Clinical lung cancer最新文献

{"title":"Conversion Surgery for Initially Unresectable Stage Ⅲ Nonsmall Cell Lung Cancer After Induction Treatment of Immunochemotherapy: A Multicenter Study.","authors":"Mingliang Wang, Xiaojun Wang, Ran Yang, Mingfei Geng, Songlin Zhang, Zebo Yang, Quanfu Huang, Sihua Wang, Shuangbing Xu, Ke Jiang, Yongde Liao","doi":"10.1016/j.cllc.2024.11.005","DOIUrl":"https://doi.org/10.1016/j.cllc.2024.11.005","url":null,"abstract":"<p><strong>Background: </strong>Immuno-chemotherapy has demonstrated significant anti-tumor effects in patients with resectable nonsmall cell lung cancer (NSCLC). Additionally, for patients initially diagnosed with unresectable stage III NSCLC, induction immuno-chemotherapy may achieve tumor downstaging, enabling conversion to resectable disease allowing for by R0 resection. This study aimed to assess the effectiveness and safety of induction immuno-chemotherapy followed by conversion surgery in unresectable stage III NSCLC.</p><p><strong>Patients and methods: </strong>A total of 113 patients with unresectable stage Ⅲ NSCLC who received induction immuno-chemotherapy at three institutions in China from March 2019 to April 2022 were retrospectively identified. After 2-4 cycles of immuno-chemotherapy, a multisiciplinary team (MDT) reassessed the tumor response and resectability in each case. Surgical resection was performed for patients who achieved tumor downstaging to resectable disease. Surgical and oncological outcomes of the patients were analyzed.</p><p><strong>Results: </strong>Of the 113 patients treated with immuno-chemotherapy, 79 (69.9%) achieved conversion to resectable state and underwent surgery. Surgical procedures included lobectomy in 55 (69.6%) patients, sleeve lobectomy in 14 (17.7%) patients, bilobectomy in 6 (7.6%) patients, and pneumonectomy in 4 (5.1%) patients, achieving an R0 resection rate of 98.7% (78/79). No surgical-related 30-day or 90-day mortalities were recorded, although 17 patients (21.5%) experienced postoperative complications. In terms of pathological response, 44 (55.7%) patients achieved major pathologic response and 25 (31.6%) patients achieved complete pathologic response. Median progression-free survival (PFS) and overall survival (OS) was not reached. The 12- and 24-month PFS rates were 82.3% and 72.2%, while OS rates were 94.9% and 84.5%, respectively.</p><p><strong>Conclusion: </strong>Conversion surgery following immuno-chemotherapy is feasible and safe, yielding promising pathological responses and favorable survival outcomes for patients with unresectable stage III NSCLC.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028130","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 Lung Biomarker Testing on Out-Of-Pocket Costs for Metastatic Non–Small-Cell Lung Cancer","authors":"Laila A. Gharzai ,&nbsp;Sarah Bell ,&nbsp;Divya M. Gupta ,&nbsp;Ruth C. Carlos","doi":"10.1016/j.cllc.2024.11.011","DOIUrl":"10.1016/j.cllc.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Biomarker testing in metastatic non–small lung cancer (NSCLC) is critical for appropriate treatment. Claims-based datasets offer real-world information on the use and cost of biomarker testing.</div></div><div><h3>Materials and Methods</h3><div>We used 2013-2021 data from Optum's de-identified Clinformatics Data Mart Database. Eligible patients were adults with ≥ 2 NSCLC diagnosis codes and ≥ 2 claims of a secondary malignant neoplasm. We excluded patients with another primary or no continuous insurance coverage 12 months prior and 6 months after diagnosis. We assessed out-of-pocket (OOP) costs. Descriptive statistics were used to assess testing rates, and multivariable analyses (MVA) were performed to assess factors associated with testing.</div></div><div><h3>Results</h3><div>We identified 4377 patients with metastatic NSCLC (mean age 60 years (SD 8.33), 49.6% female, 76.7% former smokers). Testing rates within 2 months of diagnosis increased from 58.15% in 2013 to 69.96% in 2021. On MVA, biomarker testing was associated with younger age, nonsmokers, Mountain geographic region, and point-of-service insurance plans. Biomarker testing was associated with a median OOP cost of $98 (IQR: $43.87-$306.58). Patients who underwent biomarker testing had a median total OOP cost of all services within 6 months of diagnosis of $3560.20 (IQR: $1538.37-$6199.44) compared to $1979.58 (IQR: $725.75-$4003.06) for those who did not undergo biomarker testing.</div></div><div><h3>Conclusions</h3><div>Using claims data, we find that most patients with metastatic NSCLC undergo biomarker testing early in their treatment course (0-60 days), suggesting that testing is appropriately being obtained early on in their treatment course, but this testing is associated with substantially higher overall OOP costs to patients.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 2","pages":"Pages e118-e125"},"PeriodicalIF":3.3,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806369","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, Dosimetric and Radiomic Features Predictive of Lung Toxicity After (Chemo)Radiotherapy","authors":"Cécile Evin ,&nbsp;Léo Razakamanantsoa ,&nbsp;François Gardavaud ,&nbsp;Léa Papillon ,&nbsp;Hamza Boulaala ,&nbsp;Loïc Ferrer ,&nbsp;Olivier Gallinato ,&nbsp;Thierry Colin ,&nbsp;Sondos Ben Moussa ,&nbsp;Yara Harfouch ,&nbsp;Jean-Noël Foulquier ,&nbsp;Sophie Guillerm ,&nbsp;Jean-Emmanuel Bibault ,&nbsp;Florence Huguet ,&nbsp;Mathilde Wagner ,&nbsp;Eleonor Rivin del Campo","doi":"10.1016/j.cllc.2024.11.003","DOIUrl":"10.1016/j.cllc.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Treatment of locally advanced non small cell lung cancer (LA-NSCLC) is based on (chemo)radiotherapy, which may cause acute lung toxicity: radiation pneumonitis (RP). Its frequency seems to increase by the use of adjuvant durvalumab therapy.</div></div><div><h3>Aims</h3><div>To identify clinical, dosimetric, and radiomic factors associated with grade (G)≥2 RP and build a prediction model based on selected parameters.</div></div><div><h3>Patients and Methods</h3><div>This is a retrospective multicenter cohort study including patients receiving radiation therapy between 2015 and 2019 for LA-NSCLC. Baseline computed tomography scanners were segmented to extract radiomic features from the \"Lung - Tumor\" volume. Variables associated with the risk of G≥2 RP in the descriptive analysis were then selected for explanatory analysis, followed by predictive analysis.</div></div><div><h3>Results</h3><div>153 patients were included in 4 centers (51 with G≥2 RP). Factors associated with G≥2 RP included a high initial hemoglobin level, dosimetric factors (mean dose to healthy lungs, lung V20Gy and V13Gy), the addition of maintenance durvalumab, and 7 radiomic features (intensity distribution and texture). Other factors were associated with an increased risk of G≥2 RP in our explanatory model, such as older age, low Tiffeneau ratio, and a decreased initial platelet count. The best-performing predictive model was a random forest-based learning model using clinical, dosimetric, and radiomic variables, with an area under the ROC curve of 0.72 (95%CI [0.63; 0.80]) versus 0.64 for models using one type of data.</div></div><div><h3>Conclusion</h3><div>The addition of radiomic features to clinical and dosimetric ones improves prediction of the occurrence of G≥2 RP in patients receiving radiotherapy for lung cancer.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 2","pages":"Pages 93-103.e1"},"PeriodicalIF":3.3,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821864","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":"Lobectomy Is Not Associated With Improved Survival as Compared to Segmentectomy in Early-Stage Lung Cancer Patients With Visceral Pleural Invasion","authors":"Gregory L. Whitehorn ,&nbsp;Hamza Rshaidat ,&nbsp;Isheeta Madeka ,&nbsp;Jonathan Martin ,&nbsp;Shale J. Mack ,&nbsp;Luke Meredith ,&nbsp;Sneha Alaparthi ,&nbsp;Tyler R. Grenda ,&nbsp;Nathaniel R. Evans III ,&nbsp;Olugbenga T. Okusanya","doi":"10.1016/j.cllc.2024.11.007","DOIUrl":"10.1016/j.cllc.2024.11.007","url":null,"abstract":"<div><h3>Objective</h3><div>The purpose of this study is to utilize a representative national sample to compare survival outcomes of patients with visceral pleural invasion (VPI) who underwent either a lobectomy or a segmentectomy.</div></div><div><h3>Methods</h3><div>National Cancer Database from 2010 to 2019 was utilized. Patients with tumor size ≤ 2 cm, with VPI, non–small cell lung cancer (NSCLC), with a known vital status were included in the study. A propensity match analysis was performed to compare VPI patients undergoing either lobectomy or segmentectomy.</div></div><div><h3>Results</h3><div>Of the 66,181 patients who met the inclusion criteria, 6,575 (9.9%) had VPI. In postmatch analysis, there was no significant difference in 5-year survival in patients whose cancer had VPI and underwent either lobectomy or segmentectomy (76 [77.1%] vs. 71 [65.7%]; <em>P = .</em>23). Patients who underwent lobectomy and had VPI had poorer 5-year survival compared to patients who underwent a lobectomy and did not have VPI (1,154 [73.7%] vs. 1,240 [78.5%]; <em>P &lt; .</em>001). There was no difference in 5-year survival between patients who underwent a segmentectomy and had VPI and patients who underwent a segmentectomy and did not have VPI (71 [65.7%] vs. 79 [71.0%]; <em>P = .</em>36).</div></div><div><h3>Conclusion</h3><div>A lobectomy was not associated with improved survival as compared to patients who underwent a segmentectomy in patients with early-stage NSCLC with VPI. VPI remains a poor prognostic factor for survival regardless of the procedure performed. This data would indicate that the presence of VPI should not be a determining factor in the anatomic lung resection selected in patients with small, early-stage NSCLC.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 2","pages":"Pages e99-e107.e10"},"PeriodicalIF":3.3,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142821865","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":"Enhanced Recovery With Aggressive Ambulation Decreases Length of Stay in Lung Cancer Surgery","authors":"Ju Ae Park ,&nbsp;Duy Pham ,&nbsp;Kasper Nilsson ,&nbsp;Lolita Ramsey ,&nbsp;Diana Morris ,&nbsp;Sandeep J. Khandhar ,&nbsp;Michael J. Weyant ,&nbsp;Kei Suzuki","doi":"10.1016/j.cllc.2024.11.010","DOIUrl":"10.1016/j.cllc.2024.11.010","url":null,"abstract":"<div><h3>Objective</h3><div>Thoracic Enhanced Recovery with Ambulation after Surgery (T-ERAS) protocol at our institution includes ambulation into the operating room and 250-feet ambulation within 1 hour of extubation. We compared the average length of stay (LOS) between T-ERAS patients and that predicted using a validated surgical risk calculator.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients undergoing lung cancer resection with minimally invasive approach from 2012 to 2022. Patients aged ≥ 18 were included if early ambulation was documented. Patient information were entered into the American College of Surgeon's National Surgical Quality Improvement Program Risk Calculator (NSQIP) to obtain the predicted LOS. Descriptive statistics, comparisons of observed versus predicted LOS (O/P ratio), and nonparametric testing were conducted.</div></div><div><h3>Results</h3><div>Of 940 patients reviewed, 886 met eligibility. For the study cohort, average age was 68, and 514 (58.0%) were female. By procedure, there were 631(71.2%) lobectomy, 204 (23.0%) wedge, 26 (2.9%) segmentectomy, 20 (2.3%) bilobectomy, and 5 (0.6%) pneumonectomy. The average LOS observed for the entire cohort was 1.2 days (median 1.0 day) compared to the predicted LOS of 3.4 days with the NSQIP (median 4.0). Overall, 842 (95%) of patients had LOS better than predicted (O/P ratio &lt; 1), 19 (2.1%) had LOS as predicted (O/P ratio = 1), and 25 (2.8%) had LOS longer than predicted (O/P ratio &gt; 1). The mean O/P ratio was 0.34.</div></div><div><h3>Conclusion</h3><div>Average LOS with T-ERAS protocol was 1.2 days compared to the predicted average of 3.6 days in patients undergoing minimally invasive lung cancer resections. Our study provides a potential protocol to shorten the LOS beyond what is predicted by NSQIP.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 2","pages":"Pages 140-145"},"PeriodicalIF":3.3,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791170","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 Between the Extent of N1 Lymph Node Station Examination and Prognosis in Stage I Non-small Cell Lung Cancer Patients: One Station is Insufficient","authors":"Junhong Liu ,&nbsp;Bingji Cao ,&nbsp;ZhiHua Shi ,&nbsp;Minglei Song ,&nbsp;Junfeng Liu","doi":"10.1016/j.cllc.2024.11.009","DOIUrl":"10.1016/j.cllc.2024.11.009","url":null,"abstract":"<div><h3>Background</h3><div>Examination standards for hilar and intrapulmonary (N1) lymph nodes (LNs) have been debated. The objective of this study was to assess the prognostic significance of the extent of examination for N1 LN stations in patients with pathological stage I non-small cell lung cancer (NSCLC).</div></div><div><h3>Methods</h3><div>A total of 1868 patients were identified and divided into 3 groups on the basis of the number of N1 stations examined: group A (≥3 stations), group B (2 stations) and group C (1 station). Moreover, we investigated the prognostic significance of each individual N1 station examined. The primary outcome was 5-year disease-free survival (DFS).</div></div><div><h3>Results</h3><div>Overall, 1062, 607, and 199 patients were in groups A, B, and C, respectively. The baseline demographic and clinical characteristics were similar among the groups, except for the tumor side. The 5-year DFS rates were comparable between groups A and B (85.1% vs. 82.7%, <em>P</em> = .3), both of which were significantly greater than that of group C (74.4%) (<em>P</em> &lt; .01). Similar results were observed for the corresponding 5-year overall survival rates. The number of N1 stations examined was an independent predictor in multiple analyses. Additionally, the examination of stations 10 and 13 were independent favorable predictors for 5-year DFS.</div></div><div><h3>Conclusion</h3><div>For patients with pathological stage I NSCLC, examination of only 1 N1 station is insufficient. Examinations of a minimum of two N1 stations, including stations 10 and 13, is recommended to obtain the optimal survival benefit.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 2","pages":"Pages e108-e117.e3"},"PeriodicalIF":3.3,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794189","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":"Intraoperative Molecular Imaging With Pafolacianine: Histologic Characteristics of Identified Nodules","authors":"Inderpal S. Sarkaria ,&nbsp;Timothy G. Biro ,&nbsp;Sunil Singhal ,&nbsp;Rishindra M. Reddy ,&nbsp;Linda W. Martin ,&nbsp;David C. Rice ,&nbsp;Alex S. Lopez ,&nbsp;Gary Stevens ,&nbsp;Tina Barret ,&nbsp;Sudish C. Murthy","doi":"10.1016/j.cllc.2024.11.004","DOIUrl":"10.1016/j.cllc.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>With increased early detection efforts, surgery for early-stage lung cancer is expected to rise. Pafolacianine is the first FDA approved targeted optical imaging agent indicated as an adjunct for intraoperative identification of malignant and nonmalignant pulmonary lesions in adult patients with known or suspected cancer in the lung.</div></div><div><h3>Methods</h3><div>This is a retrospective review of the malignant and nonmalignant lesions identified by pafolacianine with intraoperative molecular imaging (IMI) in the multi-center Phase 2 and Phase 3 ELUCIDATE clinical trials. All lesions meeting the intent to treat criteria from the combined studies were included. Histopathology for malignant and nonmalignant lesions and immunohistochemistry (ICH) for folate receptor alpha (FRα) and folate receptor beta (FRβ), which pafolacianine binds to, were assessed.</div></div><div><h3>Results</h3><div>A total of 273 lesions resected from 191 patients were analyzed. The identification of primary and occult malignant lesions with pafolacianine in combination with standard practice was improved (<em>P</em> &lt; .001) when compared to standard practice alone. A range of histologies were demonstrated including adenocarcinoma (primary and metastatic), squamous cell carcinoma, adenoid cystic carcinoma, chordoma, lymphoma, and papillary thyroid cancer. Ninety-two percent (205 of 223) of lesions tested for folate expression were positive for FRα or FRβ expression.</div></div><div><h3>Conclusions</h3><div>While initially intended to identify adenocarcinoma, IMI with pafolacianine targets a broad histological cross-section of malignant and nonmalignant primary and metastatic lesions in the lung. As real-world use expands, additional insight will continue to inform utility of pafolacianine in clinical practice and may broaden clinical applicability.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 2","pages":"Pages 104-115"},"PeriodicalIF":3.3,"publicationDate":"2024-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871646","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":"Association of Oncogene Driver Mutations with Recurrence and Survival in Stage I Nonsmall Cell Lung Cancer","authors":"Daniel M. Libby ,&nbsp;Laura J. Libby ,&nbsp;Xiaoyue Ma ,&nbsp;Jason Chua ,&nbsp;Tahj Blow ,&nbsp;Peyman Razavi ,&nbsp;Ashish Saxena","doi":"10.1016/j.cllc.2024.10.016","DOIUrl":"10.1016/j.cllc.2024.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Stage I nonsmall cell lung cancer (NSCLC) is primarily treated with surgical resection and has a favorable prognosis with an expected recurrence rate of 30%. New methods to risk stratify patients with stage I NSCLC are needed to help select those that might benefit from more active surveillance or adjuvant therapy.</div></div><div><h3>Methods</h3><div>We analyzed clinical data from 1330 patients (1469 tumors) with NSCLC and correlated it with next-generation sequencing (NGS). To reduce the potential confounding variables of stage and treatment, this analysis only included patients with stage I NSCLC in whom surgical resection was the primary treatment.</div></div><div><h3>Results</h3><div>In 570 patients (600 tumors), 75 (12.5%) developed recurrence. Recurrence occurred in 37.5% of patients with KRAS G12V mutation versus 11.1% of patients without this mutation (<em>P</em> &lt; .001). A lower chance of recurrence was associated with “any EGFR” mutation (6.74% vs. 14.9%, <em>P</em> = .006). A history of coronary artery disease (CAD) increased the chance of recurrence: OR 2.7 (1.57-4.89, <em>P</em> &lt; .001). Shorter survival was predicted by KRAS G12V (<em>P</em> = .009) and “other TP53” mutation (<em>P</em> = .025). KRAS G12V, KRAS G13D, MET E168D, PTEN, and “other TP53” were oncogene mutations associated with reduced survival in stage I NSCLC. CAD, type 2 diabetes (DM2), and “other cancer” were medical comorbidities associated with reduced survival in stage I NSCLC.</div></div><div><h3>Conclusions</h3><div>Oncogene mutations such as KRAS G12V and EGFR may have implications for cancer surveillance strategies and inform future treatment trials of stage I NSCLC.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 2","pages":"Pages 116-123"},"PeriodicalIF":3.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142823805","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":"Outcomes Following Treatment for Progression in Patients Treated With Durvalumab Consolidation in LA-NSCLC","authors":"Margaret Stalker ,&nbsp;Melina Marmarelis ,&nbsp;Corey Langer ,&nbsp;Roger B. Cohen ,&nbsp;Aditi Singh ,&nbsp;Charu Aggarwal ,&nbsp;Lova Sun","doi":"10.1016/j.cllc.2024.11.002","DOIUrl":"10.1016/j.cllc.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>PACIFIC established consolidative durvalumab for LA-NSCLC, but only about half of patients completed a year of therapy. Data on treatment patterns and outcomes after durvalumab are limited.</div></div><div><h3>Methods</h3><div>Our analysis included patients from a US nationwide database with LA-NSCLC who received consolidative durvalumab between 2017 and 2023 and had subsequent systemic therapy, classified as PD-L1 monotherapy, PD-L1+chemotherapy, chemotherapy alone, PD-L1+CTLA4, or targeted therapy (TT). Time to next treatment (TTNT) was analyzed from durvalumab start and finish to next line of therapy initiation. Overall survival (OS) from start of postdurvalumab therapy was analyzed using Kaplan Meier methodology.</div></div><div><h3>Results</h3><div>Our cohort included 751 patients, median age 68 (IQR, 61-74), 53% female, 80% White, 91% ECOG 0-1, 90% smoking history, and 53% nonsquamous histology. The most common postdurvalumab treatment was chemotherapy alone in 349 (46%), followed by PD-L1+chemotherapy in 147 (20%), PD-L1 monotherapy in 114 (15%), and TT in 104 (14%).</div><div>Median duration of durvalumab treatment was 5.5 months (IQR 2.3-10.6); only 9% of patients received a full year of durvalumab, and 64% started next treatment within a year of initiation. Patients treated with chemotherapy-containing regimens had shorter TTNT from durvalumab start/end, as well as shorter median OS [10.8 (5.6-18.8) months for chemotherapy and 12.9 (6.0-24.2) months for chemoimmunotherapy, versus 23.8 (8.7-34.5) months for PD-L1 monotherapy and 30.1 (9.5-NR) months for TT (<em>P</em> &lt; .001)].</div></div><div><h3>Conclusion</h3><div>Patients treated with systemic therapy after consolidative durvalumab, particularly those requiring chemotherapy-based treatment, have poor outcomes and are in need of improved treatment strategies.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 2","pages":"Pages 124-130.e1"},"PeriodicalIF":3.3,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766918","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":"The Role of Medicaid Expansion on the Receipt of Adjuvant Chemotherapy in Patients With Lung Cancer","authors":"Hamza Rshaidat ,&nbsp;Shale J. Mack ,&nbsp;Scott H. Koeneman ,&nbsp;Jonathan Martin ,&nbsp;Gregory L. Whitehorn ,&nbsp;Isheeta Madeka ,&nbsp;Sarah W. Gordon ,&nbsp;T, Olugbenga T. Okusanya","doi":"10.1016/j.cllc.2024.09.007","DOIUrl":"10.1016/j.cllc.2024.09.007","url":null,"abstract":"<div><h3>Objective</h3><div>We aimed to utilize a nationally representative database to study the effect of Medicaid expansion on the receipt of adjuvant chemotherapy in eligible patients.</div></div><div><h3>Materials and Methods</h3><div>Retrospective review of the National Cancer Database (NCDB) was performed between 2006 and 2019. Patients with clinical T1-T3, N1, and M0 were included. Patients with nodal disease or tumors &gt; 4 cm were eligible for adjuvant therapy. Demographic and clinical information were collected. A difference-in-difference analysis was performed to compare changes in the rate of adjuvant chemotherapy.</div></div><div><h3>Results</h3><div>Total 9954 eligible patients were treated in states that expanded Medicaid coverage in January 2014 or later, with 4809 patients treated in the pre-expansion years (2012-2013) and 5145 patients treated in the postexpansion years (2017-2018). Following Medicaid expansion, eligible patients were more likely to receive adjuvant therapy (70.2% vs. 62.3%; <em>P</em> &lt; .001). Compared with the pre-expansion period, patients who received adjuvant therapy were more likely to use Medicaid insurance postexpansion (7.8% vs. 5%, <em>P</em> &lt; .001). Among patients using Medicaid coverage only, a greater percentage started adjuvant therapy within 8 weeks of resection following Medicaid expansion (46.6% vs. 38.3%, <em>P</em> = .048). The observed difference-in-difference in the change in adjuvant therapy rate from the pre-expansion period to the postexpansion period between expansion and nonexpansion states was 1.25% (95% Bootstrap CI −0.36% to −3.18%). There was a modest survival benefit in expansion states postexpansion.</div></div><div><h3>Conclusion</h3><div>Medicaid expansion appears to be associated with increased access to care, as shown by the increased receipt of adjuvant systemic therapy in eligible patients.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 2","pages":"Pages 131-139"},"PeriodicalIF":3.3,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459763","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}