Clinical lung cancer最新文献

Background: Sublobar resection is increasingly used for 2-3 cm non-small cell lung cancer (NSCLC), but its survival benefit compared to lobectomy for intermediate- and high-risk histological types (acinar, papillary, micropapillary, and solid) remains unclear. This study compares oncological outcomes of 2 surgical procedures in node-negative, non-metastatic NSCLC patients with such histological types.

Methods: We conducted a retrospective analysis using data from the Surveillance, Epidemiology, and End Results database of the United States National Cancer Institute from 2004 to 2022. Patients with 2-3 cm pN0M0 histologically recorded as acinar, papillary, micropapillary, or solid carcinoma, who were treated with either sublobar resection or lobectomy, were included. We compared overall survival ​by histological type.

Results: Among 1,458 patients, univariate and multivariate analyses identified age, sex, surgical procedure, and pleural invasion as independent prognostic factors. Stratified analysis by histological type suggested that sublobar resection was associated with worse survival in patients with solid (p < .001) and acinar carcinomas (p < .001), while pleural invasion significantly affected overall survival only in acinar carcinoma (p < .001).

Conclusions: For patients with stage ​pN0M0​ non-small cell lung cancer measuring 2-3 cm, the specific histological type plays a critical role in guiding the choice of surgical extent and in evaluating the prognostic implications of pleural invasion. Individualized treatment based on histological type is essential to optimize outcomes.

While curative radiation therapy provides excellent disease control for lung tumors, adverse cardiac events can occur from treatment. Due to the central proximity of the heart to the lungs, patients treated for lung cancer with radiation therapy are at heightened risk of increased cardiac radiation exposure. Conventionally, the whole heart is considered an organ-at-risk in which radiation dose should be minimized during treatment planning, employing strategic constraints such as maximum and mean dose. Emerging research highlights specific cardiac substructure doses, which are rarely utilized in clinical organ-at-risk planning, as more accurate predictors of postradiotherapy cardiac risk than whole heart dose alone. This review consolidates findings on substructure radiation doses associated with various cardiac outcomes to optimize lung treatment planning and guide development of thresholds, particularly for high-risk patients. Two PubMed searches identified 32 key studies published between 2017 and 2024. Radiation doses to heart chambers, conduction nodes, great vessels, coronary arteries, pericardium, and valves correlate with various adverse outcomes postradiotherapy. Minimizing radiation exposure to the left ventricle, left atrium, heart base, and left coronary arteries, including the left anterior descending and left circumflex arteries, is recommended. This systematic review supports the utilization of individual substructure doses rather than solely whole heart dose during lung radiotherapy planning to improve long term patient outcomes and wellbeing.

Purpose: Amivantamab is an EGFR-MET bispecific antibody approved as an intravenous formulation for EGFR-mutated advanced non-small cell lung cancer (NSCLC). Intravenous delivery is frequently associated with infusion-related reaction (IRRs), which require adopting slow infusion rates and splitting the first dose over 2 days. The PALOMA study assessed the safety and feasibility of subcutaneous amivantamab administration and identified the formulation and recommended phase II doses (RP2Ds) for multiple dosing schedules.

Patients and methods: PALOMA is a phase Ib dose-escalation study in 158 participants with advanced solid malignancies. Primary objectives included pharmacokinetics, safety, and determining RP2Ds for every-2-week (Q2W), every-3-week (Q3W), and every-4-week (Q4W) administration.

Results: The safety profile of subcutaneous amivantamab was largely consistent with intravenous monotherapy; most common toxicities reflected on-target EGFR/MET inhibition. Subcutaneous amivantamab resulted in meaningfully shorter administration time (≤ 10 minutes vs. 2.3 hours for intravenous beyond cycle 3) and lower incidence and severity of IRRs versus historical intravenous data, which eliminates the need for split-dose administration. Pharmacokinetic analyses and population pharmacokinetic modeling/simulation were used to estimate subcutaneous amivantamab RP2Ds of 1600 mg (2240 mg, ≥ 80 kg), 2400 mg (3360 mg, ≥ 80 kg), and 3520 mg (4640 mg, ≥ 80 kg) for Q2W, Q3W, and Q4W schedules, respectively. The observed efficacy was consistent with intravenous amivantamab monotherapy.

Conclusion: Subcutaneous amivantamab administration substantially reduced IRRs, obviating the need for prolonged infusions and 2-day split-dosing at first administration. The identified RP2Ds for subcutaneous amivantamab are implemented in ongoing studies evaluating amivantamab regimens in NSCLC, colorectal cancer, and head and neck squamous cell carcinoma.