Lung Cancer最新文献

Shared decision-making in the Australian National Lung Cancer Screening Program (NLCSP) involves consultation between healthcare provider and individual to ensure participants make an informed choice about screening. Three decision support tools were co-designed: a 16-page A5 booklet (booklet), 2-page A4 leaflet (leaflet) and a 3-minute animated video (video). This randomised trial evaluated the tools' ability to support informed choice, attitudes/intentions towards lung cancer screening, acceptability, comprehension, ease of understanding and balance of information of the tool. An online survey was conducted with people eligible for the Australian NLCSP. Participants were randomised to view one of the tools and completed a questionnaire. The primary outcome was informed choice (defined as adequate knowledge and congruency between attitudes and screening intentions). 715 participants completed the survey: booklet (n = 221), leaflet (n = 252) and video (n = 242). There was no statistically significant difference in informed choice between tools; informed choice was made by 148 (67 %) people who viewed the booklet, 167 (66.3 %) for the leaflet and 153 (63.2 %) for the video. Across all the tools, over 90 % found the information clear and easy to understand, around 85 % found the tool they viewed as helpful in deciding about screening, and around 80 % would recommend the viewed tool to others. Almost 80 % in each group intended to participate in lung cancer screening. Attitudes towards screening were significantly less positive for those viewing the leaflet than the booklet or video (p = 0.006). Each decision support tool was acceptable, supported informed choice, and could be adapted for use in the Australian NLCSP.

Background: Tarlatamab, a bispecific T-cell engager, is the first treatment in many years to significantly improve overall survival in relapsed extensive stage small cell lung cancer (ES-SCLC). However, implementation of this therapy has been challenging due to unique toxicities such as cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS) requiring prolonged observation following administration.

Methods: We conducted a U.S. based multi-institutional survey through the ONWARD-SCLC consortium, compromised of 15 academic and 1 community centers actively administrating tarlatamab.

Results: We received responses from 9 U.S. academic centers and 1 community-based practice, detailing their standard operating procedures and management of toxicities. While each had unique practices, common strategies included risk stratification, multidisciplinary coordination, communication and education, and well-defined workflows. We highlighted the similarities and differences in the approaches and proposed a list of best practice considerations for tarlatamab administration and toxicity management.

Conclusions: This perspective highlights current best practices and suggests future directions to improve on our current approaches for tarlatamab administration and CRS/ICANS management.

Background: Induction therapy (IT) prior to surgery is a key strategy to improve resectability in advanced thymic tumors (ATTs). This study aimed to assess prognostic factors and the impact of IT on clinical outcomes.

Material and methods: We retrospectively analyzed 64 patients with TNM-stage II-IV ATTs treated with IT and surgery between January 2002 and December 2024, using data from the TYME multicenter Italian database. Radiological response (RR) was defined by RECIST v1.1. Statistical comparisons were performed using Chi-square, t-test, or Wilcoxon rank-sum test. Univariate and multivariate logistic models evaluated associations between variables and outcomes.

Results: Mean age was 52 years; 58 % were male. Most tumors (83.4 %) were stage III-IV, with thymoma as the predominant histology (79.7 %). Radiological signs of mediastinal or vascular invasion and tumor diameter > 5 cm were present in over 86 % of cases. Platinum-based chemotherapy was administered in 96.9 %, with CAP regimen used in 62.5 %. Partial response was achieved in 69 % (Responders, RE), while 31 % had stable/progressive disease (Non-responders, NRE). Extended surgery was performed in 84.4 %, with R0 resection in 76.3 %. Adjuvant therapy was administered in 66.7 % of cases. Relapse occurred in 78.6 % (local) and 21.4 % (distant). No significant differences were found between RE and NRE in clinical, radiological, or pathological features. Five-year OS (88 % vs 93 %) and RFS (45 % vs 43 %) were similar between groups. ECOG performance status was the strongest independent predictor of better RFS (OR 7.18), while ASA score was associated with RR (OR 0.20).

Conclusion: The TYME database analyses revealed no significant outcome differences between RE and NRE following IT in ATTs, underscoring the complexity of predicting long-term outcomes based on RR alone. This study also suggests the prognostic value of physical status via ASA score and ECOG PS. Further studies with varied chemo regimens are needed to improve response rates in multimodal ATT therapy. Accepted as poster presentation at ESMO Congress 2025, October 17-21, 2025 - Berlin.

Background: Interstitial lung disease (ILD) encompasses a spectrum of inflammatory and fibrotic lung conditions. Interstitial lung abnormalities (ILA) are incidental radiological findings with the potential to progress to clinical ILD. Evidence guiding radiotherapy in patients with ILD and ILA is very limited.

Methods: This retrospective cohort study included patients receiving curative-intent radiotherapy with or without chemotherapy at a UK tertiary oncology centre over a seven- year period. Patients with a prior ILD diagnosis or computer tomography (CT) features suggestive of ILA were identified and reviewed by specialist ILD radiologists. Patients were classified into 3 groups: ILD, ILA, or no radiological evidence of ILD/ILA. Clinical outcomes and adverse events were analysed.

Results: Of 1693 patients referred for radiotherapy, 163 underwent specialist radiological review: 53 ILD, 53 ILA, and 57 with no ILD/ILA features. Survival outcomes differed significantly between groups. Median overall survival (OS) was 9.4 months (ILD), 14.7 months (ILA), and 22.5 months (no ILD/ILA) (p = 0.001). On multivariable analysis, ILD was independently associated with worse OS (HR 2.88). Grade 5 pneumonitis occurred in 13 % of ILD patients, 6 % with ILA, and 0 % with no ILD/ILA features. Conventional radiotherapy was associated with higher treatment-related adverse events compared to hypofractionated regimens.

Conclusions: Patients with ILD experience significantly worse survival and higher risk of adverse events, including fatal pneumonitis, following radiotherapy. ILA represents an intermediate-risk group. These findings highlight the need for improved pre-treatment identification and risk stratification using radiological and clinical tools, and highlights the importance of prospective validation in future studies.

Background: Dacomitinib, a second-generation, irreversible tyrosine kinase inhibitor of epidermal growth factor receptor (EGFR), showed statistically significant progression-free survival improvement over gefitinib in patients with treatment-naive EGFR mutation-positive advanced non-small cell lung cancer (NSCLC) in the phase 3 ARCHER 1050 study (NCT01774721). We report results from the final analysis of ARIA (NCT04609319), a noninterventional study of dacomitinib's real-world utilization and associated clinical outcomes in Asian patients with EGFR mutation-positive advanced NSCLC.

Methods: This longitudinal, multicenter cohort study collected prospective and retrospective data from patients with EGFR mutation-positive locally advanced or metastatic NSCLC who were treated with first-line dacomitinib. Study objectives were to describe clinical and disease characteristics, therapeutic patterns of dacomitinib use, and clinical outcomes.

Results: 299 patients located in China (n = 261), India (n = 24), and Malaysia (n = 14) were enrolled and included in the analysis. Starting dose was 30 mg once daily in 159 (53.2 %) patients, 45 mg once daily in 138 (46.2 %), and other doses in 2 (0.7 %). As of May 28, 2024, 95 patients (31.8 %) had dose reductions, 47 (15.7 %) had dose increases, 41 (13.7 %) had dose interruptions, and 223 (74.6 %) had permanently discontinued dacomitinib. Median duration of treatment was 17.2 months (IQR, 19.2). Median time to treatment failure was 17.0 months (95 % CI, 14.5-19.8). Median progression-free survival was 20.1 months (95 % CI, 17.4-22.4). 148 (49.5 %) patients had treatment-related adverse events; most common were rash (n = 93 [31.1 %]), diarrhea (n = 81 [27.1 %]), and paronychia (n = 57 [19.1 %]).

Conclusions: To our knowledge, ARIA is the largest real-world study of dacomitinib's efficacy and safety. Final analysis of this study showed substantial clinical efficacy of dacomitinib and revealed treatment patterns, such as starting dose, in the real world. Safety data were consistent with dacomitinib's known safety profile. These results support first-line dacomitinib use in Asian patients with EGFR mutation-positive advanced NSCLC.

Clinicaltrials: gov NCT04609319.