Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00073-9
M. Remmelink
The WHO classification of lung tumours on which pathologists base their diagnosis was revised in 2015 on the basis of an international consensus established in 2011 between clinicians, radiologists and pathologists. This resulted in a histo-molecular and prognostic classification of adenocarcinomas. The use of immunohistochemistry for the classification of poorly differentiated non-small cell carcinomas and a new classification adapted to small specimens were defined. These concepts are still relevant today, as the management of small specimens is a key point in the collaboration between the sampling physician and the pathologist.
This classification was revised in 2021 and remains broadly the same except for the appearance of new entities: SMARCA4-defident undifferentiated thoracic tumour; bron-chiolar adenoma / muconodular ciliated papillar tumour. Although rare, these lesions have histopathological, clinical and/or molecular appearances that merit their presence as new entities.
For invasive adenocarcinomas, the 5 architectural patterns are maintained but the IASLC proposes a grading system which has shown a prognostic impact for early stages.
Some clarifications regarding the diagnosis of neuroendocrine tumours/carcinomas were provided.
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00095-8
E. Gaye , A. Jannin , C. Do Cao , E. Dansin
Large cell neuroendocrine carcinomas (LCNECs) are rare tumors with high grade malignancy and poor prognosis. The management of LCNECs remains complex and several clinical situations (induction, metastatic stages, etc.) are still debating. While the impact of molecular profiling of these tumors on optimal systemic treatment choice has yet to be demonstrated, the prospective evaluation of immunotherapy in metastatic stages is ongoing and could open up new therapeutic options.
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00089-2
D. Moro-Sibilot , J. Mazières , G. Berardi , M. Pérol , A. Cortot
The development of immunotherapy in first-line therapy with anti-PD-1 and anti-PD-L1 has changed the first line treatment algorithm of advanced NSCLC. The anti-PD-(L)1 pembrolizumab, atezolizumab and cemiplimab clearly improve the overall survival in NSCLC with high PD-L1 expression (≥ 50 % of tumour cells), comparatively to cytotoxic chemotherapy. Combinations of anti-PD(L)-1 to platinum-based chemotherapy are superior to chemotherapy alone, regardless of PD-L1 level of expression. They represent the 1st line gold-standard when PD-L1 is expressed in less than 50 % of tumour cells and might reduce the risk of early disease progression in comparison with pembrolizumab when PD-L1 ≥ 50 %. The room for anti-CTLA-4 + anti-PD(L)-1 combinations which are not available in France remains to be established. Second-line treatment is currently based on chemotherapy, with a platinum-based doublet for patients treated in first line by pembrolizumab alone, and standard second-line chemotherapy options for patients treated by chemotherapy-immunotherapy combinations, i.e. docetaxel regardless of histology or pemetrexed for non-squamous cell carcinoma when not used in first line. Addition of an antiangiogenic agent to docetaxel only achieved a modest improvement of overall survival but neither nintedanib, nor docetaxel is available in France. Combination of paclitaxel and bevacizumab is also an option. Immunotherapy still benefits only a minority of patients whose identification is imperfect, underscoring the need for new strategies based on ne< combination amplifying the anti-tumour immune response as well as understanding the mechanisms of resistance to treatment in order to improve these results.
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00084-3
E. Nicolas , C. Faivre-Finn , E. Giroux Leprieur , S. Ocak , P. Fournel , E. Negre , B. Roch , C. Le Pechoux
Limited-stage small cell lung cancer (LS-SCLC) represents 15-20 % of all lung cancers, and because of its rapid tumor kinetics, less than a third of SCLC are discovered at limited stage. The different steps and modalities of its management are well defined and codified. They involve a comprehensive staging assessment using CT scans of the chest, abdomen, and pelvis, PET-CT scans, and ideally brain imaging using MRI to avoid missing a more extensive stage of the disease, which would significantly alter the treatment strategy. The treatment consists of a combination of chemotherapy with platinum/ etoposide and radiotherapy, possibly delivered in a hyperfractionated schedule with two daily sessions. SCLC is particularly both chemosensitive and radiosensitive, so that the initial evaluation shows frequently a complete response, and prophylactic cranial irradiation (PCI) is then recommended. Relapses are unfortunately frequent, less responsive to second line treatments, and therapeutic options are limited. No targeted agents or immunotherapy have robustly demonstrated efficacy in the treatment of LSSCLC. Even if hyperfractionated accelerated radiotherapy (HFART) at the dose of 45Gy in 30 fractions has given the best results, most clinicians use once-daily chemoradiation regimen (60-70Gy). Studies have evaluated dose escalation either with HFRAT or with conventional fractionation (66 to 70Gy). Several trials are currently investigating the addition of immunotherapy to chemoradiation, hippocampus sparing PCI or the omission of PCI. In rare cases of very early-stage SCLC, surgery or stereotactic radiotherapy may be envisaged.
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00101-0
V. Gounant , R. Ezzedine , B. Duchemann , T. Pierret , S. Brosseau , Y. Castier , G. Zalcman , P. Mordant
Numerous factors, whether linked to cancer or to comorbidities, can affect the Performance Status (PS). PS remains a major independent prognostic factor in lung cancer despite the heterogeneity of cancer patients with poor PS. Lung cancer occurs mainly at an advanced age and is linked in most of the cases to smoking, which can also lead to long-term organ failure. Comorbidities and PS should then be considered to determine the most suited local treatment. The aim of this review is to highlight the impact of PS and certain comorbidities (coronaropathy, cirrhosis, chronic kidney disease and interstitial lung disease) on the management and treatment of localized lung cancer.
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00067-3
Thierry Berghmans, Alexis Cortot
{"title":"Éditorial : Cours du Groupe d’Oncologie Thoracique de Langue Française 2023","authors":"Thierry Berghmans, Alexis Cortot","doi":"10.1016/S1877-1203(24)00067-3","DOIUrl":"10.1016/S1877-1203(24)00067-3","url":null,"abstract":"","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"16 2","pages":"Pages 2S1-2S2"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142425872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/S1877-1203(24)00090-9
A. Cortot , P. Abdayem , D. Planchard
The prognosis of advanced Non-Small Cell Lung Cancer (NSCLC) has been significantly improving ever since the discovery of oncogenic driver alterations and the implementation of targeted therapies. Today, molecular profiling, preferably by using next-generation sequencing panels as well as liquid biopsies is crucial before starting treatment in patients with non-squamous NSCLC independent of their smoking status, as well as in those with squamous NSCLC who are little or non-smokers. In this review, we present the latest evidence on the most detected driver alterations in advanced NSCLC apart from EGFR, ALK and ROS1 alterations. A few of the novel therapies have been approved in Europe in specific settings, and many are still not reimbursed by third-party payers. This highlights the importance of encouraging patients to participate in clinical trials to gain access to innovative treatments. Translational research programs are also important to uncover mechanisms of resistance to targeted therapies and how to overcome them.
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号