Clinical lung cancer最新文献

{"title":"Treatment Patterns and Clinical Outcomes in Patients With EGFR-Mutated Non–Small-Cell Lung Cancer After Progression on Osimertinib","authors":"Nathaniel D. Robinson ,&nbsp;Maureen E. Canavan ,&nbsp;Peter L. Zhan ,&nbsp;Brooks V. Udelsman ,&nbsp;Ranjan Pathak ,&nbsp;Daniel J. Boffa ,&nbsp;Sarah B. Goldberg","doi":"10.1016/j.cllc.2024.09.006","DOIUrl":"10.1016/j.cllc.2024.09.006","url":null,"abstract":"<div><h3>Introduction</h3><div>For patients with advanced epidermal growth factor receptor (<em>EGFR</em>)-mutated non–small-cell lung cancer (NSCLC) who progress on first-line osimertinib, the optimal second-line treatment regimen after progression is not known. We sought to assess practice patterns and evaluate the association between different therapies and survival in patients with <em>EGFR</em>-mutated NSCLC following progression on first-line osimertinib.</div></div><div><h3>Methods</h3><div>Retrospective cohort study of patients who received first-line treatment with osimertinib using a population-based, multicenter nationwide electronic health record-derived deidentified database.</div></div><div><h3>Results</h3><div>We identified 2373 patients who received first-line osimertinib. The majority (n = 2279) received osimertinib monotherapy. A total of 538 patients received first-line osimertinib and had second-line treatment data available. Second-line treatment regimens were varied: 65% (n = 348) included chemotherapy, 37% (n = 197) included an immune checkpoint inhibitor (ICI), and 44% (n = 234) included an <em>EGFR</em> tyrosine kinase inhibitor (TKI).</div><div>We then analyzed the 333 patients with performance status 0-2 who received chemotherapy with osimertinib (n = 107, 32%) versus chemotherapy without osimertinib (n = 226, 68%). The continuation of osimertinib with chemotherapy was associated with superior progression-free survival (PFS; median: 10.1 versus 5.9 months, Hazard Ratio [HR]: 0.48, 95% Confidence Interval [CI]: [0.34, 0.68], <em>P</em> &lt; .001) and overall survival (OS; median: 17.0 versus 12.8 months, HR: 0.64, 95% CI: [0.44, 0.93], <em>P</em> = .018) compared to other chemotherapy approaches without osimertinib. This effect was most pronounced in patients with an <em>EGFR</em> exon 19 deletion.</div></div><div><h3>Conclusions</h3><div>Following progression on osimertinib, a wide variety of treatment regimens were used. The continuation of osimertinib with chemotherapy in the second line was associated with increased PFS and OS.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 1","pages":"Pages 9-17.e3"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496437","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":"Comment on ``Prognostic Impact of TP53 Mutations in Metastatic Nonsquamous Non-small-cell Lung Cancer''","authors":"Laurent Mathiot,&nbsp;Judith Raimbourg","doi":"10.1016/j.cllc.2024.10.011","DOIUrl":"10.1016/j.cllc.2024.10.011","url":null,"abstract":"","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 1","pages":"Pages e20-e21"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681071","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":"A Poor Prognostic ALK Phenotype: A Review of Molecular Markers of Poor Prognosis in ALK Rearranged Nonsmall Cell Lung Cancer","authors":"Sze  Wah  Samuel Chan ,&nbsp;Joy Zeng ,&nbsp;Jack Young ,&nbsp;Samir  H. Barghout ,&nbsp;Faisal Al-Agha ,&nbsp;Stavroula Raptis ,&nbsp;M.  Catherine Brown ,&nbsp;Geoffrey Liu ,&nbsp;Rosalyn Juergens ,&nbsp;Kevin Jao","doi":"10.1016/j.cllc.2024.10.009","DOIUrl":"10.1016/j.cllc.2024.10.009","url":null,"abstract":"<div><h3>Background</h3><div>Patients with nonsmall cell lung cancer with anaplastic lymphoma kinase (<em>ALK</em>) rearrangements derive a significant and durable clinical benefit from tyrosine kinase inhibitors (TKIs). However, early progression/death on treatment occurs in a subset of patients, which we term the poor prognostic ALK phenotype. This review aims to summarize the known molecular mechanisms that underlie this phenotype with a focus on variant 3 and <em>TP53</em> mutations.</div></div><div><h3>Methods</h3><div>A scoping review was performed using scientific databases such as Ovid Medline, Ovid Embase, and Cochrane Central Register of Controlled Trials. Studies included molecular markers of poor prognosis, with a focus on <em>TP53</em> mutations, variant 3 re-arrangements, and poor clinical response to TKIs.</div></div><div><h3>Results</h3><div>Of 4371 studies screened, 108 were included. Numerous studies implicated a negative prognostic role of variant 3, likely mediated through the acquisition of on-target resistance mutations and <em>TP53</em> mutations which are associated with greater chromosomal instability and mutational burden. Co-occurring variant 3 and <em>TP53</em> mutations were associated with even worse survival. Other mediators of early resistance development include aberrations in cell cycle regulators and mutations in cell signaling pathways. Comprehensive genomic analysis from first-line TKI clinical trial data was unable to identify a singular genomic signature that underlies the poor prognostic phenotype but implicated a combination of pathways.</div></div><div><h3>Conclusions</h3><div>This scoping review highlights that the poor prognostic ALK phenotype is likely composed of a heterogeneous variety of genomic factors. There remains an unmet need for a genomic assay to integrate these various molecular markers to predict this ALK phenotype.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 1","pages":"Pages e22-e32.e2"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692721","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":"Comment on “Prognostic Impact of TP53 Mutations in Metastatic Nonsquamous Non-Small-Cell Lung Cancer”","authors":"Rameez Qasim ,&nbsp;Zahra Riaz","doi":"10.1016/j.cllc.2024.10.010","DOIUrl":"10.1016/j.cllc.2024.10.010","url":null,"abstract":"","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 1","pages":"Pages e18-e19"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686049","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":"Comparison of Long-Term Survival Between Robotic and Video-Assisted Lobectomy for Stage Ⅰ NSCLC With Radiologic Solid Tumors: A Propensity Score Matching Study","authors":"Jianfeng Zhang ,&nbsp;Zhongjie Wang ,&nbsp;Yuming Wang ,&nbsp;Xuewen Yu ,&nbsp;Yanpen Liang ,&nbsp;Changbo Sun ,&nbsp;Qianjun Zhou","doi":"10.1016/j.cllc.2024.10.004","DOIUrl":"10.1016/j.cllc.2024.10.004","url":null,"abstract":"<div><h3>Background</h3><div>To compare the long-term survival between robotic and video-assisted thoracic surgery (VATS) lobectomy for stage Ⅰ non–small-cell lung cancer (NSCLC) with radiologic solid tumors.</div></div><div><h3>Methods</h3><div>Clinical stage Ⅰ NSCLC patients with radiologic solid tumors who underwent robotic-assisted thoracic surgery (RATS) or VATS lobectomy between 2015 and 2017 were retrospectively reviewed. A propensity score matching analysis was performed to balance the baseline characteristics. The primary end points were overall survival (OS) and recurrence-free survival (RFS).</div></div><div><h3>Results</h3><div>A total of 518 patients (225 RATS and 293 VATS) were included. After propensity score matching, there were 170 cases in each group. Patients undergoing RATS had shorter operative time than VATS (98.12 min vs. 112.26 min; P &lt; 0.001). The RATS approach resulted in a higher number of resected lymph nodes (LNs) (11.75 vs. 9.77; P &lt; 0.001). The postoperative complication rates were comparable (7.6% vs. 10.0%, <em>P =</em> .566). The rates of 5-year OS and RFS for the RATS and VATS were 92% versus 89% (<em>P =</em> .62) and 82% vs. 86% (<em>P =</em> .70), respectively. Multivariate analysis revealed that the number of resected LNs was significantly associated with overall survival (OR = 1.94 [95% confidence interval [CI]: 1.07-3.51], <em>P =</em> .029).</div></div><div><h3>Conclusion</h3><div>The long-term survival outcomes of RATS and VATS are similar for c-stage Ⅰ NSCLC with radiologic solid tumors. The use of robotics is associated with more lymph node dissection and shorter operative time. We suggested that the number of examined lymph nodes rather than surgical approaches was associated with overall survival.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 1","pages":"Pages e63-e72.e2"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142614748","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":"Perioperative Outcomes of Neoadjuvant Therapy in Resectable Lung Cancer Patients With Endobronchial Disease in the Era of Personalized Medicine","authors":"Joseph Seitlinger ,&nbsp;Devangi Patel ,&nbsp;Andrew Meng ,&nbsp;Luciano Bulgarelli-Maqueda ,&nbsp;Jonathan Cools-Lartigue ,&nbsp;Christian Sirois ,&nbsp;Lorenzo Ferri ,&nbsp;Jonathan Spicer ,&nbsp;Sara Najmeh","doi":"10.1016/j.cllc.2024.10.003","DOIUrl":"10.1016/j.cllc.2024.10.003","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Lung cancer remains the leading cause of cancer-related deaths worldwide. Recent studies have highlighted the benefit of neo-adjuvant therapies in the treatment of resectable stage IB to IIIA cases which will likely increase the use of neoadjuvant therapies (NAT) across multiple stages, both earlier and later. This includes the combination of chemotherapy and immunotherapy as well as the more widespread use of targeted therapies with or without the addition of radiation.&lt;/div&gt;&lt;div&gt;This heterogenous group of resectable tumors includes proximal tumors with different levels of endobronchial involvement and secondary distal atelectasis and sometimes superimposed infections which adds a level of concern and complexity when using NAT. In this study, we evaluate the prevalence of endobronchial lesions in patients treated with NAT, as well as the rate of associated complications.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Patients and Methods&lt;/h3&gt;&lt;div&gt;Data was obtained from a prospectively maintained thoracic surgery database, the Thoracic Oncology Clinical Database and Biobank. Patients with proven clinical stage II-III NSCLC that underwent resection within the Division of Thoracic Surgery at the McGill University Health Centre (Montreal, QC, Canada) from January 2015 to December 2020 were included.&lt;/div&gt;&lt;div&gt;Chest computed tomography scans prior to neoadjuvant therapy were reviewed by 2 senior thoracic surgeons to establish the presence of an endobronchial tumor lesion. The presence of an endobronchial lesion was defined by a tumoral lesion obstructing a bronchus or several bronchi AND responsible for lung atelectasis distally (with at least 1 occluded segment). Treatment-related and postoperative complications were collected retrospectively by reviewing patient charts.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Overall, 110 patients met the inclusion criteria, of which 37/110 patients had endobronchial lesions before starting neoadjuvant therapy (33.6%). These patients had a higher rate of global complications 23/37 (62.2%) during neoadjuvant treatment compared to patients without obstruction 30/73 (41.1%) (&lt;em&gt;P&lt;/em&gt; = .04). There was no difference in terms of severity of complications between the 2 groups (&lt;em&gt;P&lt;/em&gt; = .34). The group with endobronchial lesions was found to have an increased rate of pulmonary complications, of which there were none in the other group (5/37, 13.5% vs. 0/73, 0%, &lt;em&gt;P&lt;/em&gt; = .004). There were 2 cases of patients requiring urgent surgeries before completing NAT due to pulmonary complications in the endobronchial lesion group (2/37, 5.4%) and none in the group without obstruction.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Patients who are treated with NAT for locally advanced resectable lung cancer usually have larger tumors, where it is not uncommon to encounter endobronchial lesions responsible for downstream obstruction. In this study, the prevalence of endobronchial lesions was found to be 1 third of the patients unde","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 1","pages":"Pages e55-e62.e1"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643898","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":"Histologic Transformation of ALK-Rearranged Lung Adenocarcinomas to High-Grade LCNEC: Clinical and Molecular Description of Three Cases","authors":"Paolo Ambrosini ,&nbsp;Daniela Miliziano ,&nbsp;Giorgia Di Liberti ,&nbsp;Daniele Lorenzini ,&nbsp;Silvia Marchesi ,&nbsp;Anna Bassetti ,&nbsp;Elena Tamborini ,&nbsp;Rita Leporati ,&nbsp;Teresa Beninato ,&nbsp;Laura Mazzeo ,&nbsp;Marta Brambilla ,&nbsp;Monica Ganzinelli ,&nbsp;Arsela Prelaj ,&nbsp;Claudia Proto ,&nbsp;Filippo Guglielmo De Braud ,&nbsp;Giuseppe Lo Russo ,&nbsp;Mario Occhipinti","doi":"10.1016/j.cllc.2024.11.012","DOIUrl":"10.1016/j.cllc.2024.11.012","url":null,"abstract":"<div><div><ul><li><span>•</span><span><div>Anaplastic lymphoma kinase (ALK) rearrangements occur in 3-5% of non-small cell lung cancer (NSCLC) cases, with high sensitivity to ALK-tyrosine kinase inhibitors (TKIs) like alectinib, brigatinib, lorlatinib, and ensartinib. Resistance to tehse treatments is common and nearly inevitable, driven by genetic alterations and histologic transformations, notably to small cell lung carcinoma (SCLC).</div></span></li><li><span>•</span><span><div>In the present series, we describe a rare resistance mechanism in three cases of ALK-rearranged NSCLC transforming into high-grade large cell neuroendocrine carcinoma (LCNEC) after ALK-TKI treatment. These patients exhibited both histologic transformation and on-target ALK mutations, such as L1196M, D1203N, and L1198F, emphasizing the dual resistance mechanisms.</div></span></li><li><span>•</span><span><div>The identification of LCNEC transformation as a resistance mechanism emphasizes the importance of individualizing treatment strategies. The clinical outcomes of LCNEC-transformed cases varied, with some patients responding poorly to chemotherapy, underscoring the aggressive nature of this transformation. Regular tissue re-biopsies at disease progression can guide therapy choices by identifying resistance mechanisms. Liquid biopsies can serve as an alternative for monitoring molecular resistance in situations where tissue biopsies are not attainable. These findings advocate for an adaptive treatment approach, integrating molecular and histologic evaluations to optimize outcomes for patients with ALK-rearranged NSCLC.</div></span></li></ul></div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 1","pages":"Pages e11-e17"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812306","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":"Participation in Non-small Cell Lung Cancer Clinical Trials in the United States by Race/Ethnicity","authors":"Meghann Wheeler ,&nbsp;Shama Karanth ,&nbsp;Joel Divaker ,&nbsp;Hyung-Suk Yoon ,&nbsp;Jae Jeong Yang ,&nbsp;Maisey Ratcliffe ,&nbsp;Marissa Blair ,&nbsp;Hiren J Mehta ,&nbsp;Mindaugas Rackauskas ,&nbsp;Dejana Braithwaite","doi":"10.1016/j.cllc.2024.09.009","DOIUrl":"10.1016/j.cllc.2024.09.009","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite efforts by Cancer Centers and community organizations to increase diversity in clinical trials, significant racial/ethnic disparities remain. Given the high mortality rates in non-small cell lung cancer (NSCLC), it is important to increase diversity in NSCLC trials, ensuring all patients benefit from advances in new treatment modalities.</div></div><div><h3>Materials and Methods</h3><div>We evaluated the distribution of racial/ethnic minority enrollment in NSCLC clinical trials using data from ClinicalTrials.gov. We extracted trial characteristics, including start year, study phase, tumor stage, sample size, sponsor, geographic region, and masking. The number of participants by race/ethnicity was obtained from ClinicalTrials.gov or linked publications. Using annual NSCLC incidence data from SEER*Stat for each racial/ethnic group from 2010 to 2019, we applied a 2-sample test for equality of proportions with continuity correction to assess differences between incidence and trial participation.</div></div><div><h3>Results</h3><div>A total of 147 unique studies were included in the final analysis. Of the 28,540 participants, 79.6% were White, with 3% Black, 10.4% Asian or Pacific Islander and 3.4% Hispanic/Latino. Most participants were enrolled in phase III trials (63.8%), industry-sponsored (93.9%), and open-label (67.7%). Black patients were more commonly enrolled in academic sponsored trials and less commonly enrolled in masked (i.e., blinded) studies. When comparing trial participation to annual incidence data, we observed underrepresentation among Black participants (Difference: −7.9%) and Hispanic/Latino participants (Difference: −3.2%).</div></div><div><h3>Conclusion</h3><div>Persistent underrepresentation exists in NSCLC clinical trials among Black and Hispanic/Latino patients. We urge further investigation of these findings through well-designed clinical trials among diverse patient populations.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 1","pages":"Pages 52-57.e2"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496421","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":"Randomized Phase II Trial of Amrubicin Plus Irinotecan Versus Cisplatin Plus Irinotecan in Chemo-naïve Patients With Extensive-Disease Small-Cell Lung Cancer: Results of the Japan Multinational Trial Organization (JMTO) LC 08-01","authors":"Hiroshige Yoshioka ,&nbsp;Tadashi Ishida ,&nbsp;Shinji Atagi ,&nbsp;Akihiro Tamiya ,&nbsp;Takashi Nishimura ,&nbsp;Yasuo Iwamoto ,&nbsp;Masashi Kanehara ,&nbsp;Young Hak Kim ,&nbsp;Yohei Korogi ,&nbsp;Keisuke Tomii ,&nbsp;Nobuyuki Katakami ,&nbsp;Kiyoshi Komuta ,&nbsp;Masanori Nishikawa ,&nbsp;Akihiko Gemma ,&nbsp;Kenichi Yamaki ,&nbsp;Masaaki Kawahara ,&nbsp;Chisato Miyakoshi ,&nbsp;Tadashi Mio","doi":"10.1016/j.cllc.2024.09.004","DOIUrl":"10.1016/j.cllc.2024.09.004","url":null,"abstract":"<div><h3>Background</h3><div>We conducted a randomize phase II study to evaluate the efficacy and safety of topoisomerase II inhibitor amrubicin plus topoisomerase I inhibitor irinotecan (AI) compared with cisplatin plus irinotecan (PI) as first-line therapy in patients with extensive-disease (ED) small-cell lung cancer (SCLC).</div></div><div><h3>Patients and Methods</h3><div>Chemo-naïve patients with pathologically proven ED-SCLC (including limited disease (LD) SCLC with malignant effusion) were enrolled. Patients were randomized 1:1 to receive either AI (amrubicin 90mg/m² on day 1 and irinotecan 50mg/m² on days 1 and 8 of a 21-day cycle) or PI (cisplatin 60mg/m² on day 1 and irinotecan 60mg/m² on days 1, 8 and 15 of a 28-day cycle). The primary endpoint was overall survival proportion at 1 year.</div></div><div><h3>Results</h3><div>A total of 100 patients were randomly assigned to AI (<em>n</em> = 50) or to PI (<em>n</em> = 50). The 1-year overall survival proportions were 68.0% (95% confidence interval (CI): 56.2-82.2%) for AI and 59.2% (46.9-74.7%) for PI (1-sided <em>P</em> = .18). Median survival time was 14.8 months for AI and 13.5 months for PI with a hazard ratio (HR) of 0.618 (0.398-0.961, stratified log-rank test <em>P</em> = .031). Median progression-free survival time was 4.8 months for AI and 5.4 months for PI (stratified log-rank test, <em>P</em> = .54). Objective response rate was 70.0% (55.4-82.1%) for AI and 55.1% (40.2-69.3%) for PI (Fisher exact test, <em>P</em> = .15). There was no significant difference in hematological toxicity, whereas rates of vomiting, loss of appetite, diarrhea, and elevated serum creatinine are more frequent in PI. Interstitial lung disease (Grade 2 or 3) developed in 5 patients in AI and in 1 patient in PI. There was no treatment-related death.</div></div><div><h3>Conclusion</h3><div>Although the study did not meet its primary endpoint, AI showed promising efficacy and good tolerability in chemo-naïve patients with ED-SCLC.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 1","pages":"Pages 1-8"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557338","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":"Inclusion of Surgery in Multimodality Treatment is Predictive of Better Survival in Stage IIIA Non-small Cell Lung Cancer: An Inverse Probability Treatment-Weighting Analysis","authors":"Feitong Lei ,&nbsp;Janeesh Sekkath-Veedu ,&nbsp;Bin Huang ,&nbsp;Quan Chen ,&nbsp;Mansi Shah-Jadeja ,&nbsp;Thomas E. Stinchcombe ,&nbsp;Zhonglin Hao","doi":"10.1016/j.cllc.2024.10.007","DOIUrl":"10.1016/j.cllc.2024.10.007","url":null,"abstract":"<div><h3>Introduction</h3><div>Stage IIIA non-small cell lung cancers (NSCLC) are treated with surgery-based multimodality approach or definitive chemoradiation therapy plus durvalumab consolidation. It is not clear whether surgery-based multimodality therapy has any survival advantage over definitive chemoradiation plus immunotherapy consolidation.</div></div><div><h3>Method</h3><div>National Cancer Database (NCDB) was used to identify NSCLC patients at stage IIIA (AJCC8, T3N1/T4N0-1 or T1N2/T2N2) who are treated with surgery-based multimodality approach or definitive chemoradiation plus durvalumab. Survival between groups were compared using inverse probability treatment weighting (IPTW)-adjusted Kaplan Meier curves and Cox proportional hazards regression analysis. Results were independently confirmed by Landmark Inverse and Clone Censor Weight analyses to address immortal time bias.</div></div><div><h3>Results</h3><div>From 2017 to 2019, 24,170 patients are identified as potentially resectable stage IIIA (T3N1, T4N0-1, T1N2/T2N2). Among them, 2,615 (10.8%) received surgery-based multimodality therapy and 2,985 (12.4%) received definitive chemoradiation plus durvalumab. Surgery based multimodality approach had significant survival advantage over definitive chemoradiation plus durvalumab (HR 0.74; 95% CI 0.69-0.79, <em>P</em> &lt; .001). The median overall survival (mOS) for the definitive chemoradiation plus durvalumab group was 48.59 m whereas mOS was not reached for surgery-based multimodality group. This trend persisted in both N2 negative and positive tumors. Neoadjuvant chemotherapy was just as effective as adjuvant chemotherapy and delay of immunotherapy consolidation to 12 weeks after initiation of chemoradiation did not negatively affect survival outcome.</div></div><div><h3>Conclusion</h3><div>For stage IIIA NSCLC patients, surgery-based multimodality treatment outperformed chemoradiation plus durvalumab in survival.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 1","pages":"Pages e81-e90"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643897","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}