Lung Cancer Management最新文献

Treatment of extensive-stage small-cell lung cancer remains a challenge with poor local control and overall survival. Chemotherapy is the mainstay of treatment, consisting of a combination of a platinum agent plus etoposide. The role of consolidative chest radiotherapy in extensive-stage small-cell lung cancer remains controversial. Two randomized clinical trials have been published demonstrating improved intrathoracic disease control with a small survival benefit, though interpretation and application of these results to clinical practice has been debated. These two trials examined different radiotherapy techniques and doses, with a third trial treating consolidative chest and oligometastatic disease having closed prematurely due to an interim analysis demonstrating treatment futility plus increased toxicity. Patients with residual intrathoracic disease after chemotherapy appear to benefit the most from consolidative chest radiotherapy, offering a potential tool to help select appropriate patients.

The identification of driver mutations in patients with advanced non-small-cell lung cancer has changed the treatment outcomes for patients with actionable driver mutations. Lack of tissue at diagnosis, however, remains a central obstacle in making optimal treatment decisions in patients with advanced disease. Although the US FDA has approved one plasma-based test for detecting epidermal growth factor receptor mutations in patients with advanced stage disease, sensitivity of these assays remains mediocre, necessitating additional tissue testing and possible delays in patients with negative results. Serial monitoring for response and early detection of acquired resistance to targeted therapies is also possible with cell-free DNA, however the benefit of switching therapy prior to detection of changes on imaging is unknown currently.

Diagnosis of paraneoplastic neurologic disorder (PND) synthesizes the clinical picture (including the temporal relationship to the cancer diagnosis), detection of onconeural antibodies and exclusion of alternative causes. The mainstay of brain imaging of PNDs is MRI. There is also an increasingly recognized role of PET using radiotracer ¹⁸F-Fluorodeoxyglucose (FDG) in the evaluation of the brain. We describe a 67-year-old female with a 50-year smoking history and small-cell lung cancer developing subacute encephalopathy with MRI and PET abnormalities identifying paraneoplastic encephalitis. PET may complement conventional tools in diagnosing a subset of patients with PND.

Aim: The frequency of pancreatic cancer in association with cancer of other organs ranges from 1 to 20%, with the most common ones being gastric, colon, thyroid and genitourinary. The presence of synchronous lung and pancreatic cancers is extremely rare.

Case series: Two patients with extensive smoking history and variable presentations were found to have simultaneous lung and pancreatic masses both lesions being different histologically and on immunohistochemical staining. After individualized treatment plans, the first patient remains free of disease and the second patient is being treated with a palliative intent.

Conclusion: The early recognition and treatment is important as there exists a significant survival difference in patients who have synchronous primaries as opposed to those with metastatic pancreatic adenocarcinoma.

Silvia Novello speaks to Roshaine Wijayatunga, Managing Commissioning Editor: Silvia Novello is a Full Professor of Medical Oncology in the Oncology Department at San Luigi Hospital in Orbassano, Italy, part of the University of Turin. She earned her medical degree and completed the postgraduate training in respiratory medicine and medical oncology at the University of Turin and partially at the Institut Gustave Roussy in France. Currently, she is head of the Thoracic Oncology Unit at the San Luigi Hospital, Orbassano (Turin), where she also tutors medical students and postgraduate students in respiratory medicine and medical oncology. Novello's research interests include thoracic malignancies, primary prevention, gender differences in lung cancer, basic and clinical applied research on lung cancer, including pharmacogenomics. She is involved in many European and national controlled clinical trials evaluating new approaches in diagnosis and lung cancer therapy. From July 2012 until 2016, Novello has been a Member of the Board of Directors of the International Association for the Study of Lung Cancer and since October 2016 Member of the Board of Directors of the Italian Association of Medical Oncology and member of other several scientific societies including the American Society of Clinical Oncology and the European Society of Medical Oncology. Currently, she is the President of Women Against Lung Cancer in Europe, a nonprofit European Association founded in 2006 in Turin, Italy, part of the scientific Committee of Lung cancer Europe and also a member of the Scientific Committee of Bonnie J Addario Lung Cancer Foundation and Member of the Scientific Committee of Investigación sobre Cáncer de Pulmón en Mujeres. She is the author or co-author of over 100 publications in peer-reviewed journals.

Immune checkpoint inhibition has been proven to be highly efficacious in NSCLC and associated with durable responses in a limited number of patients. Chemotherapy and targeted therapies, which have also expanded rapidly in this field lead to high response rates and improved survival although inevitably resistance occurs and hence treatment failure. There is increasing evidence showing that chemotherapy and targeted therapy interplay with the immune system including exerting effects on tumor cells and the host immune cells. Naturally combining both of these treatment modalities to induce cytotoxic effects on tumor cells to release tumor antigens and priming of the immune system should in turn lead to enhanced anticancer activity. This review will explore some of the preclinical rationale and clinical trial data we have to date on combining various systemic therapies with immunotherapies.

Vassiliki A Papadimitrakopoulou speaks to Roshaine Wijayatunga, Managing Commissioning Editor: Dr Papadimitrakopoulou is the Jay and Lori Eisenberg Distinguished Professor of Medicine and Chief of the section of Thoracic Medical Oncology in the Department of Thoracic/Head and Neck Medical Oncology at the University of Texas/MD Anderson Cancer Center. Her areas of expertise include design and development of novel therapeutic clinical trials for lung and head and neck neoplasms, personalized genomics-driven lung cancer therapy and translational research and cancer chemoprevention. Her extensive experience in design, development and implementation of translational research in the context of multidisciplinary research teams has led to research funding from National Cancer Institute (NCI), American Society of Clinical Oncology (ASCO) and Department of Defense (DOD) both independently and as a member of a research team in the Head and Neck SPORE program. Currently, she serves as the principal investigator and leads numerous clinical and translational research projects with a focus on the development of biomarker-based targeted therapy to overcome therapeutic resistance in advanced disease and immunotherapy. Most notably, she has led the multidisciplinary clinical and translational research infrastructure dedicated to the treatment of metastatic refractory NSCLC as part of the BATTLE-2 program, designed and developed the first-in-the-world comprehensive genomics-driven umbrella approach in Squamous Lung Cancer, the Lung Master protocol, jointly sponsored by NCI-Cancer Therapy Evaluation Program (CTEP) and Foundation for the National Institutes of Health (FNIH)/industry, aiming at bringing personalized medicine to patients with this disease. She is the Co-PI of an R01 award focusing on the role of KRAS mutations and targeting in lung cancer. She is the lead author or coauthor of over 150 published articles, book chapters and reviews, and numerous abstracts involving cancer therapeutics, prevention and translational research and she has received several awards including the ASCO Young Investigator and Career Development Award. On this R01 application, she will serve as Co-PI, working closely with Roy Herbst (Yale Cancer Center) and Don Gibbons (UT/MD Anderson Cancer Center), building on the recently completed BATTLE-2 program, and capitalizing on both laboratory findings supporting MEK targeted therapy and clinical effectiveness of immunotherapy and their combinations in addressing KRAS mutated lung cancer.