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First-line treatment of nonsquamous NSCLC using gemcitabine: a retrospective study of real-life practice. 吉西他滨用于非鳞状NSCLC的一线治疗:一项现实实践的回顾性研究
IF 2.8 Q4 RESPIRATORY SYSTEM Pub Date : 2016-11-01 Epub Date: 2016-11-03 DOI: 10.2217/lmt-2016-0011
Filip Kohutek, Miroslava Stratena, Andrej Rosik, Maria Tamasova, Branislav Bystricky

We present results of retrospective real-life data of nonsquamous lung cancer patients treated in first-line (platinum-based chemotherapy with gemcitabine without bevacizumab). 56 patients with satisfactory performance status for cytotoxic chemotherapy were treated in 2010-2014. Median progression-free survival was 6.48 months (95% CI: 4.44-9.48), time to progression was 10.19 months (95% CI: 7.59-12.19). Median overall survival was 10.8 months (95% CI: 6.72-14.52). Although our group of patients had higher proportion of elderly patients with somewhat limited performance status, progression-free survival rate was comparable to large registration studies. Overall survival, despite intervening comorbidities and subsequent limited use of second-line treatment was analogous to large gemcitabine/platinum Phase III studies in nonsquamous population. We believe our data represent real-life survival rates of unselected patients with advanced NSCLC of nonsquamous type from mostly rural catchment area.

我们提出了一线治疗非鳞状肺癌患者的回顾性现实数据(铂基化疗加吉西他滨不含贝伐单抗)。2010-2014年对56例细胞毒化疗患者进行了满意的治疗。中位无进展生存期为6.48个月(95% CI: 4.44-9.48),进展时间为10.19个月(95% CI: 7.59-12.19)。中位总生存期为10.8个月(95% CI: 6.72-14.52)。虽然本组患者中表现受限的老年患者比例较高,但无进展生存率与大型登记研究相当。尽管存在干预合并症和随后有限使用二线治疗,但总体生存率与非鳞状人群的大型吉西他滨/铂III期研究相似。我们相信我们的数据代表了来自大部分农村集水区的未选择的晚期非鳞状型非小细胞肺癌患者的现实生存率。
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引用次数: 2
Targeting EGFR and ALK in NSCLC: current evidence and future perspective. 靶向EGFR和ALK在NSCLC中的作用:当前证据和未来展望。
IF 2.8 Q4 RESPIRATORY SYSTEM Pub Date : 2016-06-01 Epub Date: 2016-06-23 DOI: 10.2217/lmt-2016-0005
Chiara Bennati, Luca Paglialunga, Biagio Ricciuti, Giulio Metro, Luca Marcomigni, Alessio Gili, Lucio Crinò

The advent of molecular therapy targeting specific driver oncogenes has dramatically changed the prognosis of a subset of NSCLC, dilating survival and improving the quality of life of patients with advanced disease. Two of the major targets for treatment with receptor TKIs are the activated mutated forms of the EGFR and the ALK gene fusions. In advanced NSCLC patients harboring EGFR mutations or ALK rearrangements, the use of TKIs in the first-line setting, have provided unexpected large progression-free survival and overall survival benefits, compared with cytotoxic chemotherapy. However, despite initial responses and durable remissions, the development of resistance inevitably leads to treatment failure. The aim of this review is to discuss the treatment strategy currently used for tumors harboring these two genetic targets and to focus on what will be available in clinical practice in the near future.

靶向特定驱动致癌基因的分子疗法的出现极大地改变了一部分NSCLC的预后,扩大了晚期疾病患者的生存率,提高了患者的生活质量。受体TKIs治疗的两个主要靶点是EGFR和ALK基因融合的活化突变形式。在携带EGFR突变或ALK重排的晚期NSCLC患者中,与细胞毒性化疗相比,在一线环境中使用TKIs提供了意想不到的大的无进展生存率和总体生存益处。然而,尽管有最初的反应和持久的缓解,耐药性的发展不可避免地会导致治疗失败。这篇综述的目的是讨论目前用于携带这两个基因靶点的肿瘤的治疗策略,并关注在不久的将来临床实践中可用的治疗策略。
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引用次数: 0
Symptom burden in lung cancer: management updates. 肺癌的症状负担:管理更新。
IF 2.8 Q4 RESPIRATORY SYSTEM Pub Date : 2016-06-01 Epub Date: 2016-05-26 DOI: 10.2217/lmt-2016-0001
Rebecca H Lehto

Lung cancer is recognized to carry a high symptom burden with associated lowered quality of life as compared with other cancers. Research has shown that symptom severity can be a prognostic indicator of poorer clinical outcomes and survival post treatment. The purpose of this paper is to review current literature relative to symptom burden associated with diagnosis, medical and/or surgical intervention, assessment and management updates, and emerging initiatives that promote positive outcomes based on updated evidence. Discussion relative to interdisciplinary coordination of supportive services and palliative care initiation is provided.

与其他癌症相比,肺癌的症状负担较重,生活质量也随之降低。研究表明,症状严重程度可作为预后指标,预示着较差的临床疗效和治疗后的存活率。本文旨在回顾与诊断、内科和/或外科干预、评估和管理更新相关的症状负担方面的现有文献,以及基于最新证据促进积极疗效的新举措。本文还就支持性服务的跨学科协调和姑息治疗的启动进行了讨论。
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引用次数: 0
Liquid biopsy and NSCLC. 液体活检和NSCLC。
IF 2.8 Q4 RESPIRATORY SYSTEM Pub Date : 2016-06-01 Epub Date: 2016-07-08 DOI: 10.2217/lmt-2016-0006
Domenico Trombetta, Angelo Sparaneo, Federico Pio Fabrizio, Lucia Anna Muscarella

In the era of high-throughput molecular screening and personalized medicine, difficulty in determining whether cancer mutations are truly 'actionable' remains a gray zone in NSCLC. The most important prerequisite to perform such investigations is the tumor tissue retrieval via biopsy at diagnosis and after occurrence of resistance. Blood-based liquid biopsy as circulating tumor cells, circulating tumor DNA and exosomes can offer a fast and non-invasive method to elucidate the genetic heterogeneity of patients, the screening and patient stratification and give a dynamic surveillance for tumor progression and monitor treatments response. Here we prospectively discuss the three main approaches in the blood-biopsy field of lung cancer patients and its clinical applications in patient management. We also outline some of the analytical challenges that remain for liquid biopsy techniques in demonstrating that it could represent a true and actionable picture in lung cancer management for the implementation into clinical routine.

在高通量分子筛选和个性化医疗的时代,确定癌症突变是否真正“可操作”的困难仍然是NSCLC的灰色地带。进行此类调查的最重要的先决条件是在诊断时和发生耐药性后通过活检取肿瘤组织。血液液体活检作为循环肿瘤细胞、循环肿瘤DNA和外泌体,可以提供一种快速、无创的方法来阐明患者的遗传异质性、筛查和患者分层,并对肿瘤进展进行动态监测和监测治疗反应。本文就肺癌患者血活检领域的三种主要方法及其在患者管理中的临床应用进行了展望。我们还概述了液体活检技术仍然存在的一些分析挑战,以证明它可以代表肺癌管理的真实和可操作的图片,并将其应用于临床常规。
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引用次数: 9
Lymphnodal micrometastases in NSCLC: where do we stand? 非小细胞肺癌的淋巴结微转移:我们站在哪里?
IF 2.8 Q4 RESPIRATORY SYSTEM Pub Date : 2016-06-01 Epub Date: 2016-05-24 DOI: 10.2217/lmt-2016-0009
Andrea Viti, Alberto Terzi, Giuseppe Bogina, Luca Bertolaccini
Thoracic Surgery Unit, Sacro Cuore Don Calabria Research Hospital – Cancer Care Center, Via Don Angelo Sempreboni 5, 37024, Negrar Verona, Italy Pathology Service, Sacro Cuore Don Calabria Research Hospital – Cancer Care Center, Negrar Verona, Italy *Author for correspondence: vitimassa@hotmail.it
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引用次数: 2
Recent results of immunotherapy and perspectives for advanced NSCLC. 晚期非小细胞肺癌免疫治疗的最新结果和前景。
IF 2.8 Q4 RESPIRATORY SYSTEM Pub Date : 2016-06-01 Epub Date: 2016-05-24 DOI: 10.2217/lmt-2016-0007
Denis L Jardim, Debora de Melo Gagliato
Centro de Oncologia do Paraná – Oncoville, Curitiba, Brazil *Author for correspondence: Tel.: +55 41 3083 0988; denisjardim@centrodeoncologia.com It is estimated that 224,390 new cases of lung cancer will be diagnosed in 2016 in USA, making it the second most incident cancer for all genders, only behind breast cancer. Additionally, lung cancer will be first cause of cancer death in USA during this year, causing 150,080 estimated deaths [1]. Although lung cancer mortality is slowly decreasing over the last years, data indicate of lung cancer diagnosis and treatment is still an unmet need. One of the key challenges is that approximately 70% of lung cancers are diagnosed in advanced stage, for which curative treatment is not possible [2]. The majority (85%) of lung cancers are classified as NSCLC, while the reaming represents small-cell lung cancers, which is associated with a dismal prognosis [3]. The standard treatment for advanced NSCLC over the last decade is chemotherapy, including platinum-based doublets. These regimens are associated with a response rate (RR) of approximately 20%, and median overall survival (OS) under 12 months [4]. For selected patients, after four to six cycles of platinum-doublets regimens, maintenance therapy either with chemotherapy or EGFR inhibitors is associated with a modest improvement in OS [5]. One of the greatest advances obtained over the last decade for the management of advanced NSCLC is the consolidation of a molecular-based approach. Approximately 70% of NSCLC are nonsquamous, and 40% of them may present with a targetable genetic alteration. Tyrosine kinase inhibitors are available for patients whose tumors harbor EGFR mutations, ALK translocations and, more recently, ROS1 fusions. A matched targeted therapy is associated with an RR of 60–70%, and disease control that frequently surpasses 12 months [6]. Nonetheless, these therapies are not curative; treatment resistance development is almost a rule. In addition, there are no molecularly oriented therapies approved for advanced lung cancers with squamous cell histology. Second-line options for advanced NSCLC were restricted to docetaxel and pemetrexed.
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引用次数: 0
Measurement of quality of life in second-line patients with advanced NSCLC without targetable mutations: a review. 无靶向突变的晚期NSCLC二线患者的生活质量测量:综述
IF 2.8 Q4 RESPIRATORY SYSTEM Pub Date : 2016-06-01 Epub Date: 2016-07-08 DOI: 10.2217/lmt-2016-0010
David Heigener, Thomas Küchler

Quality of life (QoL) is important to cancer patients and is increasingly included as a trial end point. The methodologies/findings of randomized controlled trials evaluating the efficacy and safety of second-line treatments approved for use in the EU in patients with advanced/metastatic NSCLC, without known targetable mutations, were evaluated. Seven trials were identified; five compared active treatments and two compared active treatment to placebo. Methodologies used and reporting varied. The European Organization for Research and Treatment of Cancer lung cancer questionnaire was the most commonly used assessment method (n = 4). There was no evidence to suggest differences in QoL between active treatments. Consistent and appropriate use of standard QoL instruments in future would increase the reliability of results and their applicability to clinical decision-making.

生活质量(QoL)对癌症患者很重要,并且越来越多地被纳入试验终点。评估二线治疗在欧盟被批准用于无已知靶向突变的晚期/转移性NSCLC患者的有效性和安全性的随机对照试验的方法/结果进行了评估。确定了7项试验;5个比较了积极治疗,2个比较了积极治疗和安慰剂。使用的方法和报告各不相同。欧洲癌症研究和治疗组织肺癌问卷是最常用的评估方法(n = 4)。没有证据表明积极治疗之间的生活质量存在差异。今后一致和适当地使用标准生活质量仪器将提高结果的可靠性及其对临床决策的适用性。
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引用次数: 1
Curative intent therapy in oligometastatic lung cancer with an unresectable primary with N3 nodes: case report and review of the literature. 原发性N3淋巴结不可切除的少转移肺癌的治疗目的:病例报告和文献回顾。
IF 2.8 Q4 RESPIRATORY SYSTEM Pub Date : 2016-04-01 Epub Date: 2016-04-08 DOI: 10.2217/lmt-2016-0002
Vanita Noronha, Amit Joshi, Vijay M Patil, Sunny Jandyal, Neha Mittal, Nilendu Purandare, Jaiprakash Agarwal, Nandkumar Kadam, Kumar Prabhash

Untreated NSCLC patients with brain metastases have a median survival of approximately 2 months; locally advanced stage III NSCLC patients treated with chemoradiation have a median survival of 16-19 months. Select patients with oligometastatic disease may have a prolonged survival if managed aggressively. We present the case of a 47-year-old woman with lung adenocarcinoma, cT2aN3M1a, (supraclavicular lymph node, solitary brain metastasis). She underwent brain metastasectomy, whole brain radiation, induction chemotherapy and concurrent chemoradiotherapy. She relapsed in the brain and locoregionally and was treated with brain re-irradiation, and systemic chemotherapy. Her progression-free survival was 32 months and she is alive with recurrent disease 63 months after diagnosis. Systemic therapy is an important tool in the multimodality management of patients with oligometastatic disease.

未经治疗的非小细胞肺癌脑转移患者的中位生存期约为2个月;局部晚期III期NSCLC患者接受放化疗的中位生存期为16-19个月。选择少量转移性疾病的患者,如果积极治疗,可能会延长生存期。我们报告一例47岁女性肺腺癌,cT2aN3M1a,(锁骨上淋巴结,孤立脑转移)。她接受了脑转移切除术、全脑放疗、诱导化疗和同步放化疗。她在脑部和局部区域复发,并接受脑部再照射和全身化疗。她的无进展生存期为32个月,诊断后63个月复发。全身治疗是少转移性疾病患者多模式治疗的重要工具。
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引用次数: 0
Neurotrophic tyrosine kinase gene fusions: another opportunity for targeting in lung cancer. 神经营养酪氨酸激酶基因融合:肺癌靶向治疗的另一个机会。
IF 2.8 Q4 RESPIRATORY SYSTEM Pub Date : 2016-04-01 Epub Date: 2016-03-22 DOI: 10.2217/lmt-2016-0003
Luis E Raez, Christian Rolfo
2517 (2015). 12 Patel MR, Bauer TM, Liu SV et al. STARTRK-1: Phase 1/2a study of entrectinib, an oral Pan-Trk, ROS1, and ALK inhibitor, in patients with advanced solid tumors with relevant molecular alterations. J. Clin. Oncol. 33(Suppl.), Abstract 2596 (2015). 13 Burris HA, Brose MS, Shaw AT et al. A first-in-human study of LOXO-101, a highly selective inhibitor of the tropomyosin receptor kinase (TRK) family. J. Clin. Oncol. 33(Suppl.), Abstract TPS2624 (2015). 14 TRK inhibitor shows early promise. Cancer Discov. doi:10.1158/2159-8290.CDNB2015-165 (2015) (Epub ahead of print).
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引用次数: 1
Nintedanib in advanced NSCLC: management of adverse events. Nintedanib治疗晚期NSCLC:不良事件的处理。
IF 2.8 Q4 RESPIRATORY SYSTEM Pub Date : 2016-04-01 Epub Date: 2015-11-03 DOI: 10.2217/lmt.15.33
Liesbeth Lemmens

Nintedanib plus docetaxel is approved in the EU for the treatment of patients with locally advanced, metastatic or locally recurrent NSCLC of adenocarcinoma histology after first-line chemotherapy. Nintedanib in combination with docetaxel has a manageable safety profile in adenocarcinoma NSCLC patients. The most frequent adverse events (AEs) associated with nintedanib are gastrointestinal events and elevations in liver enzymes. Most AEs can be managed effectively with supportive treatment or a dose reduction and do not require permanent discontinuation. This article aims to provide practical guidance on management of AEs and how patients should be assessed for AEs prior to initiation and regularly monitored throughout treatment. Patients and their carers can play an important role in recognizing and managing AEs and should be given the relevant information, skills and confidence to achieve this.

欧盟批准宁替达尼联合多西他赛治疗一线化疗后局部晚期、转移性或局部复发的腺癌组织学NSCLC患者。宁替达尼联合多西他赛治疗腺癌NSCLC患者具有可控的安全性。与宁替达尼相关的最常见不良事件(AE)是胃肠道事件和肝酶升高。大多数AE可以通过支持性治疗或减少剂量有效控制,不需要永久停药。本文旨在为AE的管理以及如何在开始治疗前对患者进行AE评估和在整个治疗过程中定期监测提供实用指导。患者及其护理人员可以在识别和管理AE方面发挥重要作用,并应获得实现这一目标的相关信息、技能和信心。
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引用次数: 9
期刊
Lung Cancer Management
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