Lung Cancer Management最新文献

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.

Since the success of the NLST study, the incorporation of lung cancer screening programs into current academic programs has been growing. Center for Medicare and Medicaid Services have acknowledged the importance and potential impact of lung cancer screening by making it a reimbursable study. Based on Fleischner Society Guidelines, many nodules will require follow-up imaging. The remainder of those nodules will need tissue to appropriately make the diagnosis. The use of bronchoscopy with transbronchial biopsy has been a standard technique for many years, but as smaller nodules need to be assessed, more advanced tools, such as endobronchial ultrasound and electromagnetic navigation are now improving the yield on the diagnosis of these smaller peripheral nodules. As electromagnetic navigation and peripheral ultrasound are significant changes from practice only 10 years ago, further advancements in the technology, such as bronchoscopic robots and advanced optical imaging tools, that are becoming available, need to be assessed as to their possible incorporation into the evaluation of peripheral nodules. The ceiling to the diagnosis of these small lesions remains at 70-75%; techniques and tools need to be used to improve upon this to maximize the impact of lung cancer screening and minimize the risk to patients.

Aim: To evaluate the clinical and financial impact of introducing electromagnetic navigation bronchoscopy (ENB) at a community center.

Methods: This retrospective, single-arm, single-center study evaluated 90 consecutive patients who had undergone ENB in 2012. Radial probe endobronchial ultrasound was used to localize the lesion after initial ENB. ENB-aided diagnoses, follow-up procedures and treatments, and adverse events were collected through 2 years.

Results: ENB was conducted for lung biopsy (86 patients), fiducial placement (five), and/or dye marking (two). ENB-aided diagnostic yield was 82.6% (71/86), including 36 malignant and 35 nonmalignant cases. NSCLC was stage I-II in 84.6%. There were four false negatives. Sensitivity and negative predictive value were 90.0 and 88.6%. Pneumothorax occurred in 6/90 (5/6 with chest tube) and minor bleeding in four. The downstream revenue of new ENB cases was US$363,654.

Conclusion: ENB introduction provided high diagnostic yield, early-stage diagnosis, acceptable safety, and was financially justified.

Objectives: As tobacco use becomes increasingly concentrated in communities of low socio-economic position (SEP), scalable cessation interventions are needed. Head Start programs offer one setting in which a family-focused intervention can be implemented in low SEP communities. We assessed the experiences of Head Start (HS) staff who received training in a pilot motivational interviewing (MI) tobacco intervention, to improve future feasibility.

Methods: Focus group interviews were conducted with HS staff to assess their reactions to MI training and their use of MI in their work with families. Transcripts were analyzed using thematic analysis and a 4-step approach informed by grounded theory.

Results: HS staff reported advantages of MI beyond its use as a tobacco intervention, despite systematic barriers to broad implementation. Facilitators of MI use included enhanced engagement with families, and opportunities for professional development. Barriers to MI use included limited institutional support and low priority for a tobacco intervention among families with pressing social and financial concerns.

Conclusions: HS Staff voiced support for broader training in MI interventions in HS programs. System-wide standards to ensure adequate training and support for an MI tobacco intervention were identified as priorities.