Clinical lung cancer最新文献

{"title":"Pretreatment SUVmax Stratifies the Benefit of Consecutive Daily SBRT in Early-Stage Non-Small Cell Lung Cancer","authors":"Yupeng Di,&nbsp;Haifeng Pang,&nbsp;Xuan Wang,&nbsp;Lingling Meng","doi":"10.1016/j.cllc.2026.06.002","DOIUrl":"10.1016/j.cllc.2026.06.002","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the prognostic value of pretreatment SUVmax in early-stage NSCLC treated with stereotactic body radiotherapy (SBRT) and evaluate whether metabolic activity modulates the impact of overall treatment time (OTT) on outcomes.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 186 patients with stage I NSCLC treated with SBRT (48 Gy/4 fractions). Patients were stratified into high (SUVmax ≥ 5.0, n = 73) and low (SUVmax &lt; 5.0, n = 113) metabolic groups. Schedules were categorized as consecutive (OTT 4-5 days) or non-consecutive (OTT 6-10 days). Primary endpoints were local control (LC) and overall survival (OS).</div></div><div><h3>Results</h3><div>With a median follow-up of 41 months, high SUVmax was associated with inferior outcomes; the 3-year LC rates were 92.1% in the low metabolic group compared to 63.4% in the high metabolic group (<em>P</em> &lt; .0001). On multivariate analysis, SUVmax ≥ 5.0 independently predicted local failure (HR 3.70, 95% CI, 1.48-9.24, <em>P</em> = .005) and mortality (HR 2.38, 95% CI, 1.41-4.01, <em>P</em> = .001). Crucially, a formal interaction test revealed that metabolic activity significantly modulated the impact of scheduling on LC (<em>P</em>-interaction = .042). Subgroup analysis demonstrated that consecutive treatment significantly improved LC in the high-SUVmax group (<em>P</em> = .035), whereas no significant difference between schedules was observed in the low-SUVmax group (<em>P</em> = .57).</div></div><div><h3>Conclusion</h3><div>Pretreatment SUVmax is a robust prognostic biomarker for SBRT outcomes. High-metabolic tumors exhibit heightened sensitivity to treatment prolongation, likely driven by factors such as accelerated repopulation during gaps. Consequently, relatively short or consecutive SBRT courses may be beneficial for this “high-risk” metabolic subgroup. However, biological prioritization must be balanced against safety; non-consecutive schedules remain viable for indolent tumors and are mandatory when technical limitations, prior radiotherapy, or central/ultra-central tumor locations preclude the safe delivery of highly compressed ablative doses.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 6","pages":"Pages 75-82"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148359865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiological Predictors of Visceral Pleural Invasion in Lung Cancers With Ground-Glass Opacity and Pleural Contact","authors":"Naohiro Hayashi,&nbsp;Ken Suzawa,&nbsp;Midori Filiz Nishimura,&nbsp;Haruchika Yamamoto,&nbsp;Kumi Nakajima,&nbsp;Shin Tanaka,&nbsp;Hidejiro Torigoe,&nbsp;Kazuhiko Shien,&nbsp;Kentaroh Miyoshi,&nbsp;Mikio Okazaki,&nbsp;Seiichiro Sugimoto,&nbsp;Hidetaka Yamamoto,&nbsp;Shinichi Toyooka","doi":"10.1016/j.cllc.2026.05.006","DOIUrl":"10.1016/j.cllc.2026.05.006","url":null,"abstract":"<div><h3>Background</h3><div>Visceral pleural invasion (VPI) remains a critical factor influencing surgical decision-making in non-small cell lung cancer (NSCLC). However, accurately predicting VPI on radiological images remains challenging in lung cancers.</div></div><div><h3>Materials and Methods</h3><div>This retrospective study analyzed 299 cases of NSCLC with pleural contact and ground-glass opacity (GGO) components on thin-section CT, all of which were surgically treated between 2012 and 2019. Clinical and radiological features were evaluated for their predictive value in detecting VPI.</div></div><div><h3>Results</h3><div>VPI was confirmed in 14 cases (4.7%). Univariate analysis revealed significant associations between VPI and part-solid tumors (<em>P</em> = .025), larger tumor diameter (<em>P</em> = .006), greater solid component size (<em>P</em> &lt; .001), higher consolidation-to-tumor ratio (CTR) (<em>P</em> = .001), increased pleural contact length (<em>P</em> &lt; .001), elevated CT attenuation values (<em>P</em> &lt; .001), and SUVmax on FDG-PET (<em>P</em> &lt; .001). No cases of pathological VPI were observed in lesions where only the GGO component was in contact with the pleura.</div></div><div><h3>Conclusion</h3><div>Specific radiological features, particularly solid component–pleura contact length, may serve as practical predictors of VPI in ground-glass nodules with pleural contact. Notably, VPI was absent in tumors where only the GGO component contacted the pleura. These findings underscore the importance of careful preoperative evaluation for non-VPI, incorporating additional imaging parameters to enhance risk stratification and surgical decision-making.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 6","pages":"Pages 36-42"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Off-Protocol Radiotherapy in Prospective Systemic Therapy Trials for Metastatic Non–Small Cell Lung Cancer","authors":"Kara M. Ruicci,&nbsp;George J. Li,&nbsp;Andrew Warner,&nbsp;Andrew Youssef,&nbsp;Ambica Parmar,&nbsp;Adam Mutsaers,&nbsp;David A. Palma,&nbsp;Alexander V. Louie","doi":"10.1016/j.cllc.2026.05.009","DOIUrl":"10.1016/j.cllc.2026.05.009","url":null,"abstract":"<div><h3>Purpose</h3><div>Radiotherapy is commonly used for patients with metastatic non–small cell lung cancer (NSCLC)—for symptom palliation, or ablation of metastases. Increasing evidence shows that radiotherapy alters the natural history of metastatic NSCLC. Here, we evaluate prospective systemic therapy trials for protocol specifications and documentation of radiation use during and before trial enrollment.</div></div><div><h3>Materials and Methods</h3><div>Clinicaltrials.gov was queried for completed, phase II-IV systemic therapy trials for metastatic NSCLC. Trial information was summarized using descriptive statistics. Fisher’s exact test and logistic regression were used to assess associations between trial-related factors, radiation allowance, and trial positivity.</div></div><div><h3>Results</h3><div>A total of 405 trials were screened, and 79 were included. Most trials were phase III (<em>n</em> = 50, 63.3%), randomized (<em>n</em> = 68, 86.1%), and unmasked (<em>n</em> = 56, 70.9%). PD-1/PD-L1, EGFR, and VEGF were the most common drug targets, in 46.9% (<em>n</em> = 37), 34.2% (<em>n</em> = 27), and 15.2% (<em>n</em> = 12) of studies, respectively. Most studies (<em>n</em> = 74, 93.7%) allowed radiation before trial enrollment and required a washout period. During the study period, 8.9% (<em>n</em> = 7) of studies prohibited (“off-protocol”) radiation. A drug washout around radiation delivery was required in 21.5% (<em>n</em> = 17) of studies. No studies permitting off-protocol radiation addressed allowable total dose, fractionation, technique or organ-at-risk constraints. Allowance of off-protocol radiation was not significantly associated with trial positivity (OR 0.23; 95% CI, 0.01-1.49; <em>P</em> = .19). While pre-enrollment radiation was reported in 32.9% (<em>n</em> = 26) of studies, no study reported off-protocol radiation use or adjusted for it during outcome analyses.</div></div><div><h3>Conclusion</h3><div>Among prospective systemic therapy trials for NSCLC, radiation details are inconsistently reported. Given overlapping toxicities and the common use of radiotherapy in this setting, future trials require clear parameters regarding radiotherapy use before and during trial enrollment.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 6","pages":"Pages 58-63"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148276244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Platinum Plus Pemetrexed and Treatment Patterns Following First-Line Nivolumab and Ipilimumab in Pleural Mesothelioma: Real-World Results From the German MesoNet Study","authors":"Rajiv Shah,&nbsp;Eva L. Buchmeier,&nbsp;Hans-Georg Kopp,&nbsp;Frank Griesinger,&nbsp;Martin Reck,&nbsp;Daniel C. Christoph,&nbsp;Jonas Kuon,&nbsp;Nikolaj Frost,&nbsp;Christian Grohé,&nbsp;Martin Faehling,&nbsp;Felix C. Saalfeld,&nbsp;Petra Hoffknecht,&nbsp;Jingting Luan,&nbsp;Julia Roeper,&nbsp;Paolo Chesi,&nbsp;Martin Kimmich,&nbsp;Till Olchers,&nbsp;Laura V. Klotz,&nbsp;Inn Chung,&nbsp;Michael Thomas,&nbsp;Petros Christopoulos","doi":"10.1016/j.cllc.2026.06.001","DOIUrl":"10.1016/j.cllc.2026.06.001","url":null,"abstract":"<div><h3>Background</h3><div>There is currently no approval for second-line treatment in pleural mesothelioma (PM). Since the approval of nivolumab/ipilimumab, most guidelines recommend platinum/pemetrexed as subsequent treatment. However, the data supporting this sequence are primarily based on efficacy observed in the first-line setting, while evidence regarding the use of platinum/pemetrexed following first-line nivolumab/ipilimumab remains scarce.</div></div><div><h3>Methods</h3><div>In this retrospective, multicenter study, 57 patients with PM who received second-line therapy were included from the MesoNet cohort, comprising 12 participating cancer centers across Germany. The primary objective was to evaluate outcomes in patients who received second-line platinum/pemetrexed following nivolumab/ipilimumab. The secondary objective was to explore subsequent treatment patterns.</div></div><div><h3>Results</h3><div>Among 135 patients treated with first-line nivolumab/ipilimumab, 57 (42%) received second-line treatment, of whom 41 (72%) received platinum/pemetrexed. The median OS (overall survival) and median PFS (progression-free survival) with second-line platinum/pemetrexed were 11.5 months (95% confidence intervals [CI] 8.6-13.8) and 5.8 months (95% CI 4.1-7), respectively. The disease control rate was 72%, with partial response observed in 28% of patients. Subtype analysis revealed a trend toward better median OS in nonepithelioid versus epithelioid histology (13 months vs. 9.5 months). Only 22 patients (16% of the first-line cohort) received third-line treatment, indicating substantial treatment attrition.</div></div><div><h3>Conclusion</h3><div>In this real-world study, second-line platinum/pemetrexed following first-line nivolumab/ipilimumab demonstrated meaningful clinical activity with an mOS of 11.5 months from the initiation of second-line treatment. These findings support platinum/pemetrexed as an effective second-line option in this setting. However, the high treatment attrition rate emphasizes the importance of careful patient selection and early initiation of second-line therapy.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 6","pages":"Pages 68-74"},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Outcomes of Radiation After Chemoimmunotherapy for Stage III Lung Cancer","authors":"Giorgio Caturegli,&nbsp;Maureen Canavan,&nbsp;Oluwaseun F. Ayoade,&nbsp;Daniel J. Boffa,&nbsp;Benjamin J. Resio","doi":"10.1016/j.cllc.2026.03.016","DOIUrl":"10.1016/j.cllc.2026.03.016","url":null,"abstract":"<div><h3>Background</h3><div>Radiation following chemoimmunotherapy is not currently a standard treatment approach for Stage III non–small cell lung cancer (NSCLC). However, a need for this treatment scenario may arise in patients who underwent intended neoadjuvant chemoimmunotherapy but ultimately no resection. Here we evaluate the practice patterns and outcomes of radiation after chemoimmunotherapy as a nonsurgical option for stage III NSCLC patients.</div></div><div><h3>Methods</h3><div>Clinical Stage III NSCLC patients diagnosed between 2018 and 2022 who received chemoimmunotherapy followed by thoracic radiation (or chemoradiation) were identified in the National Cancer Database. Characteristics were compared by Chi-squared test to patients receiving chemoimmunotherapy alone, chemoradiation followed by immunotherapy, or chemoimmunotherapy followed by surgery. Three-year overall survival was described with Kaplan–Meier curves.</div></div><div><h3>Results</h3><div>In total, 1293 stage III patients received chemoimmunotherapy followed by radiation, while 5382 received chemoradiotherapy followed by immunotherapy, 1921 received chemoimmunotherapy, and 745 received chemoimmunotherapy followed by surgery. Most (1145, 88.6%) chemoimmunotherapy followed by radiation patients received a total radiation dose of ≥ 54 Gy, and 90-day mortality after radiation was 5.3%. Chemoimmunotherapy followed by radiation patients were more often staged T4 (41.5% vs. 34.8%, <em>P</em> &lt; .001) or N3 (26.2% vs. 20.5%, <em>P</em> &lt; .001) compared to chemoradiation/immunotherapy. Three-year overall survival was 51.7%. For reference, 3-year overall survival was 37.3% for chemoimmunotherapy alone, 56.0% for chemoradiation/immunotherapy, and 81.5% for chemoimmunotherapy/surgery.</div></div><div><h3>Conclusions</h3><div>Radiation after chemoimmunotherapy appears to be a substantially utilized, safe, and potentially effective regimen for Stage III NSCLC. Further study is indicated to evaluate chemoimmunotherapy followed by radiation as an alternative nonsurgical option for clinical stage III patients.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 5","pages":"Pages 48-54.e2"},"PeriodicalIF":3.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Efficacy of HER2-targeted Monotherapy in ERBB2-mutant Non–Small-Cell Lung Cancer: A Systematic Review and Single-arm Meta-Analysis","authors":"Fumihiro Kashizaki,&nbsp;Ryusuke Orii,&nbsp;Shohei Watanabe,&nbsp;Kentaro Yumoto","doi":"10.1016/j.cllc.2026.03.018","DOIUrl":"10.1016/j.cllc.2026.03.018","url":null,"abstract":"<div><h3>Background</h3><div>ERBB2 (HER2)–mutant NSCLC, most commonly driven by exon 20 insertions, has historically shown limited benefit from early pan-ERBB inhibitors. Although multiple HER2-targeted agents have since emerged, the relationship between objective response, disease control, and durability remains incompletely defined across heterogeneous single-arm studies.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and single-arm meta-analysis of HER2-targeted monotherapies in advanced HER2-mutant NSCLC. Objective response rate (ORR) and disease control rate were pooled using random-effects meta-analysis of proportions with logit transformation. PFS was summarized descriptively because time-to-event outcomes were not consistently reported in a form suitable for pooling. Prespecified analyses evaluated outcomes by drug class and TKI generation, with additional analyses restricted to ERBB2 exon 20 insertion-mutant disease.</div></div><div><h3>Results</h3><div>Twenty studies (n = 1489) met eligibility criteria; 7 prospective cohorts (n = 524) formed the main analysis. The pooled ORR was 0.51 (95% CI, 0.33-0.68; I² = 89.8%). The pooled disease control rate was 0.88 (95% CI, 0.69-0.96) with limited separation across TKI generations. Median PFS ranged from approximately 5.5-11.5 months. Twelve-month overall survival estimates were similar between pyrotinib and trastuzumab deruxtecan. In exon 20-restricted analyses (n = 392), the pooled ORR was 0.52 (95% CI, 0.28-0.74).</div></div><div><h3>Conclusions</h3><div>Next-generation HER2-selective TKIs achieved higher ORRs than older inhibitors, particularly in ERBB2 exon 20 insertion-mutant disease; however, differences in durability-related outcomes were less distinct in currently available later-line studies. These findings are exploratory and support prospective studies to better define durability and optimize sequencing strategies for HER2-mutant NSCLC.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 5","pages":"Pages 55-64.e6"},"PeriodicalIF":3.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147811746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Programmed Death-Ligand 1 Expression is Associated With a Shorter Progression Free Survival in ALK-Rearranged Lung Cancer Patients Treated With First Line Tyrosine Kinase Inhibitors","authors":"Yunan Nie,&nbsp;Alyse Staley,&nbsp;Trista K. Hinz,&nbsp;Rocio Perez-Johnston,&nbsp;Daniel T. Merrick,&nbsp;Michael C. Yang,&nbsp;Kurtis D. Davies,&nbsp;Paul A. Bunn,&nbsp;Dara L. Aisner,&nbsp;D Ross Camidge,&nbsp;Erin L. Schenk,&nbsp;Lynn E. Heasley,&nbsp;Tejas Patil","doi":"10.1016/j.cllc.2026.04.010","DOIUrl":"10.1016/j.cllc.2026.04.010","url":null,"abstract":"<div><h3>Background</h3><div>Although ALK-positive non–small cell lung cancer (NSCLC) derives limited benefit from immune checkpoint inhibitors, PD-L1 expression is frequently elevated at diagnosis. The clinical relevance of PD-L1 expression for the efficacy and durability of response to ALK tyrosine kinase inhibitors (TKIs) remains unclear. We investigated the association between tumor PD-L1 expression and outcomes with first-line ALK TKIs and used complementary preclinical models to explore potential biological mechanisms.</div></div><div><h3>Methods</h3><div>Clinical, pathologic, molecular, and treatment outcomes were evaluated among patients with ALK-rearranged NSCLC treated at the University of Colorado. PD-L1 expression was assessed by tumor proportion score (TPS). Murine <em>EML4–ALK</em> lung cancer cell lines were engineered to overexpress PD-L1, and effects on ALK TKI response were evaluated <em>in vitro</em> and in immune-competent mouse models.</div></div><div><h3>Results</h3><div>Among 130 TKI-naïve patients treated with first-line ALK TKIs, 57 (44%) had high PD-L1 expression (TPS ≥ 50%). After multivariable adjustment, high PD-L1 expression was associated with significantly shorter progression-free survival (PFS) compared with low PD-L1 expression (11 vs. 21 months; HR 2.29, 95% CI, 1.51-3.49; <em>P</em> ≤ .001), with no difference in overall survival (91 vs. 107 months; HR 1.16, 95% CI, 0.62-2.17). Objective response rates were similar between PD-L1–high and –low tumors (81.8% vs. 83.3%; Pearson <em>r</em> = −0.20, 95% CI, −0.40-0.07). In preclinical EML4–ALK models, tumor cell PD-L1 overexpression did not alter alectinib sensitivity, depth, or durability of response <em>in vitro</em> or <em>in vivo</em></div></div><div><h3>Conclusions</h3><div>High PD-L1 expression is associated with shorter PFS to first-line ALK TKIs without affecting the initial radiographic response. Preclinical findings suggest that PD-L1–intrinsic tumor cell signaling does not directly impair ALK TKI efficacy, implicating tumor microenvironment–mediated mechanisms in reduced response durability.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 5","pages":"Pages 96-105"},"PeriodicalIF":3.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting Radiation-Induced Esophagitis in Locally Advanced NSCLC Using Baseline Clinical Factors: A Model From the Japan Lung Cancer Society Integrated Phase II-III Database","authors":"Yuji Uehara,&nbsp;Kageaki Watanabe,&nbsp;Jun Tamura,&nbsp;Yuichi Ozawa,&nbsp;Makiko Yomota,&nbsp;Keigo Kishino,&nbsp;Takayuki Kobayashi,&nbsp;Kentaro Taguchi,&nbsp;Keiko Nemoto Murofushi,&nbsp;Satoshi Oizumi,&nbsp;Katsuyuki Hotta,&nbsp;Tsuneo Shimokawa,&nbsp;Seiji Niho,&nbsp;Shunichi Sugawara,&nbsp;Isamu Okamoto,&nbsp;Koji Yamamoto,&nbsp;Nobuyuki Yamamoto,&nbsp;Yukio Hosomi","doi":"10.1016/j.cllc.2026.04.009","DOIUrl":"10.1016/j.cllc.2026.04.009","url":null,"abstract":"<div><h3>Background</h3><div>Radiation-induced esophagitis (RE) is common during thoracic radiotherapy for NSCLC. We assessed its clinical impact and developed a model to predict grade ≥ 2 acute RE in patients with unresectable stage III NSCLC undergoing concurrent chemoradiotherapy, using the Japan Lung Cancer Society integrated phase II-III database.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed clinical and laboratory data from 1288 patients across 8 randomized trials (1999-2016). We evaluated associations between RE and survival outcomes and identified predictors of grade ≥ 2 acute RE using LASSO regression.</div></div><div><h3>Results</h3><div>Grade 2 RE occurred in 15% and grade 3 in 2.0%. Grade ≥ 2 RE was not significantly associated with progression-free survival (PFS; HR 0.98, 95% confidence interval [CI] 0.72-1.34) or overall survival (OS; HR 1.20, 95% CI 0.82-1.75). Grade ≥ 3 RE was significantly associated with worse PFS (HR 1.62, 95% CI 1.12-2.35) but not with OS (HR 1.22, 95% CI 0.58-2.60). Eight variables independently predicted grade ≥ 2 RE: female sex, T stage &lt; 4, N3 status, adenocarcinoma histology, primary tumor in the left upper lobe, cisplatin use, white-blood-cell count &lt; 11 × 10⁹/L, and hemoglobin ≤ 12 g/dL. The model achieved a c-statistic of 0.85 (95% CI, 0.81-0.88).</div></div><div><h3>Conclusion</h3><div>In this national clinical-trial cohort, grade ≥ 2 RE was not associated with worse OS, but grade ≥ 3 RE was associated with worse PFS in patients receiving concurrent chemoradiotherapy for unresectable stage III NSCLC. The 8-variable model provides a practical tool for predicting grade ≥ 2 RE and may facilitate tailored supportive care.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 5","pages":"Pages 87-95"},"PeriodicalIF":3.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004717","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Attrition From Surgery to Adjuvant Therapy in Stage IIB and IIIA Lung Adenocarcinoma: A National Cancer Database Analysis","authors":"Omar Bushara ,&nbsp;Mohammad S. Farooq ,&nbsp;Shawn Ahn,&nbsp;Eliana Marostica,&nbsp;Karina Bruestle,&nbsp;Giorgos Karakousis,&nbsp;John C. Kucharczuk,&nbsp;Sunil Singhal","doi":"10.1016/j.cllc.2026.04.013","DOIUrl":"10.1016/j.cllc.2026.04.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Lung cancer is the leading cause of cancer-related death. For pathologic stage IIB/IIIA tumors, standard of care may include surgery followed by adjuvant therapy. The proportion of patients who do not receive adjuvant therapy after surgery is not well-characterized. The goal of this study is to define the rate of treatment attrition from surgery to adjuvant therapy, identify factors associated with attrition, and elucidate trends in attrition from 2012 to 2022.</div></div><div><h3>Methods</h3><div>Patients with resected pathologic stage IIB/IIIA lung adenocarcinoma were included. Treatment attrition was defined as not receiving any adjuvant therapy after surgery. Trends were tested with Cochran-Armitage tests. Unadjusted and adjusted Cox proportional hazard models were used to analyze survival.</div></div><div><h3>Results</h3><div>25,436 patients had pathologic stage IIB/IIIA tumors. 16,796 (66.0%) underwent adjuvant therapy, demonstrating an attrition rate of 34.0%. Attrition decreased from 37.7% in 2012 to 25.7% in 2022 (<em>P</em> &lt; .001). Patient characteristics associated with attrition were age, morbidity, stage, private insurance, and having open surgery. Adjuvant therapy was associated with improved survival in unadjusted and adjusted analyses, and retained a survival benefit throughout the time period despite a changing patient profile.</div></div><div><h3>Discussion</h3><div>Herein we define treatment attrition from surgery to adjuvant therapy in lung adenocarcinoma utilizing a large national cohort. The overall treatment attrition rate was 34.0%, although it significantly decreased over time. Adjuvant therapy was associated with a survival benefit, underscoring the importance of reducing treatment attrition to improve outcomes.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 5","pages":"Pages 106-113"},"PeriodicalIF":3.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148053201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Significance of Inflammatory, Cellular, and Tumor-Specific Biomarkers in Patients With Pleural and Peritoneal Mesothelioma","authors":"Keval Yerigeri,&nbsp;Manjistha Sengupta,&nbsp;Jingli Zhang,&nbsp;Jeevan Puthiamadathil,&nbsp;Raffit Hassan","doi":"10.1016/j.cllc.2026.04.005","DOIUrl":"10.1016/j.cllc.2026.04.005","url":null,"abstract":"<div><h3>Background</h3><div>Mesothelioma is an aggressive malignancy with poor outcomes, particularly when diagnosed at advanced stages. This study evaluated the prognostic value of tumor-specific biomarkers: soluble mesothelin-related peptide (SMRP), megakaryocyte potentiating factor (MPF) and CA125; inflammatory markers: C-reactive protein (CRP) and fibrinogen; cellular markers: platelet count and neutrophil-to-lymphocyte ratio (NLR) in patients with pleural (MPM) and peritoneal mesothelioma (MPeM).</div></div><div><h3>Methods</h3><div>A total of 414 patients including 241 MPM, 153 MPeM and 20 with mesothelioma at other body sites were enrolled in the Natural History Protocol (NCT 01950572) at the National Cancer Institute. Blood samples collected at enrollment were assessed for biomarker levels and based on their expression levels patients were stratified into quartiles. Kaplan–Meier survival curves were plotted, and median overall survival (mOS) was compared between groups.</div></div><div><h3>Results</h3><div>For all the biomarkers evaluated, there was a significant decrease in mOS in the high expression cohorts. The mOS in years in low versus high expression cohorts being: SMRP (3 vs. 0.7), MPF (3.7 vs. 0.7), CA125 (1.6 vs. 0.8), CRP (4.1 vs. 0.4), fibrinogen (4.1 vs. 0.6), platelet count (1.4 vs. 0.8) and NLR (2.1 vs. 0.7). When analyzed separately, the pleural and peritoneal cohorts showed similar trends. Strong correlations existed between SMRP and MPF (r = 0.84), as well as CRP and fibrinogen (r = 0.86).</div></div><div><h3>Conclusions</h3><div>Biomarkers such as SMRP, MPF, CA125, CRP, fibrinogen, platelet count and NLR can independently predict overall survival in mesothelioma. These biomarkers can therefore provide prognostic information for these patients and help guide treatment strategies.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"27 5","pages":"Pages 77-86.e1"},"PeriodicalIF":3.9,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13158461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147863648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}