Pub Date : 2025-10-01DOI: 10.1016/S1877-1203(25)00093-X
B. Duchemann , J. Cadranel , A. Paix , L. Matton , M. Didier , D. Radu , M. Kambouchner , K. Chouahnia , J. Behr , P.-Y. Brillet , H. Nunes
The occurrence of lung cancer in patients with diffuse fibrosing pneumonitis is neither fortuitous nor rare. Diagnosis strategy and therapeutics are currently poorly standardized, and there is no expert consensus available in Europe. Therapeutic strategy is limited by the poor underlying respiratory function, the risk of respiratory exacerbation favored by some treatments, age and comorbidities, and more generally by the underlying frailty of patients with lung fibrosis. In the current article we will review the epidemiology, the diagnosis management, and the necessary data for discussing local or systemic therapeutics.
{"title":"Cancers pulmonaires associés à une pathologie interstitielle pulmonaire fibrosante","authors":"B. Duchemann , J. Cadranel , A. Paix , L. Matton , M. Didier , D. Radu , M. Kambouchner , K. Chouahnia , J. Behr , P.-Y. Brillet , H. Nunes","doi":"10.1016/S1877-1203(25)00093-X","DOIUrl":"10.1016/S1877-1203(25)00093-X","url":null,"abstract":"<div><div>The occurrence of lung cancer in patients with diffuse fibrosing pneumonitis is neither fortuitous nor rare. Diagnosis strategy and therapeutics are currently poorly standardized, and there is no expert consensus available in Europe. Therapeutic strategy is limited by the poor underlying respiratory function, the risk of respiratory exacerbation favored by some treatments, age and comorbidities, and more generally by the underlying frailty of patients with lung fibrosis. In the current article we will review the epidemiology, the diagnosis management, and the necessary data for discussing local or systemic therapeutics.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S350-2S358"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236476","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 : 2025-10-01DOI: 10.1016/S1877-1203(25)00063-1
D. Basille
Mediastinal lymph node staging is a critical step in the therapeutic management of non-small cell lung cancer (NSCLC). Advances in functional imaging, particularly PET-CT, have significantly improved non-invasive diagnosis. However, its limited specificity makes histological confirmation essential.
Minimally invasive endoscopic techniques, endobronchial ultrasound (EBUS) ± endoscopic ultrasound (EUS), have emerged as first-line modalities due to their low morbidity and high diagnostic accuracy, especially in patients eligible for curative treatment. These techniques are particularly recommended in cases of radiologically suspicious lymphadenopathy (cN1-N3), central tumors, or large tumors (>3 cm). In the event of negative findings but persistent clinical suspicion, surgical staging via mediastinoscopy remains indicated. Nevertheless, the systematic use of this surgical approach following complete endoscopic staging is increasingly debated in light of recent evidence.
In patients with early-stage NSCLC classified as N0 on PET, invasive staging prior to stereotactic body radiotherapy is not routinely recommended but should be considered on a case-by-case basis, depending on clinical and anatomical risk factors.
Pub Date : 2025-10-01DOI: 10.1016/S1877-1203(25)00064-3
G. Drevet , E. Gagnepain , J.-M. Maury
The progressive implementation of lung cancer screening is leading to earlier diagnoses. The treatment of localised lung cancers remains surgical, and surgery is becoming more personalised, with the possibility of peri-operative treatments even for early stages. In that context, obtaining a pre-operative diagnosis is important. Surgery itself is also becoming more individualised, adapted to the stage and location of the tumour. Complex segmentectomies are increasingly performed, this made possible by robot-assisted surgery, preoperative planning, intraoperative nodule localisation and techniques for defining intersegmental planes. When the indications are respected, sub lobar resections allow an equivalent overall survival and recurrence-free survival compared to lobectomy.
{"title":"La chirurgie du cancer du poumon localisé en 2024","authors":"G. Drevet , E. Gagnepain , J.-M. Maury","doi":"10.1016/S1877-1203(25)00064-3","DOIUrl":"10.1016/S1877-1203(25)00064-3","url":null,"abstract":"<div><div>The progressive implementation of lung cancer screening is leading to earlier diagnoses. The treatment of localised lung cancers remains surgical, and surgery is becoming more personalised, with the possibility of peri-operative treatments even for early stages. In that context, obtaining a pre-operative diagnosis is important. Surgery itself is also becoming more individualised, adapted to the stage and location of the tumour. Complex segmentectomies are increasingly performed, this made possible by robot-assisted surgery, preoperative planning, intraoperative nodule localisation and techniques for defining intersegmental planes. When the indications are respected, sub lobar resections allow an equivalent overall survival and recurrence-free survival compared to lobectomy.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S84-2S91"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236491","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 : 2025-10-01DOI: 10.1016/S1877-1203(25)00067-9
I. Martel-Lafay
For patients with locally advanced unresectable non-small cell lung cancer, the standard treatment is a combination of chemotherapy and radiation therapy, preferably concurrent, followed by consolidation immunotherapy with durvalumab. The challenge is to administer radiation therapy that is effective enough without the risk of unacceptable toxicity: defining the optimal dose and volumes, implementing modern radiation therapy techniques in routine, and taking into account all organs at risk (OAR), including some that have not been considered until now, these are the major issues of quality thoracic radiation therapy.
{"title":"La radiothérapie des cancers du poumon non à petites cellules localement avancés","authors":"I. Martel-Lafay","doi":"10.1016/S1877-1203(25)00067-9","DOIUrl":"10.1016/S1877-1203(25)00067-9","url":null,"abstract":"<div><div>For patients with locally advanced unresectable non-small cell lung cancer, the standard treatment is a combination of chemotherapy and radiation therapy, preferably concurrent, followed by consolidation immunotherapy with durvalumab. The challenge is to administer radiation therapy that is effective enough without the risk of unacceptable toxicity: defining the optimal dose and volumes, implementing modern radiation therapy techniques in routine, and taking into account all organs at risk (OAR), including some that have not been considered until now, these are the major issues of quality thoracic radiation therapy.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S106-2S112"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236535","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 : 2025-10-01DOI: 10.1016/S1877-1203(25)00075-8
E. Pons-Tostivint , J. Bennouna
Therapeutic antibodies have profoundly reshaped the management of non-small cell lung cancer (NSCLC). Following initial strategies targeting VEGF or EGFR, the introduction of immune checkpoint inhibitors (anti-PD-1 /PD-L1) represented a major breakthrough. However, primary and acquired resistance still limit their efficacy, prompting the development of innovative antibodies.
Antibodies directed against novel immune checkpoints (LAG-3, TIGIT, TIM-3, NKG2A) aim to restore the functionality of exhausted T lymphocytes. Early clinical results are mixed, with some signals of efficacy but also several failures in late-phase trials.
Bispecific antibodies such as amivantamab (anti-EGFR/MET), ivonescimab (anti-PD-1/VEGF), and tarlatamab (anti-DLL3/CD3) are emerging as promising options. By combining tumor targeting with immune modulation, they have demonstrated significant clinical benefits in phase 3 studies, notably in terms of overall survival and tolerability. Other experimental constructs, including bi- or tri-specific formats, T-cell engagers, and nanobodies, are under investigation and may further expand therapeutic indications.
Pub Date : 2025-10-01DOI: 10.1016/S1877-1203(25)00053-9
M. Duruisseaux, S. Couraud, A.-C. Toffart, A. Swalduz
{"title":"Éditorial : Cours du Groupe d'Oncologie Thoracique de Langue Française 2025","authors":"M. Duruisseaux, S. Couraud, A.-C. Toffart, A. Swalduz","doi":"10.1016/S1877-1203(25)00053-9","DOIUrl":"10.1016/S1877-1203(25)00053-9","url":null,"abstract":"","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S1-2S2"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236602","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 : 2025-10-01DOI: 10.1016/S1877-1203(25)00073-4
M. Pérol , D. Moro-Sibilot
Despite the improved results of first-line treatment of metastatic non-small-cell lung carcinoma with anti PD-(L)1, the majority of patients continue to experience disease progression, reflecting primary or acquired resistance to immunotherapy. “Second-line” treatment follows anti PD-(L)1 immunotherapy and platinum-based doublet chemotherapy, administered either sequentially or concomitantly. The multiplicity of mechanisms of resistance to immunotherapy makes it difficult to identify them at the level of a given patient; the majority of therapeutic strategies developed in the second-line setting are therefore agnostic of the mechanism of resistance to immunotherapy. Despite the development of numerous innovative strategies, treatment remains based on cytotoxic chemotherapy, mainly taxanes as monotherapy or combined with anti-angiogenic agents. It remains important to check the absence of genomic or phenotypic alterations that could be accessible to a specific treatment, particularly in the context of a clinical trial. For the time being, the development of conjugated antibodies has not transformed the second-line strategy, and is now mainly conducted in the first-line setting. Rechallenge with immunotherapy can only be envisaged after anti PD-(L)1 has been discontinued due to toxicity, or after the scheduled end of first-line treatment, after a free interval. New strategies are currently being studied to overcome primary or acquired resistance to immunotherapy.
{"title":"Algorithme thérapeutique des CBNPC sans anomalie moléculaire actionnable au-delà de la première ligne","authors":"M. Pérol , D. Moro-Sibilot","doi":"10.1016/S1877-1203(25)00073-4","DOIUrl":"10.1016/S1877-1203(25)00073-4","url":null,"abstract":"<div><div>Despite the improved results of first-line treatment of metastatic non-small-cell lung carcinoma with anti PD-(L)1, the majority of patients continue to experience disease progression, reflecting primary or acquired resistance to immunotherapy. “Second-line” treatment follows anti PD-(L)1 immunotherapy and platinum-based doublet chemotherapy, administered either sequentially or concomitantly. The multiplicity of mechanisms of resistance to immunotherapy makes it difficult to identify them at the level of a given patient; the majority of therapeutic strategies developed in the second-line setting are therefore agnostic of the mechanism of resistance to immunotherapy. Despite the development of numerous innovative strategies, treatment remains based on cytotoxic chemotherapy, mainly taxanes as monotherapy or combined with anti-angiogenic agents. It remains important to check the absence of genomic or phenotypic alterations that could be accessible to a specific treatment, particularly in the context of a clinical trial. For the time being, the development of conjugated antibodies has not transformed the second-line strategy, and is now mainly conducted in the first-line setting. Rechallenge with immunotherapy can only be envisaged after anti PD-(L)1 has been discontinued due to toxicity, or after the scheduled end of first-line treatment, after a free interval. New strategies are currently being studied to overcome primary or acquired resistance to immunotherapy.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S160-2S170"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236540","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}
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