Lung Cancer最新文献

{"title":"Inavolisib for PIK3CA-mutant non-small cell lung cancer: A case report","authors":"Lei Cheng ,&nbsp;Dongying Wang ,&nbsp;Xueyan Zhang ,&nbsp;Baohui Han ,&nbsp;Hua Zhong ,&nbsp;Wei Nie","doi":"10.1016/j.lungcan.2025.108890","DOIUrl":"10.1016/j.lungcan.2025.108890","url":null,"abstract":"<div><h3>Introduction</h3><div><em>PIK3CA</em> mutations are oncogenic drivers in 2–4% of non-small cell lung cancers (NSCLC), often co-occurring with other drivers and conferring therapeutic resistance. This report is unique in describing the efficacy of the novel, highly selective PI3Kα inhibitor inavolisib in two heavily pre-treated patients with <em>PIK3CA</em>-mutant NSCLC harboring divergent co-drivers (<em>EGFR</em> and <em>KRAS</em>).</div></div><div><h3>Case presentation</h3><div>We present a 71-year-old male with <em>EGFR/PIK3CA</em>-mutant adenocarcinoma and brain metastases, and a 54-year-old female with <em>KRAS/PIK3CA</em>-mutant squamous cell carcinoma. Both patients reported rapid symptomatic improvement (hoarseness and shoulder pain, respectively) within two weeks of initiating inavolisib.</div></div><div><h3>Diagnosis, intervention, and outcomes</h3><div>Both patients received oral inavolisib (6 mg daily). Follow-up imaging after one month revealed significant tumor reduction. Notably, regressing intrapulmonary lesions exhibited tumor cavitation, and the male patient demonstrated a marked regression of central nervous system (CNS) metastases. The treatment was well-tolerated, with only Grade 1 oral mucositis reported.</div></div><div><h3>Conclusion</h3><div>The primary take-away lesson is that selective PI3Kα inhibition with inavolisib can induce potent systemic and intracranial responses in <em>PIK3CA</em>-mutant NSCLC, regardless of the primary oncogenic co-driver. The observed tumor cavitation suggests a potential anti-angiogenic mechanism, warranting further investigation.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"212 ","pages":"Article 108890"},"PeriodicalIF":4.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145845517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of treatment sequencing on outcome of patients with non-small cell lung cancer with a synchronous solitary extrathoracic metastasis","authors":"Mandy Jongbloed ,&nbsp;Ronald A.M. Damhuis ,&nbsp;Wouter H. Van Geffen ,&nbsp;Peter de Boer ,&nbsp;Jarno W.J. Huijs ,&nbsp;Safiye Dursun ,&nbsp;Juliette Degens ,&nbsp;Ben E.E.M. van den Borne ,&nbsp;Magdolen Youssef-El Soud ,&nbsp;Michelle Steens ,&nbsp;Cordula Pitz ,&nbsp;Dirk K.M. De Ruysscher ,&nbsp;Lizza E.L. Hendriks","doi":"10.1016/j.lungcan.2025.108889","DOIUrl":"10.1016/j.lungcan.2025.108889","url":null,"abstract":"<div><div>Currently, guidelines advise local radical treatment (LRT) to all disease sites in addition to systemic therapy in patients with synchronous oligometastatic non-small cell lung cancer (NSCLC). However, the best order of treatments is unknown. This advice is largely based on expert opinion and on studies without immune checkpoint inhibitors (ICI), while an ICI-based regimen is now standard of care first-line treatment for stage IV NSCLC without an actionable genetic alteration (AGA). We conducted a retrospective study to evaluate the order of treatments in patients with synchronous oligometastatic NSCLC without an AGA, with a single extrathoracic metastasis treated with an ICI-based regimen between 2018 and 2022. We evaluated upfront LRT to the metastasis followed by ICI and if indicated LRT to the local disease (Netherlands Cancer Registry: cohort 1, n = 225), and ICI followed by LRT to all disease sites if no progression (regional retrospective series: cohort 2, n = 33). The primary endpoint was overall survival (OS). The median OS for cohort 1 and cohort 2 were 26 and 25 months, respectively, and 3-year OS rates of 45 % and 44 %, respectively. In cohort 1, better survival was seen for those with brain metastasis, good performance status, non-squamous histology and high PD-L1 expression. In cohort 2, better survival was seen for younger age and non-squamous histology. In conclusion, both upfront and delayed LRT combined with an ICI-based treatment can result in long-term survival in this patient population, however the most optimal sequence has yet to determined.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"212 ","pages":"Article 108889"},"PeriodicalIF":4.4,"publicationDate":"2025-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145878633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is sublobar resection a valid option for radiologically pure-solid clinical stage IA non-small cell lung cancer?: insights from real-world data and current status","authors":"Dong Woog Yoon ,&nbsp;Sumin Shin ,&nbsp;Chu Hyun Kim ,&nbsp;Yeong Jeong Jeon ,&nbsp;Junghee Lee ,&nbsp;Seong Yong Park ,&nbsp;Yong Soo Choi ,&nbsp;Jong Ho Cho ,&nbsp;Hong Kwan Kim ,&nbsp;Ho Yun Lee","doi":"10.1016/j.lungcan.2025.108886","DOIUrl":"10.1016/j.lungcan.2025.108886","url":null,"abstract":"<div><h3>Objectives</h3><div>We aimed to evaluate the oncologic outcomes of sublobar resection (SLR) compared with lobectomy in patients with radiologically pure-solid stage IA non–small cell lung cancer (NSCLC).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 363 patients with clinical stage IA pure-solid NSCLC who underwent curative-intent resection between 2018 and 2020. Patients were divided into SLR (n = 60) and lobectomy (n = 303) groups. Kaplan–Meier analysis was used to estimate overall survival (OS) and recurrence-free survival (RFS), and Cox regression identified prognostic factors. Subgroup analyses were performed for stage IA2 and IA3 patients.</div></div><div><h3>Results</h3><div>In the overall cohort, the SLR group had significantly worse 5-year OS (75.5 % vs. 93.3 %, p &lt; 0.01) and RFS (58.3 % vs. 77.4 %, p &lt; 0.01) compared with lobectomy. In stage IA2, OS was comparable (87.2 % vs. 91.7 %, p = 0.1), but RFS was inferior after SLR (65.9 % vs. 81.2 %, p = 0.02). In stage IA3, both OS (54.3 % vs. 94.4 %, p &lt; 0.01) and RFS (40.6 % vs. 74.9 %, p &lt; 0.01) were markedly worse after SLR. Segmentectomy showed outcomes similar to lobectomy in IA2 but was inferior in IA3, whereas wedge resection was consistently associated with poor survival.</div></div><div><h3>Conclusions</h3><div>Lobectomy remains the standard surgical procedure for pure-solid stage IA NSCLC, particularly IA3 disease. Segmentectomy may be considered in carefully selected IA2 patients, while it is advisable to avoid wedge resection. These findings emphasize the importance of selecting the most appropriate patients for SLR and support the need for prospective validation.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"212 ","pages":"Article 108886"},"PeriodicalIF":4.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145882761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of adjuvant alectinib in the treatment of patients with resected stage IB-IIIA ALK-positive non-small lung cancer in France, based on the ALINA study","authors":"Romain Supiot ,&nbsp;Alexandre Gherardi ,&nbsp;Léopoldine du Manoir de Juaye ,&nbsp;Olfa Doghri ,&nbsp;Marine Sivignon ,&nbsp;Michaël Duruisseaux ,&nbsp;Christos Chouaid","doi":"10.1016/j.lungcan.2025.108885","DOIUrl":"10.1016/j.lungcan.2025.108885","url":null,"abstract":"<div><h3>Background and objective</h3><div>Alectinib has demonstrated significant disease-free survival (DFS) benefits as adjuvant therapy for resected stage IB–IIIA ALK-positive non-small-cell lung cancer (NSCLC) in the ALINA study. This study aimed to assess the cost-effectiveness of introducing adjuvant alectinib into routine clinical practice in France compared with standard adjuvant platinum-based chemotherapy.</div></div><div><h3>Methods</h3><div>A cohort-based semi-Markov model was developed to simulate long-term health and economic outcomes for patients from the ALINA intention-to-treat population over a 40-year time horizon. Eight mutually exclusive health states were included, capturing DFS, non-metastatic recurrence, metastatic recurrence (first and second line), and death. Clinical inputs were sourced primarily from ALINA, while recurrence treatment patterns, cure assumptions, utilities, and costs reflected French clinical practice and French thoracic oncologists’ opinion. Costs (2024 euros) and outcomes were discounted following French HTA guidelines. Deterministic, probabilistic, and scenario analyses were conducted.</div></div><div><h3>Results</h3><div>Adjuvant alectinib would yield 17.6 life-years (LYs) and 15.4 quality-adjusted life-years (QALYs) per patient versus 12.4 LYs and 10.4 QALYs with chemotherapy, corresponding to incremental gains of 5.2 LYs and 5.0 QALYs. Total lifetime costs were estimated at €180,561 with alectinib and €237,011 with chemotherapy, resulting in a cost saving of €56,449. Higher upfront treatment costs with alectinib were offset by substantial reductions in recurrence-related expenditures. Across all deterministic, probabilistic, and scenario analyses, alectinib remained both more effective and less costly.</div></div><div><h3>Conclusions</h3><div>Adjuvant alectinib would provide substantial clinical benefits for patients with resected ALK-positive NSCLC and represent a dominant strategy over platinum-based chemotherapy in the French healthcare setting, improving outcomes while reducing overall costs.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"211 ","pages":"Article 108885"},"PeriodicalIF":4.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing communication for ultrafast lung cancer biomarker testing: the UTOPIA pilot study","authors":"Susana Hernandez ,&nbsp;Esther Conde ,&nbsp;Marta Alonso ,&nbsp;Daniel Curto ,&nbsp;Fatima Duran ,&nbsp;Abigail Ast ,&nbsp;Javier Torres-Jimenez ,&nbsp;Helena Bote-de Cabo ,&nbsp;Maria Zurera ,&nbsp;Javier Baena ,&nbsp;Jon Zugazagoitia ,&nbsp;Ricardo Garcia-Lujan ,&nbsp;Dolores Isla ,&nbsp;Javier De Castro ,&nbsp;Luis Paz-Ares ,&nbsp;Fernando Lopez-Rios","doi":"10.1016/j.lungcan.2025.108887","DOIUrl":"10.1016/j.lungcan.2025.108887","url":null,"abstract":"<div><h3>Background</h3><div>Non–small cell lung carcinoma (NSCLC) is a leading example of precision oncology, with a growing number of actionable targets. However, long turnaround times (TAT) for biomarker results can delay optimal treatment decisions. We evaluated whether a streamlined workflow could deliver comprehensive molecular reports within 72 h.</div></div><div><h3>Methods</h3><div>In this prospective cohort study (UTOPIA protocol), 96 patients with early-stage or advanced NSCLC at Hospital Universitario 12 de Octubre underwent molecular tumor board (MTB)-centered triage, automated NGS processing, and integrated data review. TAT was defined (in working days) from MTB triage to electronic report validation. Communication was supported by daily operational huddles and intralaboratory pre-MTB meetings using a standardized checklist.</div></div><div><h3>Results</h3><div>All 96 NGS reports met the 72-hour TAT target (100%). The NGS failure rate was 1%. Potentially actionable genomic alterations were identified in 45.8% of patients, most frequently <em>EGFR</em> (24%) and <em>KRAS</em> G12C (8.3%). Other targetable alterations included six <em>ALK</em> fusions (6.3%), four <em>MET</em> exon 14 skipping mutations (4.2%), two <em>BRAF</em> V600E mutations (2.1%), and one <em>RET</em> fusion (1%).</div></div><div><h3>Conclusion</h3><div>An ultrafast biomarker testing workflow for lung cancer, enabled by MTB-driven triage and structured team communication, can reliably generate comprehensive molecular reports within 72 h. This approach may reduce TAT-related treatment delays and support timely biomarker-guided therapy for patients with NSCLC.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"211 ","pages":"Article 108887"},"PeriodicalIF":4.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External evaluation of the Manchester score in a contemporary SCLC cohort","authors":"Charlie Cunniffe ,&nbsp;Matthew Sperrin ,&nbsp;Gerard Walls ,&nbsp;Fiona Blackhall ,&nbsp;Gareth Price","doi":"10.1016/j.lungcan.2025.108884","DOIUrl":"10.1016/j.lungcan.2025.108884","url":null,"abstract":"<div><h3>Objectives</h3><div>The Manchester Score, a prognostic model developed in 1987, was used to stratify patients with Small Cell Lung Cancer (SCLC) by mortality risk, including stage, performance status, and three blood tests as risk factors. Many tools have since been developed for this purpose, but few have seen clinical use, with lack of robust external validation frequently cited as a barrier. In this study we apply a robust and pragmatic external validation approach to the Manchester Score to understand if it remains valid in an unselected modern patient cohort.</div></div><div><h3>Methods</h3><div>SCLC patients treated in an academic centre between 2013 and 2022 (N = 1783) were included in the validation cohort. Discrimination was assessed using Kaplan-Meier curves, AUC, and Harrell’s C-index for the Manchester score and its underlying Cox model. Three levels of Cox model updating were used to address missing baseline hazard data: recalibration, recalibration with rescaling, and model refitting. Calibration was then evaluated with optimism adjustment at 6-, 12-, and 24-months post-diagnosis.</div></div><div><h3>Results</h3><div>The Manchester score shows good discrimination in the modern patient cohort. There is clear separation between risk groups in the Kaplan-Meier curves, with AUC = 0.75 and C-index = 0.68 for the Manchester Score and (AUC = 0.79, C-index = 0.70) for the underlying Cox model. Median survival in the ‘good’ prognostic group (meeting &lt; 2/5 risk criteria) has increased compared to that from 1987. All model updating methods reported good calibration, with recalibration alone providing the best observed-to-expected ratio at 6 months (1.012 [0.978,1.045]).</div></div><div><h3>Conclusion</h3><div>The original Manchester Score prognostic groups remain discriminative of survival, and when updated can predict survival probability at multiple timepoints.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"212 ","pages":"Article 108884"},"PeriodicalIF":4.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145918169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tarlatamab in routine clinical care: How much safety is enough?","authors":"Ernest Nadal ,&nbsp;Jordi Bruna","doi":"10.1016/j.lungcan.2025.108888","DOIUrl":"10.1016/j.lungcan.2025.108888","url":null,"abstract":"","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"211 ","pages":"Article 108888"},"PeriodicalIF":4.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145834342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locoregional therapies in advanced and recurrent pleural mesothelioma: A systematic review","authors":"Paolo Ambrosini ,&nbsp;Thierry Berghmans ,&nbsp;Mario Occhipinti ,&nbsp;Valérie Durieux ,&nbsp;Paul Van Schil ,&nbsp;Arnaud Scherpereel ,&nbsp;Andrea Riccardo Filippi ,&nbsp;Mariana Brandão","doi":"10.1016/j.lungcan.2025.108877","DOIUrl":"10.1016/j.lungcan.2025.108877","url":null,"abstract":"<div><h3>Background</h3><div>Locoregional therapies, including radiotherapy, surgery and other ablative techniques, are occasionally used as strategies to manage oligorecurrent or oligoprogressive pleural mesothelioma. Yet, their real-world utilization, safety and efficacy remain poorly defined.</div></div><div><h3>Methods</h3><div>We conducted a systematic review in accordance with PRISMA guidelines. A search was conducted in MEDLINE, Scopus, Academic Search Premier and ProQuest Central up to June 2025 for retrospective and prospective studies of surgical cytoreduction, radiotherapy, or other local interventions in oligorecurrent or oligoprogressive pleural mesothelioma. Data on patient demographics, treatment protocols, local control (LC), progression-free survival (PFS), overall survival (OS) and toxicity were extracted and synthesized descriptively.</div></div><div><h3>Results</h3><div>A total of 22 studies, all retrospective, encompassing 234 patients, were included. Radiotherapy series (n = 142 patients) reported one-year LC rates ranging from 73.5 to 100 %, a median PFS of 5.1–8.0 months, a median OS of 26.9–38.0 months and grade 3–4 toxicities in ≤ 13 % of patients. Surgical series of oligorecurrences (n = 67 patients) demonstrated OS ranging from 14.5 to 44.6 months, with rare long-term survivors after distant resections. A single series of percutaneous cryoablation (n = 24 patients) achieved a 90.8 % local recurrence free-survival rate at one year with minimal toxicity; a single radiofrequency ablation case yielded a 24-month PFS.</div></div><div><h3>Conclusions</h3><div>Retrospective evidence suggests that locoregional interventions can achieve long-term local control and acceptable safety in selected pleural mesothelioma patients with oligorecurrent or oligoprogressive disease. Prospective trials are warranted to establish optimal patient selection and strategies integrating these approaches into standard care.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"211 ","pages":"Article 108877"},"PeriodicalIF":4.4,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood matters: Predicting lung cancer screening adherence with explainable AI","authors":"Kun-Han Lu ,&nbsp;Yi Xiao ,&nbsp;Aamna Akhtar ,&nbsp;Jazma Tapia ,&nbsp;Calvin P. Tribby ,&nbsp;Peter Vien ,&nbsp;Naj Boucher ,&nbsp;Termisha Pete ,&nbsp;David M. Kadar ,&nbsp;Viviana Rosales ,&nbsp;Cherry Lee ,&nbsp;WingYin Lau ,&nbsp;Sophia Yueng ,&nbsp;Jonjon Macalintal ,&nbsp;Jiue-An Yang ,&nbsp;Marta Jankowska ,&nbsp;Chi Wah Wong ,&nbsp;Loretta Erhunmwunsee","doi":"10.1016/j.lungcan.2025.108882","DOIUrl":"10.1016/j.lungcan.2025.108882","url":null,"abstract":"<div><h3>Background</h3><div>This study builds a predictive model for lung cancer screening (LCS) adherence using social determinants of health (SDOH) data in high-risk populations. By identifying key factors influencing non-adherence, we seek to improve risk stratification for individuals less likely to complete annual LCS follow-up scans within 15-months.</div></div><div><h3>Methods</h3><div>We recruited 188 minoritized individuals meeting high-risk smoking pack year criteria who underwent their first low-dose computed tomography (LDCT) scan between 2017 and 2021 at four clinical centers in Los Angeles County. Participants completed an IRB-approved survey assessing demographics, tobacco use, social needs, discrimination, and lung cancer risk perception. Residential address at time of first LDCT was geocoded to match with neighborhood-level SDOH metrics. The data were split into training (N = 145) and testing cohorts (N = 43) by whether individuals received their initial LDCT by June 30, 2021. Electronic medical records were checked for LDCT follow-up within 15 months of initial LCS. Those who underwent the subsequent LDCT within 15 months of the initial LCS were considered adherent. We trained an XGBoost classifier with hyperparameter tuning and performed SHapley Additive exPlanations (SHAP) analysis to interpret model predictions.</div></div><div><h3>Results</h3><div>The cohort included 69 (37 %) Asian/Pacific Islander, 53 (28 %) Black/African American, and 49 (26 %) Hispanic/Latino participants. The LCS non-adherence rate was 66 %. The XGBoost classifier achieved an AUROC of 0.81 and AUPRC of 0.90, with prediction performance of accuracy = 0.79, recall = 0.78, specificity = 0.81, positive predictive value = 0.88, and negative predictive value = 0.68. SHAP analysis indicated that neighborhood-level SDOH factors, such as school proficiency and poverty levels, were more predictive of non-adherence than individual-level factors like smoking status.</div></div><div><h3>Conclusions</h3><div>This machine learning approach accurately predicted LCS non-adherence using individual- and neighborhood-level SDOH factors. These findings emphasize the relevance of community-level characteristics in informing LCS adherence interventions and may support the development of regionally tailored strategies to improve adherence in high-risk populations.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"211 ","pages":"Article 108882"},"PeriodicalIF":4.4,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant immunotherapy plus chemotherapy in locally advanced stage III NSCLC patients undergoing definitive chemo-radiotherapy---a real‑world multicenter retrospective study","authors":"Guoyin Li ,&nbsp;Chaoyuan Liu ,&nbsp;Pan Xi ,&nbsp;Liangxue Hou ,&nbsp;Yaoxiong Xia ,&nbsp;YunXiang Qi ,&nbsp;Wenyan Pan ,&nbsp;Wei Bai ,&nbsp;Xiaoyan Li ,&nbsp;Hao Zhou ,&nbsp;Pengyi Li ,&nbsp;Zewen Song ,&nbsp;Huiyun Zhao ,&nbsp;Xuewen Liu","doi":"10.1016/j.lungcan.2025.108883","DOIUrl":"10.1016/j.lungcan.2025.108883","url":null,"abstract":"<div><h3>Background</h3><div>The optimal integration of immunotherapy with definitive chemoradiotherapy (CRT) for unresectable stage III non-small cell lung cancer (NSCLC) remains an area of active investigation. While consolidation immunotherapy is standard, the efficacy and safety of a neoadjuvant approach are not yet established by phase III trials. This real-world study compares outcomes between neoadjuvant immuno-chemotherapy followed by CRT (NEO) and CRT followed by adjuvant immunotherapy (ADJ, the PACIFIC regimen).</div></div><div><h3>Methods</h3><div>In this multicenter retrospective analysis, we reviewed data from patients with stage III NSCLC who received radical thoracic radiotherapy and <em>peri</em>-radiotherapy immunotherapy between January 2020 and December 2023. Patients were classified into NEO (n = 321) or ADJ (n = 142) groups. Primary endpoints were progression-free survival (PFS) and overall survival (OS). Secondary endpoints included treatment patterns, recurrence modes, and incidence of pneumonitis. Propensity score matching (PSM) and robust statistical analyses were used to minimize confounding.</div></div><div><h3>Results</h3><div>The median PFS was significantly longer in the NEO group than in the ADJ group (25.0 months vs. 16.3 months; HR = 0.57, 95 % CI: 0.43–0.74; p &lt; 0.001). Median OS was not reached (NR) in the NEO group compared to 41.1 months in the ADJ group (HR = 0.54, 95 % CI: 0.37–0.78; p = 0.001). The survival benefit for the NEO group remained consistent after PSM and multivariable adjustment. The objective response rate to neoadjuvant therapy was 68.4 %. Patterns of recurrence were similar between groups, with distant metastasis being the most common site of first progression. The incidence of grade ≥2 radiation pneumonitis was comparable (31.8 % NEO vs. 30.8 % ADJ, p = 0.925), though a non-significant trend towards higher grade ≥3 radiation pneumonitis was observed in the NEO group (14.0 % vs. 7.5 %, p = 0.071). Rates of checkpoint inhibitor pneumonitis were low and similar between groups.</div></div><div><h3>Conclusion</h3><div>In this large real-world cohort, a treatment sequence incorporating neoadjuvant immuno-chemotherapy prior to definitive CRT was associated with significantly improved PFS and OS compared to the standard adjuvant immunotherapy approach, without a definitive increase in severe pneumonitis. These findings support the further investigation of neoadjuvant immunotherapy strategies in phase III randomized trials for stage III NSCLC.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"211 ","pages":"Article 108883"},"PeriodicalIF":4.4,"publicationDate":"2025-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145797436","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}