Clinical lung cancer最新文献_第3页

Pembrolizumab in Combination With Platinum-Based Chemotherapy in Patients With Recurrent EGFR and ALK Gene Altered Non-Small-Cell Lung Cancer (NSCLC) 派姆单抗联合铂基化疗治疗复发性EGFR和ALK基因改变的非小细胞肺癌（NSCLC）患者

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2026-03-01 Epub Date: 2025-10-03 DOI: 10.1016/j.cllc.2025.09.002

Shirish M. Gadgeel , Misako Nagasaka , Karen Dziubek , Thomas Braun , Khaled Hassan , Haiying Cheng , Balazs Halmos , Antoinette Wozniak , James Stevenson , Pradnya Patil , Nathan Pennell , Mary Jo Fidler , Angel Qin , Zeqi Niu , Sunitha Nagrath , Gregory P. Kalemkerian

Introduction

Immune checkpoint inhibitors have limited efficacy in patients with EGFR-mutant (EGFR+) and ALK-rearranged (ALK+) non-small cell lung cancer (NSCLC). We conducted a phase II study to evaluate the efficacy of pembrolizumab with carboplatin and pemetrexed in these patients.

Patients and Methods

EGFR+ or ALK+ NSCLC patients, previously treated with targeted therapy, were eligible. Carboplatin, pemetrexed and pembrolizumab were administered every 3 weeks for 4 cycles followed by maintenance pemetrexed and pembrolizumab. The primary endpoint was response rate (RR). Blood for circulating tumor cells (CTCs) was collected prior to the 1st and 3rd cycles. The plan was to enroll 28 evaluable patients in both EGFR+ and ALK+ cohorts.

Results

Of the 33 patients enrolled, 26 had EGFR+ and 7 had ALK+ NSCLC. RR (95% CI,) was 46% (27%, 67%) in EGFR+ and 29% (4%, 71%), in ALK+ patients, respectively. Median progression free survival (PFS) and overall survival (OS) in the EGFR+ cohort were 8.3 months (7.2-16.5) and 22.2 months (20.6-NE), respectively. In the ALK+ cohort, median PFS and OS were both 2.9 months. The median CTC count at baseline in 15 evaluable EGFR+ patients was 4 cells/mL (0-23). OS among EGFR+ patients with decreasing vs. increasing CTC count during treatment was not reached vs. 18.5 months, respectively (P = .52). The most common adverse events were fatigue, nausea, anemia and AST/ALT elevation.

Conclusion

Pembrolizumab in combination with chemotherapy demonstrated encouraging RR of 42% and OS of 22 months among patients with recurrent EGFR+ NSCLC. The efficacy in ALK+ patients was not encouraging.

免疫检查点抑制剂对EGFR突变（EGFR+）和ALK重排（ALK+）非小细胞肺癌（NSCLC）患者的疗效有限。我们进行了一项II期研究，以评估派姆单抗与卡铂和培美曲塞在这些患者中的疗效。患者和方法：EGFR+或ALK+ NSCLC患者，既往接受靶向治疗，符合条件。卡铂、培美曲塞和派姆单抗每3周给药，持续4个周期，随后培美曲塞和派姆单抗维持。主要终点为缓解率（RR）。在第1周期和第3周期之前采集循环肿瘤细胞（ctc）的血液。计划在EGFR+和ALK+队列中招募28名可评估的患者。结果：入组的33例患者中，26例为EGFR+， 7例为ALK+ NSCLC。EGFR+患者的RR （95% CI,）分别为46%（27%,67%）和29%（4%,71%）。EGFR+队列的中位无进展生存期（PFS）和总生存期（OS）分别为8.3个月（7.2-16.5）和22.2个月（20.6 ne）。在ALK+队列中，中位PFS和OS均为2.9个月。15例可评估的EGFR+患者基线时的中位CTC计数为4个细胞/mL（0-23）。EGFR+患者在治疗期间CTC计数减少和增加未达到OS，分别为18.5个月（P = 0.52）。最常见的不良事件是疲劳、恶心、贫血和AST/ALT升高。结论：在复发性EGFR+ NSCLC患者中，派姆单抗联合化疗显示出令人鼓舞的42%的RR和22个月的OS。ALK+患者的疗效并不令人鼓舞。

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引用次数: 0

Clinical Outcomes and Predictive Factors in NSCLC after Surgery: Findings from the RAC-TAC Study 非小细胞肺癌手术后的临床结果和预测因素：RAC-TAC研究的结果。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2026-03-01 Epub Date: 2025-09-30 DOI: 10.1016/j.cllc.2025.09.012

Alessio Bruni , Davide Franceschini , Beatrice Marini , Stefano Vagge , Patrizia Ciammella , Matteo Sepulcri , Roberta Grassi , Federico Gagliardi , Anna Cappelli , Elisa D'Angelo , Mattia Manetta , Melissa Scricciolo , Cesare Guida , Ivan Fazio , Paolo Borghetti , Salvatore Cappabianca , Valerio Nardone

Purpose

Recent trials like LUNG-ART and PORT-C have redefined postoperative radiation therapy (PORT) for pN2 non-small cell lung cancer (NSCLC). To assess the acute and long-term toxicities of contemporary PORT techniques, the Italian Association of Radiotherapy and Oncology Lung Cancer Study Group initiated a multicenter observational study, analyzing clinical factors influencing local control, distant control, and overall survival.

Methods

Data from 6 Italian centers were reviewed for NSCLC patients undergoing PORT between 2015 and 2020. Acute and late toxicity outcomes were previously reported. This study correlates clinical variables with local recurrence, distant recurrence, and survival outcomes.

Results

Local recurrence correlated with the number of lymph nodes removed (P = .003) and patient age (P = .006). Distant recurrence was linked to the number of positive lymph nodes (P = .001) and T stage (P = .009). Overall survival was significantly associated with the number of positive nodes (P = .006) and ECOG performance status (P < .001). A risk stratification system categorized patients into low, intermediate, and high-risk groups, with the low-risk group showing significantly better progression-free survival (P < .001), distant control (P = .004), and overall survival (P = .008).

Conclusions

Distant metastases remain the main recurrence type. The extent of lymph node dissection and the count of positive nodes significantly influence recurrence patterns. These findings support integrating systemic and local therapies to improve outcomes in pN2 NSCLC.

目的：最近的试验，如lung - art和PORT- c，重新定义了pN2非小细胞肺癌（NSCLC）的术后放射治疗（PORT）。为了评估当代PORT技术的急性和长期毒性，意大利放射与肿瘤协会肺癌研究组发起了一项多中心观察性研究，分析了影响局部对照、远程对照和总生存期的临床因素。方法：对2015年至2020年间接受PORT手术的6个意大利中心的非小细胞肺癌患者的数据进行了回顾。急性和晚期毒性结果先前有报道。该研究将临床变量与局部复发、远处复发和生存结果联系起来。结果：局部复发与淋巴结切除数（P = 0.003）和患者年龄（P = 0.006）相关。远处复发与阳性淋巴结数目（P = 0.001）和T分期（P = 0.009）有关。总生存率与阳性淋巴结数（P = 0.006）和ECOG功能状态（P < 0.001）显著相关。风险分层系统将患者分为低、中、高风险组，低风险组的无进展生存期（P < 0.001）、远端对照（P = 0.004）和总生存期（P = 0.008）明显更好。结论：远处转移仍是主要的复发类型。淋巴结清扫的程度和阳性淋巴结的计数显著影响复发类型。这些发现支持整合全身和局部治疗来改善pN2 NSCLC的预后。

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引用次数: 0

Response to Letter to the Editor 对给编辑的信的回应

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2026-03-01 Epub Date: 2025-09-19 DOI: 10.1016/j.cllc.2025.09.006

Margrethe Bang Henriksen , Ole Hilberg , Christian Juul , Rasmus Thomsen , Sara Witting Christensen Wen , Morten Borg , Andreas Fanø , Alon Lanyado , Itamar Menuhin-Gruman

引用次数: 0

Management of Pulmonary Large-Cell Neuroendocrine Carcinoma (LCNEC): An Updated Review 肺大细胞神经内分泌癌（LCNEC）的治疗：最新综述。

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2026-03-01 Epub Date: 2026-01-11 DOI: 10.1016/j.cllc.2026.01.003

Anson Man Lok Yeung, James Chung Hang Chow

Pulmonary large-cell neuroendocrine carcinoma (LCNEC) is an uncommon and aggressive malignancy, accounting for approximately 3% of all primary lung malignancies. Due to its rarity, the treatment paradigm for LCNEC is primarily derived from retrospective data from non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). This review synthesizes current evidence and discusses emerging treatment strategies. For medically fit patients with resectable disease, surgical resection, in particular lobectomy, should be offered, while stereotactic body radiation therapy can be reserved for medically inoperable patients. Adjuvant chemotherapy is suggested for most resected tumors, with SCLC regimens (eg, etoposide-cisplatin) associated with better outcomes; however, very early-stage tumors (stage IA) warrant individualized decision-making. There is currently no evidence supporting the use of adjuvant immunotherapy in LCNEC. The role of adjuvant radiotherapy, neoadjuvant therapy and prophylactic cranial irradiation in LCNEC remains undefined. For unresectable, locally advanced disease, concurrent chemoradiation with etoposide-cisplatin followed by consolidation durvalumab is recommended, although the optimal dose-fractionation and the duration of consolidation immunotherapy remain to be investigated. In metastatic disease, etoposide-platinum chemotherapy remains the first-line treatment, while targeted therapy can be considered if tumors harbor actionable genomic alterations. The potential benefit of immunotherapy is currently under investigation. While several second-line treatment options have been reported with modest efficacy, local ablative treatment has shown promise in oligometastatic LCNEC. Among the most promising emerging treatment strategies are DLL3-targeting therapies, buoyed by the recent success of tarlatamab in SCLC. The evolving role of molecular profiling in prognostication and treatment decision-making is also examined.

肺大细胞神经内分泌癌（LCNEC）是一种罕见的侵袭性恶性肿瘤，约占所有原发性肺恶性肿瘤的3%。由于其罕见性，LCNEC的治疗模式主要来源于非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC）的回顾性数据。这篇综述综合了目前的证据并讨论了新兴的治疗策略。对于医学上适合切除疾病的患者，应提供手术切除，特别是肺叶切除术，而立体定向体放射治疗可保留给医学上不能手术的患者。大多数切除的肿瘤建议辅助化疗，SCLC方案（例如依托泊滨-顺铂）与更好的结果相关；然而，非常早期的肿瘤（IA期）需要个性化的决策。目前没有证据支持在LCNEC中使用辅助免疫治疗。辅助放疗、新辅助治疗和预防性颅脑照射在LCNEC中的作用尚不明确。对于不可切除的局部晚期疾病，建议同时使用依托泊赛-顺铂进行放化疗，然后再进行巩固性杜伐单抗，尽管最佳剂量-分割和巩固性免疫治疗的持续时间仍有待研究。在转移性疾病中，依托泊肽-铂化疗仍然是一线治疗，而如果肿瘤有可操作的基因组改变，则可以考虑靶向治疗。免疫疗法的潜在益处目前正在调查中。虽然一些二线治疗方案的疗效一般，但局部消融治疗在低转移性LCNEC中显示出希望。其中最有希望的新兴治疗策略是dll3靶向治疗，最近tarlatamab在SCLC中的成功受到鼓舞。分子谱在预测和治疗决策中的作用也在不断发展。

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引用次数: 0

Selpercatinib-Associated Nephropathy in RET Fusion-Positive Lung Cancer: A Case Successfully Managed With Dose Adjustment and Nephroprotective Therapy selpercatinib相关肾病RET融合阳性肺癌：剂量调整和肾保护治疗成功一例

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2026-03-01 Epub Date: 2025-12-06 DOI: 10.1016/j.cllc.2025.12.001

Kohei Oe , Koichi Saruwatari , Yoshikazu Miyasato , Yutaka Kakizoe , Kaori Mochida , Tsuguhiro Furukawa , Kei Muramoto , Kimitaka Akaike , Yusuke Tomita , Takuro Sakagami

•
Nephrotic syndrome developed after selpercatinib in RET fusion-positive lung cancer
•
Renal biopsy revealed podocyte injury and mesangial IgA/IgM deposition
•
Proteinuria improved with selpercatinib dose reduction and ARB/SGLT2 use
•
Selpercatinib was successfully continued after nephroprotective intervention

•selpercatinib治疗RET融合阳性肺癌后出现肾病综合征•肾活检显示足细胞损伤和系膜IgA/IgM沉积•减少selpercatinib剂量和使用ARB/SGLT2后蛋白尿改善•肾保护干预后成功继续使用selpercatinib

引用次数: 0

Lung SBRT Outcomes for Inoperable Early-Stage Lung Cancer Are Impaired in Patients With Solid Organ Transplants 不能手术的早期肺癌的肺SBRT结果在实体器官移植患者中受损

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2026-03-01 Epub Date: 2025-12-08 DOI: 10.1016/j.cllc.2025.12.003

Gregory M.M. Videtic , Christopher W. Fleming , Chandana A. Reddy , Kevin L. Stephans

Purpose

To characterize outcomes for solid organ transplant patients with medically inoperable early-stage lung cancer (ES-LC) treated with lung stereotactic body radiotherapy (SBRT).

Methods

We surveyed our institutional review board-approved prospective lung SBRT data registry from 2003 to 2023 for any transplant patients. Patterns of failure were assessed, as well as overall survival (OS) and disease-free survival (DFS). Univariate prognostic factors for OS and DFS were identified with Cox proportional hazards regression.

Results

Twenty-eight of 1976 definitively treated patients (1.4%) met study criteria. Median follow up was 12.4 months. Patient characteristics included: male (67.9%), median pack-years smoking of 34; median age 70.0 years; median Karnofsky Performance Status (KPS) 80. Organs transplanted were lung (57.2%), liver (21.4%), heart (21.4%). Tumor characteristics included: median size 2.4 cm; 85.7% with biopsy-proven cancer. Toxicity (any grade/type) was reported in 9 (32.1%) patients. Failure patterns were local 21.4%, lobar 7.1%, nodal 10.7% and distant 32.1%. First site of failure was distant in 50.0% patients. Median DFS and OS were 17.1 and 14.5 months, respectively. Increasing pack-years smoking was the only factor associated with increased disease failure on univariate analysis (UVA) (P = .0016). KPS and tumor size were significantly associated with OS on UVA and on multivariable analysis (P = .0075) and (P = .0181), respectively.

Conclusions

Organ transplant patients with inoperable ES-LC had higher than expected rates of local failure, decreased cancer control and poorer overall survival after SBRT. We hypothesize that transplant-associated immunosuppression promotes metastatic progression and a tumor biology resistant to SBRT.

目的探讨实体器官移植合并医学上不能手术的早期肺癌（ES-LC）患者肺立体定向放射治疗（SBRT）的疗效。方法：我们调查了机构审查委员会批准的2003年至2023年任何移植患者的前瞻性肺SBRT数据注册表。评估失败模式，以及总生存期（OS）和无病生存期（DFS）。采用Cox比例风险回归确定OS和DFS的单因素预后因素。结果1976例确诊患者中有28例（1.4%）符合研究标准。中位随访时间为12.4个月。患者特征包括：男性（67.9%），中位吸烟年数34；中位年龄70.0岁；Karnofsky Performance Status （KPS）中位数80。移植器官为肺（57.2%）、肝（21.4%）、心（21.4%）。肿瘤特征包括：中位尺寸2.4 cm；85.7%为活检证实的癌症。9例（32.1%）患者报告毒性（任何级别/类型）。失败类型为局部21.4%，大叶性7.1%，淋巴结性10.7%，远处性32.1%。在50.0%的患者中，第一次失败的部位在远处。中位DFS和OS分别为17.1和14.5个月。单变量分析（UVA）显示，吸烟年数增加是与疾病失败增加相关的唯一因素（P = 0.0016）。在UVA和多变量分析中，KPS和肿瘤大小分别与OS显著相关（P = 0.0075）和（P = 0.0181）。结论不能手术的ES-LC器官移植患者SBRT术后局部失败率高于预期，肿瘤控制率下降，总生存率较差。我们假设移植相关的免疫抑制促进了转移进展和肿瘤生物学对SBRT的抗性。

{"title":"Lung SBRT Outcomes for Inoperable Early-Stage Lung Cancer Are Impaired in Patients With Solid Organ Transplants","authors":"Gregory M.M. Videtic , Christopher W. Fleming , Chandana A. Reddy , Kevin L. Stephans","doi":"10.1016/j.cllc.2025.12.003","DOIUrl":"10.1016/j.cllc.2025.12.003","url":null,"abstract":"<div><h3>Purpose</h3><div>To characterize outcomes for solid organ transplant patients with medically inoperable early-stage lung cancer (ES-LC) treated with lung stereotactic body radiotherapy (SBRT).</div></div><div><h3>Methods</h3><div>We surveyed our institutional review board-approved prospective lung SBRT data registry from 2003 to 2023 for any transplant patients. Patterns of failure were assessed, as well as overall survival (OS) and disease-free survival (DFS). Univariate prognostic factors for OS and DFS were identified with Cox proportional hazards regression.</div></div><div><h3>Results</h3><div>Twenty-eight of 1976 definitively treated patients (1.4%) met study criteria. Median follow up was 12.4 months. Patient characteristics included: male (67.9%), median pack-years smoking of 34; median age 70.0 years; median Karnofsky Performance Status (KPS) 80. Organs transplanted were lung (57.2%), liver (21.4%), heart (21.4%). Tumor characteristics included: median size 2.4 cm; 85.7% with biopsy-proven cancer. Toxicity (any grade/type) was reported in 9 (32.1%) patients. Failure patterns were local 21.4%, lobar 7.1%, nodal 10.7% and distant 32.1%. First site of failure was distant in 50.0% patients. Median DFS and OS were 17.1 and 14.5 months, respectively. Increasing pack-years smoking was the only factor associated with increased disease failure on univariate analysis (UVA) (<em>P</em> = .0016). KPS and tumor size were significantly associated with OS on UVA and on multivariable analysis (<em>P</em> = .0075) and (<em>P</em> = .0181), respectively.</div></div><div><h3>Conclusions</h3><div>Organ transplant patients with inoperable ES-LC had higher than expected rates of local failure, decreased cancer control and poorer overall survival after SBRT. We hypothesize that transplant-associated immunosuppression promotes metastatic progression and a tumor biology resistant to SBRT.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 2","pages":"Pages 6-13"},"PeriodicalIF":3.3,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915439","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

Partial Response to Repotrectinib in ROS1-Rearranged Lung Squamous Cell Carcinoma: A Brief Report Repotrectinib在ros1重排肺鳞状细胞癌中的部分应答：简要报告

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2026-03-01 Epub Date: 2026-01-07 DOI: 10.1016/j.cllc.2026.01.002

Yukiko Yoshida , Hajime Asahina , Ken Kuwahara , Hidenori Mizugaki , Noriyuki Yamada , Hiroshi Yokouchi , Naohiro Nomura , Yoshihiro Matsuno , Satoshi Oizumi

•
ROS1 fusions are rare in lung squamous cell carcinoma (SCC), but they can occur, especially in non-smoking patients, highlighting the importance of comprehensive molecular testing even in SCC histology.
•
Repotrectinib, a next-generation ROS1 tyrosine kinase inhibitor, demonstrated marked tumor regression and good tolerability as first-line treatment in an older adult patient with ROS1-rearranged lung SCC—the first such report to date.
•
This case suggests that ROS1-targeted therapies may provide clinical benefit in SCC harboring ROS1 rearrangements, emphasizing the need for molecular profiling to guide treatment decisions, regardless of tumor histology.
•
Even at a reduced dose, repotrectinib was effective and well tolerated in this older adult patient, suggesting dose adjustment may be considered based on individual patient characteristics.
•
Comprehensive molecular profiling, including ROS1 testing, should be part of routine diagnostic workup in non-smoking patients with NSCLC, including those with SCC histology, to identify potential actionable targets and optimize treatment strategy.

•ROS1融合在肺鳞状细胞癌（SCC）中很少见，但它们可能发生，特别是在非吸烟患者中，这突出了在SCC组织学中进行全面分子检测的重要性。•Repotrectinib，新一代ROS1酪氨酸激酶抑制剂，在ROS1重排肺scc的老年成人患者中作为一线治疗显示出明显的肿瘤消退和良好的耐受性，这是迄今为止的第一个此类报道。•本病例提示，ROS1靶向治疗可能为含有ROS1重排的SCC提供临床益处，强调无论肿瘤组织学如何，都需要分子谱分析来指导治疗决策。•即使在减少剂量时，repotrectinib在该老年患者中也是有效且耐受性良好的，这表明可以根据患者的个体特征考虑剂量调整。•全面的分子谱分析，包括ROS1检测，应成为非吸烟非小细胞肺癌患者（包括具有鳞状细胞癌组织学的非吸烟非小细胞肺癌患者）常规诊断检查的一部分，以确定潜在的可行靶点并优化治疗策略。

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引用次数: 0

Factors Influencing Refusal of Adjuvant Chemotherapy in Non–Small Cell Lung Carcinoma 非小细胞肺癌患者拒绝辅助化疗的影响因素

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2026-03-01 Epub Date: 2026-01-29 DOI: 10.1016/j.cllc.2026.01.008

Claire Perez, Vikram Krishna, Drew Bolster, Kellie Knabe, Raffaele Rocco, Philicia Moonsamy, Harmik J. Soukiasian, Andrew R. Brownlee

Background

Adjuvant chemotherapy is recommended for patients with resectable stage II and IIIA non–small cell lung cancer (NSCLC) and may be considered for high-risk stage I cases. Despite these guidelines, a significant number of patients decline treatment. We hypothesize that socioeconomic factors contribute to adjuvant chemotherapy refusal.

Methods

We queried the National Cancer Database (2010-2020) for patients with stage IB–IIIB NSCLC who underwent complete surgical resection. Patients were stratified by receipt of adjuvant chemotherapy. Multivariable logistic regression identified factors associated with chemotherapy refusal. Survival outcomes were analyzed using Kaplan–Meier curves.

Results

Of 47,481 eligible patients, 6701 (14.1%) refused adjuvant chemotherapy. Older patients (age > 75) had higher odds of refusal (OR 5.2, 95% CI, 7.7-3.5). In contrast, Hispanic (OR 0.76, 95% CI, 0.90-0.63) and Black patients (OR 0.86, 95% CI, 0.95-0.78) were less likely to refuse. Higher comorbidity burden (Charlson-Deyo > 3) and lack of insurance increased the likelihood of refusal (OR 1.32 and OR 1.3, respectively). Patients treated at academic centers were less likely to refuse than those at community centers (OR 0.88, 95% CI, 0.93-0.82). No sex-based differences were observed. Refusal was associated with reduced survival (HR 1.1, 95% CI, 1.1-1.01).

Conclusions

Refusal of adjuvant chemotherapy in resectable NSCLC is influenced by age, comorbidities, insurance status, and treatment facility type. These findings highlight the need for targeted strategies to address treatment disparities and improve patient outcomes.

背景：辅助化疗推荐用于可切除的II期和IIIA期非小细胞肺癌（NSCLC）患者，并可考虑用于高风险的I期病例。尽管有这些指导方针，仍有相当数量的患者拒绝接受治疗。我们假设社会经济因素有助于辅助化疗的拒绝。方法：我们查询了国家癌症数据库（2010-2020）中接受完全手术切除的IB-IIIB期非小细胞肺癌患者。通过接受辅助化疗对患者进行分层。多变量logistic回归确定了与化疗拒绝相关的因素。生存结果采用Kaplan-Meier曲线分析。结果：在47,481例符合条件的患者中，6701例（14.1%）拒绝辅助化疗。年龄较大的患者（50 ~ 75岁）有较高的拒绝率（OR 5.2, 95% CI, 7.7 ~ 3.5）。相比之下，西班牙裔患者（OR 0.76, 95% CI, 0.90-0.63）和黑人患者（OR 0.86, 95% CI, 0.95-0.78）拒绝的可能性较小。较高的合并症负担（Charlson-Deyo >3）和缺乏保险增加了拒绝的可能性（OR分别为1.32和1.3）。在学术中心接受治疗的患者比在社区中心接受治疗的患者更不可能拒绝治疗（OR 0.88, 95% CI, 0.93-0.82）。没有观察到基于性别的差异。拒绝治疗与生存率降低相关（HR 1.1, 95% CI, 1.1-1.01）。结论：可切除的非小细胞肺癌患者拒绝辅助化疗受年龄、合并症、保险状况和治疗机构类型的影响。这些发现强调需要有针对性的策略来解决治疗差异和改善患者的结果。

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引用次数: 0

Amivantamab-Associated Vasculitis in a Patient With EGFR Exon 20 Insertion Non–Small Cell Lung Cancer: A Case Report 伴有EGFR外显子20插入的非小细胞肺癌患者阿米万他单相关血管炎一例报告

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2026-03-01 Epub Date: 2026-01-30 DOI: 10.1016/j.cllc.2026.01.012

Daisuke Morinaga , Megumi Furuta , Doppo Fukui , Yuki Matsuura , Yukiko Yoshida , Shotaro Ito , Yuta Takashima , Hidenori Kitai , Zenichi Tanei , Jun Sakakibara-Konishi , Satoshi Konno

•
Amivantamab is a bispecific antibody targeting both EGFR and MET, with antibody-dependent cellular cytotoxicity activity and other immune-activating abilities.
•
It represents the first-in-class drug for the established standard therapy of NSCLC harboring EGFR exon 20 insertion mutations.
•
Real-world safety data on amivantamab remain limited, and vasculitis has not been previously reported.
•
We report a first case of amivantamab-associated vasculitis confirmed by lymph node biopsy, which resolved rapidly with corticosteroid treatment.

•Amivantamab是一种针对EGFR和MET的双特异性抗体，具有抗体依赖的细胞毒性活性和其他免疫激活能力。•它代表了具有EGFR外显子20插入突变的NSCLC建立标准治疗的一流药物。•amivantamab的实际安全性数据仍然有限，血管炎以前没有报道。•我们报告了第一例经淋巴结活检证实的阿米万他单抗相关血管炎，经皮质类固醇治疗后迅速缓解。

引用次数: 0

Real-World Effectiveness of Second-Line Therapies in Advanced Non-Small Cell Lung Cancer: Insights From Propensity-Weighted Comparative Analyses of Longitudinal EHR Data 二线治疗晚期非小细胞肺癌的实际有效性：来自纵向电子病历数据倾向加权比较分析的见解

IF 3.3 3区医学 Q2 ONCOLOGY

Clinical lung cancer

Pub Date : 2026-03-01 Epub Date: 2025-09-26 DOI: 10.1016/j.cllc.2025.09.010

Gary C.N. Hettinger PhD , Qi Long PhD , Ravi B. Parikh MD

Background

While substantial research has focused on first-line (1L) therapies for advanced-stage non-small cell lung cancer (aNSCLC), less is known about the effectiveness of second-line (2L) treatments following disease progression on 1L. The poor prognosis after 1L progression, limited guidance for 2L treatment, and constraints of clinical trials in addressing these questions underscore the need for real-world comparative effectiveness research.

Methods

We conducted a retrospective analysis to compare real-world overall survival (rwOS) associated with 2L treatments among patients with disease progression during 1L. Eligible patients were selected from Flatiron Health’s nationwide electronic health record (EHR)-derived de-identified database. 1L and 2L treatments were categorized as chemotherapy-only (Chemo-alone), combination chemo- and immunotherapy (Chemo + Immuno), immunotherapy-only (IO-alone), targeted-alone therapy, or targeted-plus therapy. We used inverse probability of treatment weighting to adjust for extensive static and longitudinal patient-level confounding and compared rwOS using Kaplan-Meier curves and restricted mean survival time (RMST).

Results

Among patients previously treated with 1L Targeted therapy, those receiving 2L Targeted-alone therapy had longer life expectancies than those receiving a nontargeted (ΔRMST-36 + 2.61 months) or Targeted-plus regimen (ΔRMST-36 + 3.11 months). For patients progressing on 1L Chemo + Immuno, 2L Chemo + Immuno outperformed Chemo-alone (ΔRMST-36 + 2.98 months). Among patients progressing ≥1 year after initiating 1L IO-alone, 2L Chemo + Immuno again showed better life expectancy than Chemo-alone (ΔRMST-36 + 5.70 months).

Conclusions

Longitudinal real-world data can enhance assessment of 2L therapy effectiveness. After confounder adjustment, we found clinically meaningful survival differences by 2L choice. These findings underscore the importance of 2L treatment selection and the need for prospective validation.

背景：虽然大量研究集中在一线（1L）治疗晚期非小细胞肺癌（aNSCLC），但对1L疾病进展后二线（2L）治疗的有效性知之甚少。1L进展后预后不良，2L治疗指导有限，以及解决这些问题的临床试验的局限性，强调了对现实世界比较有效性研究的需求。方法：我们进行了一项回顾性分析，比较在1L期间疾病进展的患者中与2L治疗相关的真实世界总生存期（rwOS）。从Flatiron Health的全国电子健康记录（EHR）衍生的去识别数据库中选择符合条件的患者。1L和2L治疗分为单独化疗（单独化疗）、联合化疗和免疫治疗（化疗+免疫）、单独免疫治疗（单独化疗）、单独靶向治疗或靶向加治疗。我们使用治疗加权逆概率来调整广泛的静态和纵向患者水平的混杂，并使用Kaplan-Meier曲线和限制平均生存时间（RMST）比较rwOS。结果：在先前接受1L靶向治疗的患者中，接受2L靶向单独治疗的患者比接受非靶向治疗（ΔRMST-36 + 2.61个月）或靶向治疗+方案（ΔRMST-36 + 3.11个月）的患者预期寿命更长。对于1L化疗+免疫治疗进展的患者，2L化疗+免疫治疗优于化疗单独治疗（ΔRMST-36 + 2.98个月）。在开始单独使用1L化疗后进展≥1年的患者中，2L化疗+免疫治疗再次显示出比单独使用化疗更好的预期寿命（ΔRMST-36 + 5.70个月）。结论：真实世界的纵向数据可以增强对2L治疗效果的评估。在混杂校正后，我们发现2L选择的生存差异具有临床意义。这些发现强调了2L治疗选择的重要性和前瞻性验证的必要性。

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引用次数: 0