Clinical lung cancer最新文献

{"title":"Real-life Experience of Rare Hepatoid Adenocarcinomas of the Lung: A Large Retrospective French Cohort.","authors":"Thomas Fave, Jessica Nguyen, Renaud Descourt, Gilles Quéré, Estelle Dhamelincourt, Arnaud Simaki, Victor Basse, Arnaud Uguen, Chloé Ntshaykolo, Chantal Decroisette, François Lucia, Margaux Geier","doi":"10.1016/j.cllc.2025.05.003","DOIUrl":"10.1016/j.cllc.2025.05.003","url":null,"abstract":"<p><strong>Background: </strong>Hepatoid adenocarcinoma of the lung (HAL) is a rare subtype of lung cancer exhibiting common histological features with hepatocellular carcinomas (HCC). Therapeutic landscape is currently similar to lung adenocarcinoma standards. We report here the largest descriptive cohort of HAL with focus on (chemo)immunotherapy (chemo)IO) efficacy.</p><p><strong>Methods: </strong>In this single-center retrospective observational study, we selected all consecutive cases of HAL patients from January 2013 to December 2022. Eligible patients had primary lung tumor with positive immunohistochemical hepatocyte marker. HCC was eliminated with liver imaging. We provide a descriptive analysis of HAL population and describe our therapeutic experience.</p><p><strong>Results: </strong>A total of 23 patients were included. Main characteristics at diagnosis were: median age of 64.5 years [41-81], 78.3% of males, with 79% of PS 0-1. All patients had smoking history, with 8 active smokers. Majority of HAL (73.9%) originated from the upper lobes and 69.5% affected the right lung. Twenty-two patients (95.6%) had stage IV disease. Median number of metastatic sites was 2 with a maximum of 6 metastatic sites; most common metastatic sites were the bone (39.1%) and the brain (30.4%). PD-L1 status was < 1% (n = 11), 1-49% (n = 3), ≥ 50% (n = 5), unknown (n = 4). Ten (43.5%) patients harbored KRAS mutation: G12C (n = 6), G60D (n = 1), G12V (n = 1), G12F (n = 1), G13C (n = 1). Median overall survival (mOS) since diagnosis achieved 6.4 months (95% CI, 3.7-9.6). Early exclusive palliative care concerned 7 patients. Seven patients received first-line chemoIO. Best overall response was: partial response (n = 3), stable disease (n = 2), progressive disease (n = 1), not evaluable (n = 1). One patient treated with first-line pembrolizumab achieved stable disease. Median progression free survival of first line (chemo)IO was estimated at 4.5 months (95% CI, 2.3-5.4), objective response rate was 37.5%, and disease control rate was 75%. Five patients received second-line IO but experienced early progressive disease. Two patients received a KRAS inhibitor as third-line treatment, but no response was observed.</p><p><strong>Conclusion: </strong>Our results highlighted that HAL patients were more frequently male and heavy smokers. HALs most often originate from the right upper lobe, with an overrepresentation of KRAS mutations and an aggressive, metastatic profile, which accounted for the poor mOS of 6.4 months. Patients may benefit from upfront (chemo)IO, but further studies were warranted to confirm it.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144332583","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":"Correlation of PET-CT, Endobronchial Ultrasound Cytology and Surgical Biopsy in Patients with Non-Small Cell Lung Cancer Undergoing Curative Surgery.","authors":"Stav Rakedzon, Elad Mor, Yaniv Yechiel, Yaron Saiet, Fuad Khoury, Ivan Gur, Tzah Feldman, Ludmila Guralnik, Amit Katz, Yaniv Zohar, Zohar Keidar, Sameh Daher, Olga Kagna, Anna Solomonov, Hanna Dawood, Talia Shentzer Kutiel, Alona Zer Kuch, Eyal Fuchs, Yaniv Dotan","doi":"10.1016/j.cllc.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.cllc.2025.05.005","url":null,"abstract":"<p><strong>Background: </strong>Non-small cell lung cancer (NSCLC) is the leading cause of cancer mortality worldwide. The recommended approach for mediastinal staging is a combination of both positron emission tomography- computed tomography (PET-CT) and endobronchial ultrasound (EBUS). Data on the correlation of PET-CT uptake to EBUS cytology and surgical lymph node biopsy is scarce.</p><p><strong>Patients and methods: </strong>Of 379 patients diagnosed with NSCLC, 65 underwent preoperative PET-CT, EBUS, and surgical lymph node biopsies. The correlations between EBUS cytology, fluoro-deoxy glucose (FDG) uptake (SUVmax) by PET-CT, and surgical biopsy were analyzed.</p><p><strong>Results: </strong>About 229 lymph nodes derived from 65 patients were sampled, of which 67 lymph nodes had data from EBUS, PET-CT, and surgical biopsy. 58 nodes were negative in all modalities; 6 were malignant on EBUS but negative on surgical biopsy; 2 were malignant for both modalities; and one was EBUS negative but malignant in surgical staging. EBUS sensitivity was 89% with a negative predictive value of 98%. Six patients were upstaged after surgery due to inaccessible lymph nodes (at stations 5 and intralobar) for EBUS. No malignant lymph nodes had maximum standardized uptake (SUVmax) lower than 2.9.</p><p><strong>Conclusion: </strong>EBUS has high sensitivity and specificity rates, however it misses intralobar and station 5 lymph nodes which might upstage the patient after surgery. In cases when there is a high suspicion for malignant lymph nodes inaccessible to EBUS, other invasive strategies or neoadjuvant treatment should be considered. PET-CT was shown to be accurate in ruling out but not ruling in lymph node involvement.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293418","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":"Mortality in a Diverse, Real-World Lung Cancer Screening Cohort.","authors":"Mary E Gwin, Tanushree Prasad, Urooj Wahid, Sheena Bhalla, Song Zhang, Jessica L Lee, David H Johnson, George Oliver, Lauren Vice, Cornelia Tan, Cynthia Watkins, David E Gerber","doi":"10.1016/j.cllc.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.cllc.2025.05.004","url":null,"abstract":"<p><strong>Background: </strong>Lung cancer screening (LCS) is indicated exclusively for older individuals with substantial tobacco use, a risk factor not only for lung cancer but also for other malignancies, cardiovascular disease, and chronic obstructive pulmonary disease. Because LCS trial populations are commonly regarded as healthier than the broader LCS-eligible population, the real-world mortality rate among individuals undergoing LCS represents a key consideration in LCS implementation.</p><p><strong>Methods: </strong>We performed a retrospective, observational cohort study of individuals for whom LCS was ordered between March 2017 and December 2022 in an integrated safety-net healthcare system. Demographic characteristics and Charlson comorbidity index were obtained from the medical record. Dates and causes of death were captured from the medical record and National Death Index. We compared mortality according to patient characteristics using Cox proportional hazard ratios.</p><p><strong>Results: </strong>A total of 1598 patients (mean age 62 years, 43% female, 45% Black, 18% Hispanic) were included in the analysis, of whom 60% had moderate and 20% severe comorbidity; 91% of patients were current smokers. With a median follow-up of 31.3 months, 93 patients (6%) had died. For patients without a date of death, 55% had an encounter in the healthcare system within 3 months of data collection. Mortality was significantly associated with age (HR 1.06; 95% CI, 1.02-1.11; P = .01), but not with patient sex, race, comorbidity, smoking status, or LCS completion.</p><p><strong>Conclusions: </strong>Despite substantial comorbidity burden, short-term mortality is low in a diverse, real-world LCS population, suggesting potential for benefit from screening and early detection of lung cancer.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246793","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":"Combined Impact of Coronary Artery Calcification and Heart Radiation Dose on Overall Survival in Locally Advanced Non-Small Cell Lung Cancer: Who Benefits Most from Reducing Heart Radiation Dose?","authors":"Yui Watanabe, Yutaro Koide, Hidetoshi Shimizu, Takahiro Aoyama, Yurika Shindo, Shingo Hashimoto, Hiroyuki Tachibana, Takeshi Kodaira","doi":"10.1016/j.cllc.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.cllc.2025.05.002","url":null,"abstract":"<p><strong>Background: </strong>Despite advances in treatment for unresectable locally advanced non-small cell lung cancer (LA-NSCLC), overall survival (OS) remains poor. The effects of coronary artery calcification (CAC) and heart radiation doses on OS in LA-NSCLC patients, especially their combined impact, have not been thoroughly investigated. This study aimed to examine the individual and combined effects of CAC and heart dose on OS in LA-NSCLC patients treated with radiotherapy over a 3-year follow-up period.</p><p><strong>Patients and methods: </strong>The study included 140 patients who received definitive radiotherapy for LA-NSCLC (stage III, 92.1%) from 2015 to 2021. The endpoint was OS, with each patient followed for a fixed 3-year period.</p><p><strong>Results: </strong>Univariate Cox regression analysis identified mean heart dose (MHD; hazard ratio [HR], 4.0 [2.2-7.3]; P < .001) and CAC in multiple vessels (HR, 2.6 [1.5-4.8]; P = .001) as significant predictors of worse OS, both serving as independent predictors of poorer outcomes in multivariate analysis. Kaplan-Meier analysis revealed that combining MHD and CAC in any coronary artery, each specific artery, and multivessels provided enhanced risk stratification for OS (P < .001 for all combinations). Among patients with higher MHD, those with calcification in the left main trunk (LMT) had the highest annual event rate (28.2%), showing a significant difference (P < .001) compared to patients with lower MHD (4.4%).</p><p><strong>Conclusion: </strong>Combination of CAC and heart dose enhanced risk stratification for 3-year OS in LA-NSCLC patients treated with radiotherapy. Importantly, patients with calcification in the LMT derived the greatest benefit from reducing heart doses.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144246792","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":"Postoperative Pain Reduction and Clinical Value of Uniportal Video-Assisted Thoracic Surgery: A Secondary Analysis of the J-RATSIG 01 Study.","authors":"Takuya Watanabe, Masayuki Tanahashi, Masato Chiba, Kumiko Hashimoto, Noriaki Sakakura, Mikio Okazaki, Shoichi Mori, Masaki Hashimoto, Toyofumi Fengshi Chen-Yoshikawa, Masahiro Miyajima, Isao Matsumoto, Masayuki Shitara, Motoshi Takao, Toru Ogura, Koji Kawaguchi","doi":"10.1016/j.cllc.2025.05.001","DOIUrl":"https://doi.org/10.1016/j.cllc.2025.05.001","url":null,"abstract":"<p><strong>Background: </strong>The J-RATSIG 01 multi-institutional prospective study found robot-assisted thoracic surgery to be inferior to video-assisted thoracic surgery (VATS) in terms of postoperative pain. Because reducing the number of ports was linked to pain reduction, we conducted a secondary analysis comparing uniportal VATS (U-VATS) and multiportal VATS (M-VATS).</p><p><strong>Methods: </strong>This analysis included 205 patients who underwent anatomical lung resection using VATS at 12 institutions. Postoperative pain was assessed using the numerical rating scale (NRS) and painDETECT questionnaire (PDQ) on postoperative days 10, 30, and 90.</p><p><strong>Results: </strong>Ninety-five patients underwent U-VATS, and 110 underwent M-VATS. The U-VATS group had significantly shorter operation times, chest tube duration, and hospital stay than the M-VATS group (146 vs. 180 min, 2.1 vs. 2.6 days, 4.8 vs. 6.4 days, respectively). Analgesic use was also significantly lower in the U-VATS group at all postoperative phases (64% vs. 90%, 14% vs. 52%, and 1% vs. 15%, all P < .001). NRS scores were significantly lower in the U-VATS group on postoperative days 10 (1.2 vs. 1.9, P < .001) and 30 (0.7 vs. 1.5, P < .001). The PDQ scores were consistently lower in the U-VATS group at all postoperative phases (all P < .001). A multivariate analysis showed that U-VATS significantly reduced the odds of an NRS score of > 3 on postoperative days 10 and 30 (odds ratio: 0.26, 95% CI: 0.08-0.84; odds ratio: 0.09, 95% CI: 0.01-0.76).</p><p><strong>Conclusions: </strong>U-VATS significantly reduced postoperative pain and was associated with shorter operation times, chest tube duration, and hospitalization than M-VATS.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144224590","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 Propensity-Matched Comparison Between Minimally Invasive Surgery and Stereotactic Radiotherapy in the Treatment of Clinical Stage IA Non-Small-Cell Lung Cancer (NSCLC).","authors":"Eleni Josephides, Niccolò Daddi, Pietro Bertoglio, Marialuisa Lugaresi, Akshay Patel, Eleonora Farinelli, Giulia Fabbri, Sara Volpi, Giovanni Frezza, Tom Routledge, Shahreen Ahmad, Mieke Van Hemelrijck, Eleni Karapanagiotou, Daniel Smith, Solli Piergiorgio, Andrea Billè","doi":"10.1016/j.cllc.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.cllc.2025.04.011","url":null,"abstract":"<p><strong>Background: </strong>Non-small cell lung cancer (NSCLC) is the leading cause of cancer-related death globally, with stage IA NSCLC presenting a unique opportunity for curative interventions. The efficacy of minimally invasive surgery (MIS) vs. stereotactic ablative radiotherapy (SABR) remains debated due to limited direct comparative data.</p><p><strong>Methods: </strong>This multicenter observational study analyzed data from 1014 patients diagnosed with clinical stage IA NSCLC (2015-2021) and treated with MIS (including VATS and RATS) or SABR. After propensity score matching, 234 patients (117 per group) were included. Matching balanced age, ECOG performance status, Charlson Comorbidity Index, lung function, and histological subtype to compare overall survival (OS), freedom from recurrence (FFR), and recurrence rates.</p><p><strong>Results: </strong>The mean follow-up was 35 months for MIS and 33 months for SABR. The matched cohort (n = 234) showed superior 5-year locoregional control (LRC) rates for MIS (93%) vs. SABR (88%). FFS at 2 and 5 years was higher for MIS (93.5% and 90.3%) than SABR (82.1% and 77.9%; P = .010). OS was significantly higher in MIS, with a hazard ratio of 1.60 (95% CI: 1.11-2.31). Early mortality rates were 2.6% for MIS at 30 and 90 days. SABR exhibited no 30-day mortality and a 90-day rate of 1.7%.</p><p><strong>Conclusion: </strong>MIS is associated with higher OS, LRC and FFR, but higher treatment-related mortality compared to SABR for stage IA NSCLC. This study supports the preference for surgical interventions where feasible. While future randomized controlled trials may provide more insights, this observational study contributes valuable evidence to guide clinical decision-making.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132206","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":"Multiple Sclerosis and Lung Cancer: A Single Cancer Center Experience in Philadelphia.","authors":"Julia Palecki, Matthew Tucker, Andrew Bernstein, Garrett Melby, Tingting Zhan, Ida Micaily","doi":"10.1016/j.cllc.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.cllc.2025.04.013","url":null,"abstract":"<p><strong>Background: </strong>The association between multiple sclerosis (MS) and lung cancer (LC) remains poorly understood. This retrospective, single center study aims to characterize the clinical features and outcomes of LC in patients with MS, shedding light on this unique patient cohort characterized by immune dysregulation and significant immunosuppressive therapy.</p><p><strong>Methods: </strong>This retrospective study analyzed 38 MS patients diagnosed with LC at Sidney Kimmel Comprehensive Cancer Center at Jefferson in Philadelphia, PA between January 1, 2016 and July 1, 2023. Clinical data including patient demographics, MS treatments, cancer diagnosis details (date, stage, histology), molecular and fusion data, PD-L1 status, and survival data were recorded and analyzed.</p><p><strong>Results: </strong>In our cohort of 38 patients, 27 patients were female. Twenty nine patients identified as White and 6 as Black. About 33 patients had NSCLC (24 adenocarcinoma, 6 squamous cell carcinoma, 1 large cell lung cancer, 1 mucoepidermoid tumor, and 1 carcinoid tumor), 3 had SCLC, and 1 had unknown pathology. Nine patients received steroids and 15 received biologic therapy for the treatment of MS. The median time between MS and LC diagnosis was 16.3 years. The average age at LC diagnosis was 68.2 ± 9.8 years. Among the 38 patients, 19 patients were diagnosed with stage I disease, 2 were diagnosed with stage II, 1 was diagnosed with stage III, and 16 were diagnosed with stage IV diseases. Among 15 patients with molecular testing, BRAF mutation was found in 1 patient, EGFR mutation in 4 patients, and KRAS mutation in 2 patients. 1 patient out of 14 tested demonstrated an ALK fusion. PD-L1 testing was recorded in 12 patients: 3 had 0%, 6 had 1% to 49%, and 3 had > 50% PD-L1 expression. The average overall survival was 2.4 years (95% CI: 1.4-8.1 years).</p><p><strong>Conclusions: </strong>Patients with MS were significantly exposed to immunosuppressive therapies, which may impact immune surveillance and the development of LC. In this cohort, MS patients with LC exhibited targetable mutations and PD-L1 expression. However, the use of immunotherapy in LC with concurrent MS remains limited. Nearly half of the patients had stage I LC and demonstrated favorable overall survival. Our findings highlight the need for further investigation into the relationship between MS and LC.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093023","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":"Impact of TP53 Co-Mutation on Clinicopathological Features, Prognosis, Recurrence Patterns, and the Efficacy of EGFR-TKI Treatment After Recurrence in Resected Early-Stage EGFR-Mutated Lung Adenocarcinoma.","authors":"Tatsuya Masuda, Shinya Katsumata, Mitsuhiro Isaka, Masakuni Serizawa, Takuya Kawata, Momoko Asami, Daisuke Yamaguchi, Keigo Matsushima, Kazuki Hayasaka, Hideaki Kojima, Naoya Yokomakura, Hayato Konno, Takeshi Nagashima, Kenichi Urakami, Ken Yamaguchi, Yasuhisa Ohde","doi":"10.1016/j.cllc.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.cllc.2025.04.009","url":null,"abstract":"<p><strong>Objectives: </strong>TP53 is the most frequently mutated gene in non-small-cell lung cancer. Although TP53 co-mutation is associated with poor responses to EGFR tyrosine kinase inhibitors (EGFR-TKIs) in advanced EGFR-mutated adenocarcinoma, its impact in resected early-stage lung adenocarcinoma remains unclear. In this study, we evaluated the effect of TP53 co-mutation on clinicopathological features, prognosis, and recurrence patterns in resected early-stage EGFR-mutated lung adenocarcinoma.</p><p><strong>Methods: </strong>We analyzed 400 patients with completely resected lung adenocarcinoma across pathological stages I-III, screening for EGFR and TP53 mutations using whole-exome sequencing. Among 121 patients positive for EGFR mutations, we categorized those with TP53 co-mutations and those with wild-type TP53. We then compared clinicopathological features, prognostic outcomes, recurrence patterns, and the efficacy of EGFR-TKI treatment postrecurrence between these groups.</p><p><strong>Results: </strong>TP53 co-mutations were identified in 22 cases (18.2%). The TP53 co-mutation group had significantly more lymphovascular invasion (P = .037) and a higher tumor mutation burden (P = .007) compared with the TP53 wild-type group. Moreover, the co-mutation group exhibited markedly poorer recurrence-free and overall survival rates [hazard ratio (HR) 2.32, 95% confidence interval (CI) 1.12-4.85, P = .025; HR 2.54, 95% CI 1.01-6.36, P = .047, respectively]. However, progression-free survival in patients treated with EGFR-TKIs postrelapse did not differ significantly between the groups.</p><p><strong>Conclusions: </strong>TP53 co-mutations may negatively affect the prognosis of patients with resected early-stage EGFR-mutated lung adenocarcinoma. Larger studies are needed to confirm these findings.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144132208","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":"Common Medical Comorbidities Influence Pneumonitis Risk After Chemoradiotherapy and Durvalumab Maintenance in Stage III Non-small Cell Lung Cancer.","authors":"Kim Ohaegbulam, Christopher Anderson, Reid F Thompson, Timur Mitin","doi":"10.1016/j.cllc.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.cllc.2025.04.012","url":null,"abstract":"<p><strong>Objective: </strong>Approximately 25% of patients with non-small cell lung cancer (NSCLC) present with Stage III disease. The standard treatment for inoperable patients involves definitive chemoradiotherapy (CRT) followed by 12 months of maintenance durvalumab. However, the incidence of pneumonitis-an adverse effect of this regimen-affects a significant proportion of patients. This study aimed to identify predictors of pneumonitis in a large cohort of patients with unresectable Stage III NSCLC receiving CRT and durvalumab, with a focus on common medical comorbidities.</p><p><strong>Methods: </strong>Using data from the Veterans Health Administration's Corporate Data Warehouse, we identified 1,524 patients who received the standard regimen between June 2017 and July 2023. Pneumonitis was assessed via ICD codes and severity determined using National Cancer Institute criteria. We analyzed associations between pneumonitis and various covariates including age, comorbidities, and medication use.</p><p><strong>Results: </strong>Our findings indicated a cumulative pneumonitis incidence of 14.5%, with 7.68% of cases classified as grade 3 or higher. Significant risk factors included advanced age, higher Charlson Comorbidity Index (CCI), prior pneumonia, diabetes, obesity, and antibiotic use, particularly cephalosporins and macrolides. Notably, severe chronic obstructive pulmonary disease (COPD) and uncontrolled diabetes were associated with an increased risk of pneumonitis. In contrast, prior tobacco use and better ECOG performance status (lower score) were protective.</p><p><strong>Conclusion: </strong>These results highlight the complex interplay between comorbid conditions, medication, and pneumonitis risk in patients undergoing CRT and durvalumab therapy. Further research is needed to explore these relationships and potentially inform strategies to mitigate pneumonitis risk.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075916","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":"Efficacy and Safety of EGFR-TKI Combined With Early Brain Radiotherapy Versus TKI Alone in Patients With EGFR-Mutated NSCLC With Brain Metastases: A Systematic Review and Meta-Analysis.","authors":"Zihan Zeng, Simin Feng, Tinghua Gao, Chengye Chen, Jun Chen, Junliang Chen, Yingni Lian","doi":"10.1016/j.cllc.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.cllc.2025.04.010","url":null,"abstract":"<p><p>To evaluate the efficacy and safety of early brain radiotherapy combined with EGFR-TKI versus EGFR-TKI alone in EGFR-mutation-positive non-small cell lung cancer (NSCLC) patients with brain metastases (BMS). A systematic literature search was conducted in several databases. The primary outcome measures were overall survival (OS) and intracranial progression-free survival (iPFS), while secondary outcome measures included adverse events (AEs). Meta-analysis was performed using STATA 15.1 software. A total of 18 retrospective trials involving 2,119 patients were included. Meta-analysis showed that early brain radiotherapy combined with EGFR-TKI was superior to monotherapy in improving OS (HR = 0.87, 95% CI, 0.76-0.99) and iPFS (HR = 0.77, 95% CI, 0.61-0.97). Subgroup analysis indicated that among patients treated with Osimertinib, monotherapy showed a trend towards improved OS (HR = 1.44, 95% CI, 0.94-2.22) and iPFS (HR = 1.10, 95% CI, 0.76-1.60), though without statistical significance. In contrast, first- and second-generation EGFR-TKI combined with early brain radiotherapy significantly prolonged OS (HR = 0.83, 95% CI, 0.72-0.95) and iPFS (HR = 0.72, 95% CI, 0.55-0.93). Regarding AEs, the incidence of neurological adverse reactions was significantly higher in the combined treatment group (RR = 15.82, 95% CI, 2.31-108.54). Early brain radiotherapy combined with EGFR-TKI can significantly improve OS and iPFS in EGFR-mutated NSCLC patients with BMS but may increase the risk of neurological adverse reactions. Further research is needed to verify the efficacy differences between monotherapy and combination therapy for patients using Osimertinib.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274338","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}