Lung Cancer Management最新文献

Aim: To estimate brain metastases (BM) management costs in Chinese ALK+ advanced non-small-cell lung cancer (NSCLC) patients receiving first-line (1 L) ALK tyrosine kinase inhibitors (TKIs).

Methods: A survey of 105 clinical experts across 23 Chinese regions evaluated healthcare resource utilization (HCRU). Total annual costs with TKIs were calculated by weighting the management costs of patients with and without BM using the cumulative incidence rate (CIR) of BM from ALK-TKI clinical trials.

Results: First-year management cost averaged ¥24,974 per-patient without BM versus ¥89,859 per-patient with BM, saving ¥64,885. Subsequent years saved ¥33,231. Applying 12-month CIR of BM, the annual costs per-patient were ¥26,791 for 1 L lorlatinib versus ¥46,516 for crizotinib in the intention-to-treat (ITT) population. Subgroup analysis showed annual costs of ¥25,623 per-patient with lorlatinib in those without BM and ¥29,775 in those with BM. Alectinib's and brigatinib's costs were ¥31,073 and ¥32,760 respectively, using the 12-month CIR of BM. Lorlatinib's cost savings increased progressively over 1-4 years. Limited CIR beyond 12 months existed for brigatinib and ensartinib. Results from the Asian group's CIR aligned with global trials.

Conclusion: Due to lower BM CIR, lorlatinib showed higher BM management cost savings compared to crizotinib and alectinib in Chinese 1 L patients.

Aims: This study aimed to predict post-transplant malignancy risks at multiple levels among lung transplant recipients using machine learning (ML) and to identify key clinical and immunogenetic predictors.

Materials and methods: A dataset of 30,917 lung transplant recipients with no prior cancer history was analyzed using pre-, peri-, and post-transplant variables. Multiple ML algorithms-gradient boosting, random forest, neural networks, and logistic regression-were applied to predict: (1) overall de novo malignancies (DNM), (2) skin versus non-skin cancers, and (3) skin cancer subtypes, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).

Results: Gradient boosting achieved the highest AUC for overall malignancies (0.746) and skin versus non-skin cancers (0.642), while random forest performed best for BCC versus SCC classification (AUC = 0.726). Significant predictors included HLA-DR alleles (DR52, DR1, DR53), A locus mismatch, recipient ethnicity, BMI, serum albumin, CMV/EBV serostatus, and cardiac-related measures (LV remodeling, cardiac output, prior cardiac surgery). Additional subtype predictors included peak PRA Class I sensitization, insulin signaling, donor-derived transfusions, and waiting list duration.

Conclusions: ML-driven predictive modeling enables personalized assessment of post-transplant malignancy risk, supporting early detection, targeted surveillance, and optimized long-term care for lung transplant recipients.

We present the case of a 66-year-old male patient who was found to have a lung nodule during the perioperative period for poorly differentiated carcinoma of the ileocecal region. Subsequent surgical procedures were performed to remove the intestinal and lung masses. Next-generation sequencing (NGS) testing demonstrated that the intestinal and lung lesions exhibited the same ALK pathogenic fusion. Following 7 months of Alectinib treatment, the patient's clinical evaluation showed stable disease. This is the first report of intestinal metastases from lung cancer with ALK fusion. Our findings indicate that a comprehensive approach, including histopathological examination and genetic testing, is necessary to diagnose and treat intestinal metastases from lung cancer accurately.

Background: Blood-based DNA methylation biomarkers have great potential for the early detection of lung cancer (LC). Here, we investigated the association between HYAL2 methylation in peripheral blood and LC.

Methods: Matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry was performed to measure the methylation levels of 4 CpG sites in HYAL2 gene in two independent case-control studies (168 LC cases and 167 controls in Study I, 677 LC cases and 833 controls in Study II). Logistic regression adjusted for covariates was conducted for odds ratios (ORs) and 95% confidence intervals (CIs). Non-parametric tests were applied for the comparisons of stratified groups.

Results: Hypomethylation of all 4 CpG sites in HYAL2 was associated with early-stage LC in the two studies (ORs range from 1.91 to 3.07 in Study I, ORs range from 1.39 to 1.86 in Study II, p < 0.05 for all). The associations were still significant for the very early-stage LC patients (stage I). Subgroup analysis indicated that the associations could be enhanced by male gender and older age. Moreover, decreased HYAL2 methylation was correlated with increased tumor size, tumor length and stage.

Conclusions: Our results suggested blood-based HYAL2 hypomethylation as a potential biomarker for LC early detection.

Aims: To describe tomographic findings in a high-risk lung cancer population in resource-limited Brazilian areas, quantify pulmonary nodules and lung cancer frequency, analyze challenges in lung cancer screening within the Brazilian public health system, assess lung function in individuals with moderate or severe emphysema, and evaluate the role of community health agents in recruiting high-risk populations.

Methods: This is a prospective, single-arm, longitudinal observational study involving individuals aged 50-80 years, current or former smokers with a smoking history of at least 20 pack-years, undergoing low-dose computed tomography (LDCT) with a 12-month follow-up. Screening results are classified according to Lung-RADS v2022 standards, with those rated as 3 or 4 undergoing further diagnostic assessments. The study aims to demonstrate the feasibility and effectiveness of lung cancer screening in socially vulnerable populations within resource-limited settings, providing essential insights to reduce mortality and improve health outcomes.

Conclusions: The findings will assist the development of policies on lung cancer screening in the public health system. The study's dissemination plan includes a website, social media, and participation in scientific conferences.

Introduction: This study aimed to examine the association between social determinants of health (SDOH) and lung cancer screening (LCS) utilization.

Methods: We analyzed data from 15,957 LCS-eligible individuals in the 2022 Behavioral Risk Factor Surveillance System survey. Primary outcomes included ever having (lifetime) LCS and meeting LCS recommendations (i.e., annual LCS). Multivariable logistic regression models examined associations between LCS outcomes and 12 adverse SDOH factors, controlling for covariates (i.e., demographics, diagnosis of asthma/COPD, and perceived general health status).

Results: LCS-eligible individuals with more adverse SDOH had lower odds of ever having LCS and being up to date. Those with ≥5 adverse SDOH had the lowest odds of having lifetime LCS (AOR = 0.58, 95%CI: 0.45-0.74) and meeting LCS recommendations (AOR = 0.49, 95%CI: 0.36-0.65) compared to those with none. Life dissatisfaction, lack of social and emotional support, housing insecurity, lack of health insurance, and cost as a barrier for needed medical care were independently associated with lower LCS uptake.

Conclusions: Having more adverse SDOH was associated with a lower likelihood of having lifetime LCS and meeting the recommendation, with life dissatisfaction, lack of social and emotional support, housing insecurity, lack of health insurance, and medical care cost being independently associated factors.

Background: Metabolic reprogramming, particularly toward oxidative phosphorylation (OXPHOS), is a hallmark of lung squamous cell carcinoma (LUSC) and contributes to its aggressive phenotype and immunosuppressive microenvironment. While OXPHOS activation is increasingly recognized as a key metabolic feature in LUSC, its prognostic implications and associated gene signatures remain underexplored. This study aimed to identify OXPHOS-related differentially expressed genes (DEGs) and construct a robust prognostic signature for LUSC.

Methods: Using GEO datasets, we developed an OXPHOS-related prognostic signature via ssGSEA, differential analysis, and LASSO-Cox regression.

Results: An 8-gene OXPHOS-related signature (LTBP1, MFGE8, ACTN1, CD59, CDC25C, SAAL1, SFXN4, PTTG1) was identified. High-risk patients exhibited significantly shorter overall survival than low-risk patients across all cohorts. The model demonstrated strong predictive accuracy for 1-, 3-, and 5-year survival. Notably, the high-risk group showed enriched pathways related to tumor stemness and immunosuppression.

Conclusion: We developed and validated a novel OXPHOS-based gene signature that effectively stratifies LUSC patients by risk. This signature highlights the clinical relevance of OXPHOS in LUSC prognosis and may guide personalized therapeutic strategies targeting metabolic vulnerabilities. Study limitations include its retrospective design and lack of experimental validation.

Objectives: This was a pooled analysis of data from weekly vinorelbine (VNR) treatment arms of four individual open-label, phase II studies to assess and refine the efficacy and tolerance of weekly oral VNR in a larger cohort of patients with advanced NSCLC.

Materials and methods: All patients included in this pooled analysis received oral VNR at the dose of 60 mg/m² weekly at cycle 1 (3-week cycle), followed by an increase to 80 mg/m² weekly for subsequent cycles until disease progression or toxicity. Efficacy was based on objective response rate (ORR), progression-free survival (PFS), and disease control rate (DCR).

Results: A total of 247 patients were included. The ORR and DCR were 8.9% and 57.5% respectively, median PFS and OS were 3.3 and 8.5 months, respectively. Less than half (40.7%) of patients reported ≥1 serious AE (regardless of causality), with 12.3% reporting ≥1 treatment-related serious AE (grade ≥3: 11.1%). The most reported grade ≥3 AEs were neutropenia (17.6%), fatigue (5.8%), and decreased appetite (4.9%).

Conclusion: This pooled analysis showed that weekly oral VRN is a valid option, with an acceptable safety profile, in this population of patients with advanced NSCLC, confirming results from previous individual studies.

Pleural mesothelioma is a rare disease with few therapeutic options, especially in the first line refractory setting. Targeted agents did not demonstrate a significant clinical benefit in mesothelioma treatment, nevertheless a small group of patients might harbor potentially actionable somatic mutations, as in homologous repair recombination genes. In this paper we report two cases of patients with heavily pretreated pleural mesothelioma that had a relevant clinical benefit with rucaparib treatment based on somatic BRCA 1 and BRCA 2 mutations detected through next generation sequencing.

Aim: To summarize current knowledge, gaps, quality of the evidence and show main results related to the role of the autonomic nervous system in lung cancer.

Methods: Studies were identified through electronic databases (PubMed, Scopus, Embase and Cochrane Library) in October 2023, and a descriptive analysis was performed. Twenty-four studies were included, and most were observational.

Results: Our data indicated an increased expression of β-2-adrenergic receptors in lung cancer, which was associated with poor prognosis. However, the use of β-blockers as an add-on to standard treatment promoted enhanced overall survival, recurrence-free survival and reduced metastasis occurrence.

Conclusion: Although the results herein seem promising, future research using high-quality prospective clinical trials is required to draw directions to guide clinical interventions.