3><div>This study analyzed the comparative effectiveness of immune-checkpoint inhibitor (ICI) monotherapy versus ICI+chemotherapy (CIT) in the first-line (1L) setting among metastatic NSCLC (mNSCLC) patients with ≥ 50% programmed death-ligand 1 (PD-L1) expression, and without epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and c-ros oncogene 1 (ROS1) alterations.</div></div><div><h3>Methods</h3><div>Patients were identified from COTA’s real-world (rw) database meeting the criteria: aged ≥ 18 years at diagnosis with mNSCLC on or after January 1, 2017, ≥ 50% PD-L1 expression, negative for EGFR, ALK, and ROS1 mutations, and received 1L ICI monotherapy or CIT. Characteristics and treatment patterns were summarized overall and by treatment group. Rw time to next treatment (rwTTNT), progression-free survival (rwPFS), and overall survival (rwOS) were summarized using Kaplan-Meier methodology. The inverse probability of treatment weighting method was used to balance baseline characteristics for adjusted analyses.</div></div><div><h3>Results</h3><div>Of 311 patients, 178 received ICI monotherapy and 133 received CIT. Adjusted median rwTTNT was 11.31 months for the CIT group compared to 7.63 for the ICI group (HR: 0.68, 95% CI: 0.50, 0.93). Adjusted rwPFS for the CIT group vs. ICI group was 8.78 and 5.56 months, respectively (HR: 0.82, 95% CI: 0.61, 1.11), and adjusted median rwOS for CIT and ICI was 23.08 and 20.28 months, respectively (HR: 0.83, 95% CI: 0.59, 1.18).</div></div><div><h3>Conclusions</h3><div>Although adjusted rwTTNT differed by treatment group, this did not translate to a significant difference in survival. Among mNSCLC patients with high PD-L1 expression, the addition of chemotherapy to ICI did not improve survival.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages 564-572.e4"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945593","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}
Pub Date : 2025-11-01Epub Date: 2025-07-03DOI: 10.1016/j.cllc.2025.07.001
Margaret Locke , Wint Yan Aung , Michael Esposito , Nagashree Seetharamu
Background
Histopathological features can be valuable prognostic tools in risk stratification of early-stage nonsmall cell lung cancers (NSCLC). This study evaluates the correlation between lymphovascular invasion (LVI), visceral pleural invasion (VPI), micropapillary pattern, and spread through airspaces (STAS) with outcomes in stage I NSCLC.
Methods
Retrospective chart review was conducted on patients who underwent lung resection at a single academic center between 2015 and 2019 with pathology confirming NSCLC. Patients treated with neoadjuvant chemotherapy or with stage II or above cancers were excluded. Records were reviewed for demographics, histopathological features, Charlson comorbidity index (CCI), TNM staging (IASLC 8th edition), recurrence, and death. Recurrence free survival (RFS) was estimated via Kaplan–Meier Method. Correlation between STAS, VPI, LVI, micropapillary pattern, and patient outcomes was examined via multivariate Cox proportional hazards regression models.
Results
A total of 596 patients were included in the analysis. Median follow-up was 35.3 months. Median RFS at 3 years was 88.4%. In multivariate analysis, LVI was an independent predictor for shorter RFS (HR = 4.19; 95% CI, 1.85-9.47; P < .001). Age > 75 and receipt of adjuvant chemotherapy were also found to be independent poor prognosticators. STAS, VPI, and micropapillary pattern had nonsignificant associations with RFS. A significant interaction was noted between LVI and adjuvant chemotherapy suggesting lower risk of recurrence (HR = 0.12; 95% CI, 0.02-0.74; P = .022).
Conclusions
LVI was a strong independent predictor associated with postoperative recurrence. Adjuvant chemotherapy, while associated with poor prognosis overall, seemed to decrease the risk of recurrence in patients whose tumors had LVI.
{"title":"Lymphovascular Invasion is a Predictor of Postoperative Recurrence or Death in Stage I Non-small-cell Lung Cancer (NSCLC)","authors":"Margaret Locke , Wint Yan Aung , Michael Esposito , Nagashree Seetharamu","doi":"10.1016/j.cllc.2025.07.001","DOIUrl":"10.1016/j.cllc.2025.07.001","url":null,"abstract":"<div><h3>Background</h3><div>Histopathological features can be valuable prognostic tools in risk stratification of early-stage nonsmall cell lung cancers (NSCLC). This study evaluates the correlation between lymphovascular invasion (LVI), visceral pleural invasion (VPI), micropapillary pattern, and spread through airspaces (STAS) with outcomes in stage I NSCLC.</div></div><div><h3>Methods</h3><div>Retrospective chart review was conducted on patients who underwent lung resection at a single academic center between 2015 and 2019 with pathology confirming NSCLC. Patients treated with neoadjuvant chemotherapy or with stage II or above cancers were excluded. Records were reviewed for demographics, histopathological features, Charlson comorbidity index (CCI), TNM staging (IASLC 8th edition), recurrence, and death. Recurrence free survival (RFS) was estimated via Kaplan–Meier Method. Correlation between STAS, VPI, LVI, micropapillary pattern, and patient outcomes was examined via multivariate Cox proportional hazards regression models.</div></div><div><h3>Results</h3><div>A total of 596 patients were included in the analysis. Median follow-up was 35.3 months. Median RFS at 3 years was 88.4%. In multivariate analysis, LVI was an independent predictor for shorter RFS (HR = 4.19; 95% CI, 1.85-9.47; <em>P</em> < .001). Age > 75 and receipt of adjuvant chemotherapy were also found to be independent poor prognosticators. STAS, VPI, and micropapillary pattern had nonsignificant associations with RFS. A significant interaction was noted between LVI and adjuvant chemotherapy suggesting lower risk of recurrence (HR = 0.12; 95% CI, 0.02-0.74; <em>P</em> = .022).</div></div><div><h3>Conclusions</h3><div>LVI was a strong independent predictor associated with postoperative recurrence. Adjuvant chemotherapy, while associated with poor prognosis overall, seemed to decrease the risk of recurrence in patients whose tumors had LVI.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e560-e565"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717656","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}
Pub Date : 2025-11-01Epub Date: 2025-05-29DOI: 10.1016/j.cllc.2025.05.012
Paul D. Kruithof , Anita J.W.M. Brouns , Juliette H.R.J. Degens , Lizza E.L. Hendriks , Dennis R. Wong , Robin M.J.M. van Geel , Sander Croes
•
High exposures of osimertinib are associated with toxicity, and evidence for efficacy at low exposures is scarce: therapeutic drug monitoring can be applied to minimize toxicity while maintaining expected effectiveness.
•
CYP3A polymorphisms may cause substantial deviations in osimertinib exposure, potentially leading to increased toxicity.
•
Comedication which induces CYP3A may substantially decrease osimertinib exposure, potentially resulting in subtherapeutic exposures.
{"title":"Osimertinib Dose Optimization Guided by Therapeutic Drug Monitoring in Patients With EGFR-Mutated Advanced Non-Small Cell Lung Cancer: A Case series","authors":"Paul D. Kruithof , Anita J.W.M. Brouns , Juliette H.R.J. Degens , Lizza E.L. Hendriks , Dennis R. Wong , Robin M.J.M. van Geel , Sander Croes","doi":"10.1016/j.cllc.2025.05.012","DOIUrl":"10.1016/j.cllc.2025.05.012","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>High exposures of osimertinib are associated with toxicity, and evidence for efficacy at low exposures is scarce: therapeutic drug monitoring can be applied to minimize toxicity while maintaining expected effectiveness.</div></span></li><li><span>•</span><span><div>CYP3A polymorphisms may cause substantial deviations in osimertinib exposure, potentially leading to increased toxicity.</div></span></li><li><span>•</span><span><div>Comedication which induces CYP3A may substantially decrease osimertinib exposure, potentially resulting in subtherapeutic exposures.</div></span></li></ul></div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e496-e502"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332570","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}
Pub Date : 2025-11-01Epub Date: 2025-06-20DOI: 10.1016/j.cllc.2025.06.008
C. Kouroussis , L. Thanos , A. Tsipoura , G. Koulaxouzidis , V. Chaniotis
•
Immune checkpoint inhibitors, such as pembrolizumab, can rarely cause fibro-inflammatory reactions beyond classical immune-related adverse events (irAEs).
•
This is one of the very few histologically confirmed cases of retroperitoneal fibrosis (RPF) following PD-1 blockade in a lung cancer patient.
•
The diagnosis of RPF should be considered in patients on immunotherapy who develop new abdominal symptoms, even mild or nonspecific ones.
•
Immunohistochemistry can aid in distinguishing idiopathic RPF from IgG4-related disease or other immune-mediated conditions.
•
Corticosteroid treatment led to rapid resolution of symptoms and radiological findings, supporting the immune-mediated mechanism of RPF.
{"title":"A Case of Retroperitoneal Fibrosis During Antiprogrammed Cell Death 1 Antibody Treatment","authors":"C. Kouroussis , L. Thanos , A. Tsipoura , G. Koulaxouzidis , V. Chaniotis","doi":"10.1016/j.cllc.2025.06.008","DOIUrl":"10.1016/j.cllc.2025.06.008","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>Immune checkpoint inhibitors, such as pembrolizumab, can rarely cause fibro-inflammatory reactions beyond classical immune-related adverse events (irAEs).</div></span></li><li><span>•</span><span><div>This is one of the very few histologically confirmed cases of retroperitoneal fibrosis (RPF) following PD-1 blockade in a lung cancer patient.</div></span></li><li><span>•</span><span><div>The diagnosis of RPF should be considered in patients on immunotherapy who develop new abdominal symptoms, even mild or nonspecific ones.</div></span></li><li><span>•</span><span><div>Immunohistochemistry can aid in distinguishing idiopathic RPF from IgG4-related disease or other immune-mediated conditions.</div></span></li><li><span>•</span><span><div>Corticosteroid treatment led to rapid resolution of symptoms and radiological findings, supporting the immune-mediated mechanism of RPF.</div></span></li></ul></div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages 595-602"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697814","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}
Previously, we reported on osimertinib (OSI) as a first-line treatment for EGFR mutation-positive non-small cell lung cancer (EGFRm+ NSCLC) in a real-world setting. However, owing to the limited observation period, data on overall survival (OS) and long-term safety were not reported. Therefore, in this study, we aimed to assess the long-term efficacy and safety of OSI in patients with EGFRm+ NSCLC.
Patients and methods
We extended the observation period until July 2023 for 538 patients with EGFRm+ NSCLC who received OSI between August 2018 and December 2019.
Results
The median observation period was 37 months. The number of events was 392 (72.9%) for progression-free survival (PFS) and 285 (53%) for OS. The median PFS was 20.1 months (95% CI: 17.1-22.1) and median OS was 42.0 months (95% CI: 37.7-48.4). Safety data showed incidences of the following adverse events: pneumonitis (all grades/grade ≥ 3/grade 5), 90 (16.7%)/28 (5.2%)/5 (0.9%); grade ≥ 3 nonhematologic toxicity, 69 (12.8%); grade ≥ 3 hematologic toxicity, 34 (6.3%); QT prolongation (all grades/grade ≥ 3), 25 (4.6%)/8 (1.3%); and ejection fraction decrease and heart failure (all grades/grade ≥ 3), 14 (2.6%)/10 (1.9%). Regarding late adverse events manifesting after 1 year of treatment, 17 cases of pneumonitis and 7 cases of cardiotoxicity were recorded.
Conclusion
This study supports the long-term efficacy of OSI, with PFS and OS comparable to those in the FLAURA trial in a Japanese real-world setting. However, it highlights the need for careful and long-term safety monitoring throughout the treatment period.
{"title":"Osimertinib as First-Line Treatment for Patients With Advanced EGFR Mutation-Positive Non-Small Cell Lung Cancer in a Real-World Setting: Updated Overall Survival Data (OSI-FACT-OS)","authors":"Yoshihiko Sakata , Go Saito , Shinya Sakata , Teppei Yamaguchi , Motohiro Tamiya , Hidekazu Suzuki , Ryota Shibaki , Asuka Okada , Toshihide Yokoyama , Hirotaka Matsumoto , Taiichiro Otsuki , Yuki Sato , Junji Uchida , Yoko Tsukita , Megumi Inaba , Hideki Ikeda , Daisuke Arai , Hirotaka Maruyama , Satoshi Hara , Shinsuke Tsumura , Takuro Sakagami","doi":"10.1016/j.cllc.2025.05.015","DOIUrl":"10.1016/j.cllc.2025.05.015","url":null,"abstract":"<div><h3>Background</h3><div>Previously, we reported on osimertinib (OSI) as a first-line treatment for <em>EGFR</em> mutation-positive non-small cell lung cancer (<em>EGFR</em>m+ NSCLC) in a real-world setting. However, owing to the limited observation period, data on overall survival (OS) and long-term safety were not reported. Therefore, in this study, we aimed to assess the long-term efficacy and safety of OSI in patients with <em>EGFR</em>m+ NSCLC.</div></div><div><h3>Patients and methods</h3><div>We extended the observation period until July 2023 for 538 patients with <em>EGFR</em>m+ NSCLC who received OSI between August 2018 and December 2019.</div></div><div><h3>Results</h3><div>The median observation period was 37 months. The number of events was 392 (72.9%) for progression-free survival (PFS) and 285 (53%) for OS. The median PFS was 20.1 months (95% CI: 17.1-22.1) and median OS was 42.0 months (95% CI: 37.7-48.4). Safety data showed incidences of the following adverse events: pneumonitis (all grades/grade ≥ 3/grade 5), 90 (16.7%)/28 (5.2%)/5 (0.9%); grade ≥ 3 nonhematologic toxicity, 69 (12.8%); grade ≥ 3 hematologic toxicity, 34 (6.3%); QT prolongation (all grades/grade ≥ 3), 25 (4.6%)/8 (1.3%); and ejection fraction decrease and heart failure (all grades/grade ≥ 3), 14 (2.6%)/10 (1.9%). Regarding late adverse events manifesting after 1 year of treatment, 17 cases of pneumonitis and 7 cases of cardiotoxicity were recorded.</div></div><div><h3>Conclusion</h3><div>This study supports the long-term efficacy of OSI, with PFS and OS comparable to those in the FLAURA trial in a Japanese real-world setting. However, it highlights the need for careful and long-term safety monitoring throughout the treatment period.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e623-e631.e3"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526724","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}
Pub Date : 2025-11-01Epub Date: 2025-05-29DOI: 10.1016/j.cllc.2025.05.010
Kira-Lee Koster , Sarvaganthasenay Yohasenan , Ahmet Samil Pakmak , Michael Mark , Yannis Metaxas , Carolin Lips , Felicitas Hitz , Pawel Leskow , Corinna Ludwig , Paul Martin Putora , Markus Glatzer , Tino Schneider , Claudio Caviezel , Thomas Mader , Mohsen Mousavi , Marcel Blum , Martin Früh , Markus Joerger
Background
While formalized treatment recommendations for non-small cell lung cancer (NSCLC) by a multidisciplinary tumor board (MDT) have been associated with improved patient care and potentially improved survival, there is no data on the prognostic impact of individual adherence to initial MDT treatment recommendations in patients (pts) with stage III NSCLC.
Patients and methods
Multimodal treatment data for stage III NSCLC pts between 2014 and 2020 were collected from 3 Swiss referral centers. All pts underwent MDT before treatment. MDT-adherence was defined as implementation of the initially recommended treatment modalities and their sequence. Event-free survival (EFS) (primary endpoint) and overall survival (OS) were subjected to Kaplan-Meier analysis, MDT adherence to multivariable Cox regression analysis.
Results
Adherence to initial MDT recommendations was found in 385/547 (70.4%) eligible pts. Treatment de-escalation was the prominent feature in 109/162 (67.3%) non MDT-adherent pts, resulting in 89/547 (16.3%) pts receiving non-curative treatment. Pts ≥ 65 years of age had an increased risk for MDT nonadherence (32.8% vs. 23.0%, P = .02), as had pts with a higher tumor stage (19.8% for IIIA, 38.5% for IIIB, 43.3% for IIIC, P < .001) and frail (ECOG ≥ 2) pts (53.7% vs. 22.8%, P < .001). Median EFS was higher in MDT-adherent pts (11.9 months vs. 8.6 months (mo), P = 0.003), as was OS (20.3 mo vs. 9.4 mo, P < .001).
Conclusions
One third of stage III NSCLC pts is unable to adhere to initial MDT recommendations even in tertiary referral centers. Nonadherence was associated with worse outcome. Treatment strategies for vulnerable pts should critically be reviewed.
{"title":"Predictors of Multidisciplinary Tumor Board Adherence in Stage III Non-Small-Cell Lung Cancer Patients From a Large Multicenter Study","authors":"Kira-Lee Koster , Sarvaganthasenay Yohasenan , Ahmet Samil Pakmak , Michael Mark , Yannis Metaxas , Carolin Lips , Felicitas Hitz , Pawel Leskow , Corinna Ludwig , Paul Martin Putora , Markus Glatzer , Tino Schneider , Claudio Caviezel , Thomas Mader , Mohsen Mousavi , Marcel Blum , Martin Früh , Markus Joerger","doi":"10.1016/j.cllc.2025.05.010","DOIUrl":"10.1016/j.cllc.2025.05.010","url":null,"abstract":"<div><h3>Background</h3><div>While formalized treatment recommendations for non-small cell lung cancer (NSCLC) by a multidisciplinary tumor board (MDT) have been associated with improved patient care and potentially improved survival, there is no data on the prognostic impact of individual adherence to initial MDT treatment recommendations in patients (pts) with stage III NSCLC.</div></div><div><h3>Patients and methods</h3><div>Multimodal treatment data for stage III NSCLC pts between 2014 and 2020 were collected from 3 Swiss referral centers. All pts underwent MDT before treatment. MDT-adherence was defined as implementation of the initially recommended treatment modalities and their sequence. Event-free survival (EFS) (primary endpoint) and overall survival<span> (OS) were subjected to Kaplan-Meier analysis, MDT adherence to multivariable Cox regression analysis.</span></div></div><div><h3>Results</h3><div>Adherence to initial MDT recommendations was found in 385/547 (70.4%) eligible pts. Treatment de-escalation was the prominent feature in 109/162 (67.3%) non MDT-adherent pts, resulting in 89/547 (16.3%) pts receiving non-curative treatment. Pts ≥ 65 years of age had an increased risk for MDT nonadherence (32.8% vs. 23.0%, <em>P</em> = .02), as had pts with a higher tumor stage (19.8% for IIIA, 38.5% for IIIB, 43.3% for IIIC, <em>P</em> < .001) and frail (ECOG ≥ 2) pts (53.7% vs. 22.8%, <em>P</em> < .001). Median EFS was higher in MDT-adherent pts (11.9 months vs. 8.6 months (mo), <em>P</em> = 0.003), as was OS (20.3 mo vs. 9.4 mo, <em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>One third of stage III NSCLC pts is unable to adhere to initial MDT recommendations even in tertiary referral centers. Nonadherence was associated with worse outcome. Treatment strategies for vulnerable pts should critically be reviewed.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e487-e495"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144495030","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}
Pub Date : 2025-11-01Epub Date: 2025-06-12DOI: 10.1016/j.cllc.2025.06.006
Owen Y. Cai , Jessica R. Fernandez , Melinda C. Aldrich , Jennifer Richmond
Background
Patient-provider shared decision-making discussions are an important component of lung cancer screening guidelines, but little is known about factors associated with these discussions among screening-eligible patients. We used Andersen’s Behavioral Model of Health Services Utilization to examine factors associated with discussing LCS with a provider.
Patients
Data came from an online survey of N = 516 U.S. adults meeting United States Preventive Services Task Force LCS eligibility criteria (ie, were 50-80 years of age and had at least a 20-pack year history of tobacco use).
Methods
We used logistic regression to investigate whether having a LCS discussion was associated with predisposing factors (eg, chronic obstructive pulmonary disease [COPD] diagnosis), enabling factors (eg, having a primary care provider [PCP]), and need factors (eg, smoking history).
Results
About 36% participants had ever discussed LCS with a provider. Participants diagnosed with COPD (OR = 3.56, 95% CI, 1.90-6.67) and who had a first-degree relative with lung cancer (OR = 1.78, 95% CI, 1.02-3.09) had higher odds of LCS discussion than those without COPD and with no family history, respectively. Women had lower odds of LCS discussion than men (OR = 0.37, 95% CI, 0.24-0.58). Participants with an income of $30,000 to $59,999 had higher odds of LCS discussion compared to those earning < $30,000 (OR = 1.78, 95% CI, 1.06-2.98). Not having a PCP (OR = 0.39, 95% CI, 0.21-0.72) and currently smoking (OR = 0.38, 95% CI, 0.18-0.79) were associated with lower odds of LCS discussion.
Conclusions
Future interventions are needed to ensure all LCS-eligible individuals have access to provider discussions about LCS.
{"title":"Assessing Factors Associated With Patient-Provider Discussions About Lung Cancer Screening Using Andersen’s Behavioral Model of Health Services Utilization","authors":"Owen Y. Cai , Jessica R. Fernandez , Melinda C. Aldrich , Jennifer Richmond","doi":"10.1016/j.cllc.2025.06.006","DOIUrl":"10.1016/j.cllc.2025.06.006","url":null,"abstract":"<div><h3>Background</h3><div>Patient-provider shared decision-making discussions are an important component of lung cancer screening guidelines, but little is known about factors associated with these discussions among screening-eligible patients. We used Andersen’s Behavioral Model of Health Services Utilization to examine factors associated with discussing LCS with a provider.</div></div><div><h3>Patients</h3><div>Data came from an online survey of <em>N</em> = 516 U.S. adults meeting United States Preventive Services Task Force LCS eligibility criteria (ie, were 50-80 years of age and had at least a 20-pack year history of tobacco use).</div></div><div><h3>Methods</h3><div>We used logistic regression to investigate whether having a LCS discussion was associated with predisposing factors (eg, chronic obstructive pulmonary disease [COPD] diagnosis), enabling factors (eg, having a primary care provider [PCP]), and need factors (eg, smoking history).</div></div><div><h3>Results</h3><div>About 36% participants had ever discussed LCS with a provider. Participants diagnosed with COPD (OR = 3.56, 95% CI, 1.90-6.67) and who had a first-degree relative with lung cancer (OR = 1.78, 95% CI, 1.02-3.09) had higher odds of LCS discussion than those without COPD and with no family history, respectively. Women had lower odds of LCS discussion than men (OR = 0.37, 95% CI, 0.24-0.58). Participants with an income of $30,000 to $59,999 had higher odds of LCS discussion compared to those earning < $30,000 (OR = 1.78, 95% CI, 1.06-2.98). Not having a PCP (OR = 0.39, 95% CI, 0.21-0.72) and currently smoking (OR = 0.38, 95% CI, 0.18-0.79) were associated with lower odds of LCS discussion.</div></div><div><h3>Conclusions</h3><div>Future interventions are needed to ensure all LCS-eligible individuals have access to provider discussions about LCS.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e534-e542"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574958","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}
Pub Date : 2025-11-01Epub Date: 2025-06-19DOI: 10.1016/j.cllc.2025.06.002
Aya Ghaleb Hashim , Rasmus Froberg Brøndum , Martin Skovmos Nielsen , Kasper Lind Laursen , Sille Vestergaard , Wenja Heijkoop , Weronika Maria Szejniuk
Objectives
Radiation pneumonitis (RP) presents a significant concern in the management of patients with locally advanced non-small cell lung cancer (NSCLC) undergoing definitive radiation therapy (RT). This study aims to investigate the clinical implication of unsuccessful steroid tapering due to rebound of respiratory symptoms in patients diagnosed with RP.
Materials and methods
This retrospective analysis included NSCLC patients treated with definitive RT between 2010 and 2020. Clinical data, steroid treatment outcome for RP, progression and survival data were collected. Patients were stratified based on RP diagnosis and successful or unsuccessful tapering of steroids due to rebound of respiratory symptoms. Survival was estimated using Kaplan-Meier and log-rank analyses. Univariate and multivariate Cox regression analyses were performed, P-values < .05 were considered significant.
Results
The cohort consisted of 273 patients. About 30.4% of patients (n = 83) developed RP. In the RP-group, 22.9% (n = 19) experienced unsuccessful tapering of steroid due to rebound of respiratory symptoms. Median progression-free survival (PFS) and overall survival (OS) in those patients were 9.0 months (95% CI 6.4-13.8) and 22.2 months (95% CI 17.0-34.9) respectively, significantly shorter than median PFS of 14.8 months (95% CI 5.9-36.3) and OS of 43.4 months (95% CI 27.9-71.2) in patients with successful tapering. A multivariate Cox regression with time-varying covariates confirmed the significantly higher risk of progression and death in those patients.
Conclusion
Patients with RP who experienced unsuccessful tapering of steroids due to rebound of respiratory symptoms had a significantly higher risk of progression and death compared to RP patients with successful tapering of steroids. More frequent surveillance may be considered in those patients.
目的：放射性肺炎（RP）在局部晚期非小细胞肺癌（NSCLC）患者接受最终放射治疗（RT）时的管理中具有重要意义。本研究旨在探讨诊断为RP的患者因呼吸道症状反弹而导致类固醇减量不成功的临床意义。材料和方法：本回顾性分析包括2010年至2020年间接受明确RT治疗的非小细胞肺癌患者。收集临床数据、类固醇治疗RP的结果、进展和生存数据。根据RP诊断和因呼吸道症状反弹导致的类固醇减量成功或不成功对患者进行分层。使用Kaplan-Meier和log-rank分析估计生存率。进行单因素和多因素Cox回归分析，p值< 0.05为显著性。结果：该队列包括273例患者。约30.4%的患者（n = 83）发生RP。在rp组中，22.9% （n = 19）的患者由于呼吸道症状的反弹而逐渐减少类固醇治疗失败。这些患者的中位无进展生存期（PFS）和总生存期（OS）分别为9.0个月（95% CI 6.4-13.8）和22.2个月（95% CI 17.0-34.9），显著短于成功减量患者的中位PFS 14.8个月（95% CI 5.9-36.3）和OS 43.4个月（95% CI 27.9-71.2）。具有时变协变量的多变量Cox回归证实，这些患者的进展和死亡风险明显更高。结论：由于呼吸道症状反弹导致类固醇减量治疗失败的RP患者与类固醇减量治疗成功的RP患者相比，其进展和死亡的风险明显更高。这些患者可以考虑进行更频繁的监测。
{"title":"Impact of Unsuccessful Steroid Tapering on Survival in Patients Treated for Radiation Pneumonitis Following Definitive Radiation for Non-Small Cell Lung Cancer","authors":"Aya Ghaleb Hashim , Rasmus Froberg Brøndum , Martin Skovmos Nielsen , Kasper Lind Laursen , Sille Vestergaard , Wenja Heijkoop , Weronika Maria Szejniuk","doi":"10.1016/j.cllc.2025.06.002","DOIUrl":"10.1016/j.cllc.2025.06.002","url":null,"abstract":"<div><h3>Objectives</h3><div>Radiation pneumonitis (RP) presents a significant concern in the management of patients with locally advanced non-small cell lung cancer (NSCLC) undergoing definitive radiation therapy (RT). This study aims to investigate the clinical implication of unsuccessful steroid tapering due to rebound of respiratory symptoms in patients diagnosed with RP.</div></div><div><h3>Materials and methods</h3><div>This retrospective analysis included NSCLC patients treated with definitive RT between 2010 and 2020. Clinical data, steroid treatment outcome for RP, progression and survival data were collected. Patients were stratified based on RP diagnosis and successful or unsuccessful tapering of steroids due to rebound of respiratory symptoms. Survival was estimated using Kaplan-Meier and log-rank analyses. Univariate and multivariate Cox regression analyses were performed, <em>P</em>-values < .05 were considered significant.</div></div><div><h3>Results</h3><div>The cohort consisted of 273 patients. About 30.4% of patients (<em>n</em> = 83) developed RP. In the RP-group, 22.9% (<em>n</em> = 19) experienced unsuccessful tapering of steroid due to rebound of respiratory symptoms. Median progression-free survival (PFS) and overall survival (OS) in those patients were 9.0 months (95% CI 6.4-13.8) and 22.2 months (95% CI 17.0-34.9) respectively, significantly shorter than median PFS of 14.8 months (95% CI 5.9-36.3) and OS of 43.4 months (95% CI 27.9-71.2) in patients with successful tapering. A multivariate Cox regression with time-varying covariates confirmed the significantly higher risk of progression and death in those patients.</div></div><div><h3>Conclusion</h3><div>Patients with RP who experienced unsuccessful tapering of steroids due to rebound of respiratory symptoms had a significantly higher risk of progression and death compared to RP patients with successful tapering of steroids. More frequent surveillance may be considered in those patients.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e517-e526.e1"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616627","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}
Pub Date : 2025-11-01Epub Date: 2025-06-10DOI: 10.1016/j.cllc.2025.06.001
Meagan Miller , Tim Lautenschlaeger , Thomas Birdas , Nasser Hanna , Greg Durm
Treatment options for resectable stage III (N2) NSCLC have evolved rapidly over the last few years. However, an optimal treatment strategy has yet to be determined. In the below article, we present the results of LUN17-321 in the context of current treatment options available.
{"title":"In the Era of Neoadjuvant Chemoimmunotherapy, is There a Role for Radiation Intensification Therapy in Patients With Stage III (N2) Non-Small Cell Lung Cancer (NSCLC) Who Undergo Surgery? Results of LUN17-321 in the Context of Current Clinical Treatment Options","authors":"Meagan Miller , Tim Lautenschlaeger , Thomas Birdas , Nasser Hanna , Greg Durm","doi":"10.1016/j.cllc.2025.06.001","DOIUrl":"10.1016/j.cllc.2025.06.001","url":null,"abstract":"<div><div>Treatment options for resectable stage III (N2) NSCLC have evolved rapidly over the last few years. However, an optimal treatment strategy has yet to be determined. In the below article, we present the results of LUN17-321 in the context of current treatment options available.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 7","pages":"Pages e514-e516"},"PeriodicalIF":3.3,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616628","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}
Pub Date : 2025-11-01Epub Date: 2025-07-09DOI: 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.
{"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":"2025-11-01","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号