Pub Date : 2026-01-01Epub Date: 2025-11-08DOI: 10.1016/j.cllc.2025.11.007
Parth Anil Desai, Hossein Borghaei, Martin J. Edelman
Abstract
Definitive resection has long anchored curative therapy for early–stage and locally advanced non–small cell lung cancer (NSCLC), with adjuvant platinum doublets—and now adjuvant immune–checkpoint inhibitors (ICIs)—providing incremental gains in disease–free survival. Neoadjuvant chemo–immunotherapy may amplify benefit by expanding tumour–specific T–cell clones in situ, thereby addressing occult micrometastatic disease. Randomised trials (CheckMate 816, KEYNOTE–671, AEGEAN, CheckMate 77T) consistently improve event–free survival, pathological response, and in some cases overall survival over neoadjuvant chemotherapy alone. However, none compared directly with the long–standing standard of upfront surgery followed by adjuvant therapy, and 15–24 % of enrolled patients never reach the operating room—most commonly because of radiographic progression (5–8 %) or evolving surgical ineligibility. Consequently, roughly one in five potentially curable patients may lose their window for resection, highlighting a clinically meaningful tradeoff. These findings underscore three priorities: (i) rigorous prospective comparison of perioperative versus purely adjuvant systemic strategies—now underway in the PROSPECT–LUNG trial (NCT06632327); (ii) biomarker discovery to predict primary resistance and identify patients better served by immediate surgery; and (iii) nuanced shared decision–making that balances hoped–for systemic control against the risk of surgical attrition. Realising the full promise of ICIs in resectable NSCLC will require optimising both treatment sequencing and patient selection.
{"title":"Neoadjuvant Chemo-Immunotherapy for Surgically Resectable Non-Small Cell Lung Cancer: Balancing Promise and Pitfalls","authors":"Parth Anil Desai, Hossein Borghaei, Martin J. Edelman","doi":"10.1016/j.cllc.2025.11.007","DOIUrl":"10.1016/j.cllc.2025.11.007","url":null,"abstract":"<div><h3>Abstract</h3><div>Definitive resection has long anchored curative therapy for early–stage and locally advanced non–small cell lung cancer (NSCLC), with adjuvant platinum doublets—and now adjuvant immune–checkpoint inhibitors (ICIs)—providing incremental gains in disease–free survival. Neoadjuvant chemo–immunotherapy may amplify benefit by expanding tumour–specific T–cell clones in situ, thereby addressing occult micrometastatic disease. Randomised trials (CheckMate 816, KEYNOTE–671, AEGEAN, CheckMate 77T) consistently improve event–free survival, pathological response, and in some cases overall survival over neoadjuvant chemotherapy alone. However, none compared directly with the long–standing standard of upfront surgery followed by adjuvant therapy, and 15–24 % of enrolled patients never reach the operating room—most commonly because of radiographic progression (5–8 %) or evolving surgical ineligibility. Consequently, roughly one in five potentially curable patients may lose their window for resection, highlighting a clinically meaningful tradeoff. These findings underscore three priorities: (i) rigorous prospective comparison of perioperative versus purely adjuvant systemic strategies—now underway in the PROSPECT–LUNG trial (NCT06632327); (ii) biomarker discovery to predict primary resistance and identify patients better served by immediate surgery; and (iii) nuanced shared decision–making that balances hoped–for systemic control against the risk of surgical attrition. Realising the full promise of ICIs in resectable NSCLC will require optimising both treatment sequencing and patient selection.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 1","pages":"Pages 55-58"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145687159","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}
While smoking is a principal risk factor for lung cancer, the steadily increasing incidence in never smokers is underscoring the impact of additional factors, such as genetic predisposition. The presence of pathogenic or likely pathogenic germline variants in cancer predisposition genes has been recognized as a contributing factor to lung cancer, suggesting that familial aggregation is a pertinent criterion for genetic testing. This study attempts to identify the prevalence of Pathogenic germline variants (PGVs) in Indian lung cancer patients with familial aggregation.
Methods
Patients with non-small cell lung cancer (NSCLC) were screened for significant family history and they underwent genetic testing. Germline DNA from blood samples was analyzed using a next-generation sequencing panel of 143 cancer predisposition genes. The clinical, pathological, demographic, and survival data of patients with positive family history and PGVs were analyzed.
Results
A total of 750 patients were screened, with 137 (18.26%) identified as having a significant family history, and a median age of 60 years (range: 21-79 years). Of these, 103 patients underwent next-generation sequencing (NGS), revealing pathogenic or likely pathogenic alterations in 17 individuals. These 17 patients exhibited mutations across 12 genes, 10 of which were associated with DNA damage repair pathways. Most commonly mutated genes were ATM and BRCA2. One unaffected first-degree relative (FDR) from 12 of these 17 patient’s family were tested, and 8 such FDRs were found to carry the same mutation as that of the index patient.
Conclusion
In this study we report the frequency of pathogenic/likely pathogenic (P/LP) germline variants in Indian patients with NSCLC with significant family history of cancer to be 16.5%. It suggests the potential utility of genetic testing to guide targeted screening strategies in this high-risk population.
{"title":"Germline Variants in Indian Non-Small Cell Lung Cancer Patients With Familial Aggregation: A Prospective Cohort Study","authors":"Aayushi Agrawal , Sindhura Durga Chitikela , Abhay Rastogi , Sachin Khurana , Deepam Pushpam , Raja Pramanik , Akash Kumar , Aparna Sharma , Monika Chettri , Ishaan Gupta , Amber Rathore , Deepali Jain , Sachin Kumar , Prabhat Singh Malik","doi":"10.1016/j.cllc.2025.10.020","DOIUrl":"10.1016/j.cllc.2025.10.020","url":null,"abstract":"<div><h3>Background</h3><div>While smoking is a principal risk factor for lung cancer, the steadily increasing incidence in never smokers is underscoring the impact of additional factors, such as genetic predisposition. The presence of pathogenic or likely pathogenic germline variants in cancer predisposition genes has been recognized as a contributing factor to lung cancer, suggesting that familial aggregation is a pertinent criterion for genetic testing. This study attempts to identify the prevalence of Pathogenic germline variants (PGVs) in Indian lung cancer patients with familial aggregation.</div></div><div><h3>Methods</h3><div>Patients with non-small cell lung cancer (NSCLC) were screened for significant family history and they underwent genetic testing. Germline DNA from blood samples was analyzed using a next-generation sequencing panel of 143 cancer predisposition genes. The clinical, pathological, demographic, and survival data of patients with positive family history and PGVs were analyzed.</div></div><div><h3>Results</h3><div>A total of 750 patients were screened, with 137 (18.26%) identified as having a significant family history, and a median age of 60 years (range: 21-79 years). Of these, 103 patients underwent next-generation sequencing (NGS), revealing pathogenic or likely pathogenic alterations in 17 individuals. These 17 patients exhibited mutations across 12 genes, 10 of which were associated with DNA damage repair pathways. Most commonly mutated genes were ATM and BRCA2. One unaffected first-degree relative (FDR) from 12 of these 17 patient’s family were tested, and 8 such FDRs were found to carry the same mutation as that of the index patient.</div></div><div><h3>Conclusion</h3><div>In this study we report the frequency of pathogenic/likely pathogenic (P/LP) germline variants in Indian patients with NSCLC with significant family history of cancer to be 16.5%. It suggests the potential utility of genetic testing to guide targeted screening strategies in this high-risk population.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 1","pages":"Pages 15-23"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145555391","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 : 2026-01-01Epub Date: 2025-11-07DOI: 10.1016/j.cllc.2025.11.001
Parth Aphale, Shashank Dokania, Himanshu Shekhar
{"title":"Letter to the Editor: “Prognostic Implications of Lymph Node Status in Non–Small-Cell Lung Cancer Patients Before and After Neoadjuvant Chemoimmunotherapy: A Multicenter Retrospective Study”","authors":"Parth Aphale, Shashank Dokania, Himanshu Shekhar","doi":"10.1016/j.cllc.2025.11.001","DOIUrl":"10.1016/j.cllc.2025.11.001","url":null,"abstract":"","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 1","pages":"Pages 47-48"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619917","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 : 2026-01-01Epub Date: 2025-11-22DOI: 10.1016/j.cllc.2025.11.016
Ivy Riano , Maria A. Velez , Hugo Pomares-Millan , Juan Blaquier , Supriya Peshin , Jill Feldman , Ana I. Velazquez
Introduction
Brain metastases (BM) occur in approximately 20% of lung cancer patients. Despite recent treatment advances, people with BM are often excluded from clinical trials (CT) limiting our understanding of therapy effectiveness. We evaluated how the 2017 ASCO/FDA/Friends of Cancer Research (FoCR) recommendations on inclusion of patients with BM and leptomeningeal disease (LMD) in CT have been adopted by registered lung cancer trials.
Methods
We retrieved U.S.-based phase I/II/III interventional CT from ClinicalTrials.gov enrolling patients with metastatic lung cancer. We evaluated the eligibility criteria of each CT for the inclusion of patients with: (1) BM, and classified them as excluded, partially included, or included; (2) LMD, and classified them as included or excluded. Fisher’s exact tests and odds ratios (OR) were conducted using logistic regression models.
Results
Among 307 CTs reviewed, 75.6% were phase I/II trials and 7.8% evaluated central nervous system (CNS) outcomes. While most trials partially included patients with treated/stable BM (74.3%, n = 228), only 11.4% (n = 35) included patients with active, untreated BM. Patients with LMD were included in 5.8% (n = 18) trials. A statistically significant difference was noted in the inclusion of patients with BM pre and postrecommendations (32.6% pre vs. 53.1% postrecommendations; P = .046), with CNS outcomes more likely evaluated in trials that included active BM or LMD.
Conclusions
There is an increasing trend of including patients with BM in lung cancer CTs since the publication of the 2017 ASCO/FDA/FoCR guidelines. However, patients with LMD and those with active BM continue to be excluded from most lung cancer CTs.
{"title":"Expanding Lung Cancer Clinical Trial Criteria: A Systematic Review on Inclusion of Patients with Brain Metastases and Leptomeningeal Disease","authors":"Ivy Riano , Maria A. Velez , Hugo Pomares-Millan , Juan Blaquier , Supriya Peshin , Jill Feldman , Ana I. Velazquez","doi":"10.1016/j.cllc.2025.11.016","DOIUrl":"10.1016/j.cllc.2025.11.016","url":null,"abstract":"<div><h3>Introduction</h3><div>Brain metastases (BM) occur in approximately 20% of lung cancer patients. Despite recent treatment advances, people with BM are often excluded from clinical trials (CT) limiting our understanding of therapy effectiveness. We evaluated how the 2017 ASCO/FDA/Friends of Cancer Research (FoCR) recommendations on inclusion of patients with BM and leptomeningeal disease (LMD) in CT have been adopted by registered lung cancer trials.</div></div><div><h3>Methods</h3><div>We retrieved U.S.-based phase I/II/III interventional CT from ClinicalTrials.gov enrolling patients with metastatic lung cancer. We evaluated the eligibility criteria of each CT for the inclusion of patients with: (1) BM, and classified them as excluded, partially included, or included; (2) LMD, and classified them as included or excluded. Fisher’s exact tests and odds ratios (OR) were conducted using logistic regression models.</div></div><div><h3>Results</h3><div>Among 307 CTs reviewed, 75.6% were phase I/II trials and 7.8% evaluated central nervous system (CNS) outcomes. While most trials partially included patients with treated/stable BM (74.3%, n = 228), only 11.4% (n = 35) included patients with active, untreated BM. Patients with LMD were included in 5.8% (n = 18) trials. A statistically significant difference was noted in the inclusion of patients with BM pre and postrecommendations (32.6% pre vs. 53.1% postrecommendations; <em>P</em> = .046), with CNS outcomes more likely evaluated in trials that included active BM or LMD.</div></div><div><h3>Conclusions</h3><div>There is an increasing trend of including patients with BM in lung cancer CTs since the publication of the 2017 ASCO/FDA/FoCR guidelines. However, patients with LMD and those with active BM continue to be excluded from most lung cancer CTs.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 1","pages":"Pages 92-98"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862290","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}
{"title":"Response to the letter to the Editor on “The Changing Landscape of Lung Cancer Resection Outcomes Over the Past Two Decades”","authors":"Charles-Antoine Guay , Alexandre Suhani , Laurie Perreault , Vicky Mai , Anne-Sophie Laliberté , Catherine Labbé , Steeve Provencher","doi":"10.1016/j.cllc.2025.11.004","DOIUrl":"10.1016/j.cllc.2025.11.004","url":null,"abstract":"","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 1","pages":"Pages 70-71"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145691177","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 : 2026-01-01Epub Date: 2025-10-22DOI: 10.1016/j.cllc.2025.10.018
James Chih-Hsin Yang , Yuh-Min Chen , Ullas Batra , Kien Hung Do , Piyada Sitthideatphaiboon , Pongwut Danchaivijitr , Kang-Yun Lee , Jarin Chindaprasirt , Cheng-Ta Yang , Gee-Chen Chang , Chaiyut Charoentum , Teerapat Ungtrakul , Juan Ignacio Hernandez Moran , Ryan Hartmaier , Ike Igwegbe , Alexander Gont , Matthew Haskins , Wanning Xu , Jonathan W. Riess
Background
MET amplification is the most common resistance mechanism to first-line osimertinib. We report safety and efficacy data from a phase II study assessing savolitinib plus osimertinib in epidermal growth factor receptor (EGFR)-mutated, MET-amplified, advanced non-small cell lung cancer (NSCLC).
Patients and Methods
Patients with EGFR-mutated, MET-amplified (MET gene copy number ≥ 5 or MET:CEP7 ratio ≥ 2), advanced NSCLC post-osimertinib were enrolled. Patients received savolitinib 300 mg once daily (QD) plus osimertinib 80 mg QD or savolitinib plus placebo. The primary endpoint was investigator-assessed objective response rate (ORR). Secondary endpoints included progression-free survival (PFS) and safety. Exploratory analysis included retrospective efficacy assessment by higher MET cutoffs (immunohistochemistry 3+ staining ≥ 90% tumor cells and / or MET gene copy number ≥ 10).
Results
Thirty patients were randomized (14 savolitinib-osimertinib; 16 savolitinib-placebo). Among all patients, ORR (95% confidence interval [CI]) was 57% (29-82) versus 13% (2-38); median PFS (95% CI) was 7.4 months (5.6-not calculable [NC]) versus 1.6 months (1.3-4.1) for savolitinib-osimertinib and savolitinib-placebo, respectively. In patients with higher MET cutoffs, ORR was 63% (24-91) and 29% (4-71); median PFS was 8.2 months (4.1-NC) and 4.0 months (1.3-NC) for savolitinib-osimertinib (n = 8) and savolitinib-placebo (n = 7), respectively. There were no new safety signals. This study was terminated early and the contribution of osimertinib to savolitinib is being assessed further in SAVANNAH (NCT03778229) in patients with higher MET biomarker cutoffs.
Conclusions
Savolitinib plus osimertinib demonstrated numerically higher clinical activity versus savolitinib plus placebo in all patients and patients with higher MET biomarker cutoffs.
{"title":"Savolitinib Plus Osimertinib in Epidermal Growth Factor-Mutated, MET-Amplified Advanced Non-Small Cell Lung Cancer: A Randomized Phase II trial","authors":"James Chih-Hsin Yang , Yuh-Min Chen , Ullas Batra , Kien Hung Do , Piyada Sitthideatphaiboon , Pongwut Danchaivijitr , Kang-Yun Lee , Jarin Chindaprasirt , Cheng-Ta Yang , Gee-Chen Chang , Chaiyut Charoentum , Teerapat Ungtrakul , Juan Ignacio Hernandez Moran , Ryan Hartmaier , Ike Igwegbe , Alexander Gont , Matthew Haskins , Wanning Xu , Jonathan W. Riess","doi":"10.1016/j.cllc.2025.10.018","DOIUrl":"10.1016/j.cllc.2025.10.018","url":null,"abstract":"<div><h3>Background</h3><div>MET amplification is the most common resistance mechanism to first-line osimertinib. We report safety and efficacy data from a phase II study assessing savolitinib plus osimertinib in epidermal growth factor receptor (EGFR)-mutated, MET-amplified, advanced non-small cell lung cancer (NSCLC).</div></div><div><h3>Patients and Methods</h3><div>Patients with EGFR-mutated, MET-amplified (MET gene copy number ≥ 5 or MET:CEP7 ratio ≥ 2), advanced NSCLC post-osimertinib were enrolled. Patients received savolitinib 300 mg once daily (QD) plus osimertinib 80 mg QD or savolitinib plus placebo. The primary endpoint was investigator-assessed objective response rate (ORR). Secondary endpoints included progression-free survival (PFS) and safety. Exploratory analysis included retrospective efficacy assessment by higher MET cutoffs (immunohistochemistry 3+ staining ≥ 90% tumor cells and / or MET gene copy number ≥ 10).</div></div><div><h3>Results</h3><div>Thirty patients were randomized (14 savolitinib-osimertinib; 16 savolitinib-placebo). Among all patients, ORR (95% confidence interval [CI]) was 57% (29-82) versus 13% (2-38); median PFS (95% CI) was 7.4 months (5.6-not calculable [NC]) versus 1.6 months (1.3-4.1) for savolitinib-osimertinib and savolitinib-placebo, respectively. In patients with higher MET cutoffs, ORR was 63% (24-91) and 29% (4-71); median PFS was 8.2 months (4.1-NC) and 4.0 months (1.3-NC) for savolitinib-osimertinib (<em>n</em> = 8) and savolitinib-placebo (<em>n</em> = 7), respectively. There were no new safety signals. This study was terminated early and the contribution of osimertinib to savolitinib is being assessed further in SAVANNAH (NCT03778229) in patients with higher MET biomarker cutoffs.</div></div><div><h3>Conclusions</h3><div>Savolitinib plus osimertinib demonstrated numerically higher clinical activity versus savolitinib plus placebo in all patients and patients with higher MET biomarker cutoffs.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 1","pages":"Pages 38-46"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145622272","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 : 2026-01-01Epub Date: 2025-11-22DOI: 10.1016/j.cllc.2025.11.017
Charu Aggarwal , Sophia Ng , Rajesh Kamalakar , Sue Beruti , Archana Simmons , Mary Beth Beasley
Background
Comprehensive biomarker testing for patients with advanced/metastatic non-small cell lung cancer (a/mNSCLC) is essential for treatment decision-making. However, there is limited understanding of testing adoption across lines of therapy (LoT).
Materials and Methods
This retrospective real-world study used the ConcertAI Patient360™ NSCLC database in the US to assess biomarker testing patterns among adults with nonsquamous a/mNSCLC (2017-2022) who received ≥ 1 LoT with ≥ 90-day follow-up. Testing and rebiopsy rates for actionable biomarkers were analyzed by LoT (1L, 2L, 3L), test modality, and sample type.
Results
Of 4528 patients, 51% were female, 76% were White; the mean (SD) age at diagnosis was 67.2 (10.2) years. Testing rates for ≥ 1 biomarker were 85% (1L), 31% (2L), and 26% (3L). 1L IHC and 1L NGS testing rates were 52% and 57%, respectively (2017-2022). Tissue was tested most often in 1L; liquid biopsy was prioritized in 2L. Among patients who received corresponding LoT and any biomarker test for the prior line, Black patients had lower crude rates of 2L rebiopsy and male patients had significantly lower rates of 2L rebiopsy/testing. Adjusted odds ratio (95% CI) for rebiopsy was lower for patients with EGFR WT versus EGFR mutation at 2L (0.40 [0.28-0.59]; P < .001) and 3L (0.46 [0.24-0.89]; P = .020).
Conclusions
While tissue was most frequently used in 1L testing, rebiopsy was less frequent in 2L + . Racial and sex differences in rebiopsy/testing rates were observed. Standardization for 2L + biomarker testing is needed to optimize later-line treatment decisions for patients with a/mNSCLC.
{"title":"A United States-Based Real-World Study on Biomarker Testing and Rebiopsy Rates Among Patients With Non-Small Cell Lung Cancer Across Lines of Therapy","authors":"Charu Aggarwal , Sophia Ng , Rajesh Kamalakar , Sue Beruti , Archana Simmons , Mary Beth Beasley","doi":"10.1016/j.cllc.2025.11.017","DOIUrl":"10.1016/j.cllc.2025.11.017","url":null,"abstract":"<div><h3>Background</h3><div>Comprehensive biomarker testing for patients with advanced/metastatic non-small cell lung cancer (a/mNSCLC) is essential for treatment decision-making. However, there is limited understanding of testing adoption across lines of therapy (LoT).</div></div><div><h3>Materials and Methods</h3><div>This retrospective real-world study used the ConcertAI Patient360™ NSCLC database in the US to assess biomarker testing patterns among adults with nonsquamous a/mNSCLC (2017-2022) who received ≥ 1 LoT with ≥ 90-day follow-up. Testing and rebiopsy rates for actionable biomarkers were analyzed by LoT (1L, 2L, 3L), test modality, and sample type.</div></div><div><h3>Results</h3><div>Of 4528 patients, 51% were female, 76% were White; the mean (SD) age at diagnosis was 67.2 (10.2) years. Testing rates for ≥ 1 biomarker were 85% (1L), 31% (2L), and 26% (3L). 1L IHC and 1L NGS testing rates were 52% and 57%, respectively (2017-2022). Tissue was tested most often in 1L; liquid biopsy was prioritized in 2L. Among patients who received corresponding LoT and any biomarker test for the prior line, Black patients had lower crude rates of 2L rebiopsy and male patients had significantly lower rates of 2L rebiopsy/testing. Adjusted odds ratio (95% CI) for rebiopsy was lower for patients with <em>EGFR</em> WT versus <em>EGFR</em> mutation at 2L (0.40 [0.28-0.59]; <em>P</em> < .001) and 3L (0.46 [0.24-0.89]; <em>P</em> = .020).</div></div><div><h3>Conclusions</h3><div>While tissue was most frequently used in 1L testing, rebiopsy was less frequent in 2L + . Racial and sex differences in rebiopsy/testing rates were observed. Standardization for 2L + biomarker testing is needed to optimize later-line treatment decisions for patients with a/mNSCLC.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 1","pages":"Pages 82-91"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145827054","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 : 2026-01-01Epub Date: 2025-11-04DOI: 10.1016/j.cllc.2025.11.002
Asim Armagan Aydin , Erkan Kayikcioglu
{"title":"Minimally Invasive Surgery Versus SABR in Stage IA NSCLC: Interpreting Real-World Evidence with Caution","authors":"Asim Armagan Aydin , Erkan Kayikcioglu","doi":"10.1016/j.cllc.2025.11.002","DOIUrl":"10.1016/j.cllc.2025.11.002","url":null,"abstract":"","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 1","pages":"Pages 49-50"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145619918","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}
The Advanced Lung Cancer Inflammation Index (ALI) has shown potential as a prognostic marker in lung cancer, but its role in early-stage non-small cell lung cancer (NSCLC) remains underexplored. This study evaluated the prognostic value of ALI in stage I NSCLC patients.
Methods
This registry-based study enrolled 934 stage I NSCLC patients diagnosed between 2015 and 2020 from the Danish Lung Cancer Registry (DLCR). Data from DLCR were merged with laboratory records. ALI was calculated as body mass index x albumin/neutrophil-to-lymphocyte ratio and dichotomized at the cohort median. Kaplan–Meier analysis (restricted mean survival time truncated at 6 years), Cox proportional hazards model, and C-statistics were used to assess the value of ALI on overall survival (OS) and disease-free survival (DFS).
Results
In patients receiving stereotactic radiation therapy (RT) (n = 301), a significantly longer mean survival was observed in the high ALI group compared with the low ALI group (5.12 vs. 4.81 years; P = .040). Multivariate analysis confirmed ALI as an independent prognostic factor for OS (HR 0.70, 95% CI, 0.51-0.96). No significant association with DFS was observed. In the surgically treated patients (n = 633), ALI was not associated with OS or DFS. C-statistics demonstrated that adding ALI significantly improved prognostic models for OS but not DFS independent of treatment.
Conclusion
ALI is an independent prognostic factor for OS in stage I NSCLC patients treated with stereotactic RT, but not in surgically treated patients. Incorporating ALI into prognostic models improved OS prediction, supporting its role as a simple biomarker in early-stage NSCLC.
{"title":"Advanced Lung Cancer Inflammation Index has Prognostic Impact in Stage I Non-Small Cell Lung Cancer: A Registry-Based Analysis of 934 Patients","authors":"Camilla Højbjerg Gregersen , Ninna Aggerholm-Pedersen , Birgitte Sandfeld-Paulsen , Anne Winther-Larsen","doi":"10.1016/j.cllc.2025.10.013","DOIUrl":"10.1016/j.cllc.2025.10.013","url":null,"abstract":"<div><h3>Background</h3><div>The Advanced Lung Cancer Inflammation Index (ALI) has shown potential as a prognostic marker in lung cancer, but its role in early-stage non-small cell lung cancer (NSCLC) remains underexplored. This study evaluated the prognostic value of ALI in stage I NSCLC patients.</div></div><div><h3>Methods</h3><div>This registry-based study enrolled 934 stage I NSCLC patients diagnosed between 2015 and 2020 from the Danish Lung Cancer Registry (DLCR). Data from DLCR were merged with laboratory records. ALI was calculated as body mass index x albumin/neutrophil-to-lymphocyte ratio and dichotomized at the cohort median. Kaplan–Meier analysis (restricted mean survival time truncated at 6 years), Cox proportional hazards model, and C-statistics were used to assess the value of ALI on overall survival (OS) and disease-free survival (DFS).</div></div><div><h3>Results</h3><div>In patients receiving stereotactic radiation therapy (RT) (<em>n</em> = 301), a significantly longer mean survival was observed in the high ALI group compared with the low ALI group (5.12 vs. 4.81 years; <em>P</em> = .040). Multivariate analysis confirmed ALI as an independent prognostic factor for OS (HR 0.70, 95% CI, 0.51-0.96). No significant association with DFS was observed. In the surgically treated patients (<em>n</em> = 633), ALI was not associated with OS or DFS. C-statistics demonstrated that adding ALI significantly improved prognostic models for OS but not DFS independent of treatment.</div></div><div><h3>Conclusion</h3><div>ALI is an independent prognostic factor for OS in stage I NSCLC patients treated with stereotactic RT, but not in surgically treated patients. Incorporating ALI into prognostic models improved OS prediction, supporting its role as a simple biomarker in early-stage NSCLC.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 1","pages":"Pages 24-33"},"PeriodicalIF":3.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578334","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