Clinical lung cancer最新文献

{"title":"Neratinib Efficacy in Patients With EGFR Exon 18-Mutant Non-Small-Cell Lung Cancer: Findings From the SUMMIT Basket Trial","authors":"Jonathan W. Goldman ,&nbsp;Alejandro Martinez Bueno ,&nbsp;Christophe Dooms ,&nbsp;Komal Jhaveri ,&nbsp;Maria de Miguel ,&nbsp;Sarina A. Piha-Paul ,&nbsp;Nisha Unni ,&nbsp;Aviad Zick ,&nbsp;Amit Mahipal ,&nbsp;J. Marie Suga ,&nbsp;Charles Naltet ,&nbsp;Monica Antoñanzas ,&nbsp;John Crown ,&nbsp;Judith Bebchuk ,&nbsp;Lisa D. Eli ,&nbsp;Beth H. Lowenthal ,&nbsp;Devalingam Mahalingam","doi":"10.1016/j.cllc.2024.12.003","DOIUrl":"10.1016/j.cllc.2024.12.003","url":null,"abstract":"<div><h3>Background</h3><div>Activating mutations in the epidermal growth factor receptor (<em>EGFR</em>) gene occur in 7% to 23% of patients with non-small-cell lung cancer (NSCLC). A small proportion of these (3–5%) are exon 18 mutations. Neratinib, an irreversible pan-HER tyrosine kinase inhibitor (TKI), had activity in the phase II SUMMIT basket study. We report efficacy and safety of neratinib in patients with <em>EGFR</em> exon 18-mutant NSCLC in SUMMIT, according to prior EGFR TKI treatment.</div></div><div><h3>Patients and Methods</h3><div>Eligible patients had ECOG performance status 0–2. Prior EGFR TKIs, chemotherapy, and checkpoint inhibitors were allowed. Patients received neratinib (240 mg orally daily) and mandatory diarrhea prophylaxis with loperamide. The primary endpoint was objective response rate (ORR) at 8 weeks (ORR₈); other endpoints included ORR, progression-free survival (PFS), duration of response, and safety.</div></div><div><h3>Results</h3><div>Thirty-one patients were included (24/7 with/without prior TKI). ORR₈ was 19.4% (95% CI 7.5–37.5); ORR was 32.3% (95% CI: 16.7–51.4); median PFS 5.75 months (95% CI: 2.27–9.23). Two of 7 patients with baseline central nervous system metastasis had partial responses (median PFS 3.6 months; 95% CI: 1.9–9.1). Six patients with G719A/X/C mutations had partial responses &gt;10 months. Diarrhea was generally controlled (10% grade 3, no grade 4; one patient discontinued treatment because of diarrhea).</div></div><div><h3>Conclusion</h3><div>Neratinib had meaningful activity in selected patients with <em>EGFR</em> exon 18-mutant NSCLC, including patients pretreated with ≥1 TKI. Diarrhea was generally low grade. Given the lack of effective treatments after EGFR TKI failure for NSCLC with uncommon mutations, further examination of neratinib is warranted.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 3","pages":"Pages 191-200.e1"},"PeriodicalIF":3.3,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143001329","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 Phase II, Open Label, Single-Arm Study on the Efficacy of Cabozantinib in Patients With Advanced/Metastatic Nonsmall Cell Lung Cancer Harboring MET Exon 14 Alterations who Developed Acquired Resistance to Tepotinib or Capmatinib (CAPTURE Trial)","authors":"Masayuki Takeda ,&nbsp;Masahide Ota ,&nbsp;Eiji Iwama ,&nbsp;Shunichi Sugawara ,&nbsp;Takehito Shukuya ,&nbsp;Shigeki Umemura ,&nbsp;Hiroshi Tanaka ,&nbsp;Masahide Oki ,&nbsp;Takayuki Takahama ,&nbsp;Takeshi Masuda ,&nbsp;Naoyuki Nogami ,&nbsp;Mototsugu Shimokawa","doi":"10.1016/j.cllc.2024.12.004","DOIUrl":"10.1016/j.cllc.2024.12.004","url":null,"abstract":"<div><h3>Background</h3><div><em>MET</em> gene exon 14 skipping was identified as a potential driver mutation that occurs in approximately 3%-4% of patients with nonsmall cell lung cancer (NSCLC), typically in the absence of other driver mutations. Capmatinib and tepotinib were the first MET- tyrosine kinase inhibitors (MET-TKIs) approved by the FDA and PMDA, specifically for patients with metastatic NSCLC. Several studies have reported acquired resistance after MET-TKI treatment for <em>MET</em> mutation-positive NSCLC. Sequencing of the MET kinase region of resistant cell lines revealed secondary mutations at residues D1228 and Y1230 that were sensitive to type II MET-TKIs, such as cabozantinib. This suggested that sequential administration of other MET-TKIs may overcome the development of secondary mutations after acquired resistance in <em>MET</em> exon 14 mutation-positive NSCLC.</div></div><div><h3>Methods</h3><div>We designed the single arm phase II study CAPTURE Trial to assess the efficacy of cabozantinib in patients with advanced/metastatic NSCLC with activating <em>MET</em> exon 14 alterations who developed acquired resistance to tepotinib or capmatinib, as well as after 2 prior chemotherapy regimens that included platinum and docetaxel. The primary endpoint was objective response rate by independent review committees. The sample size (<em>n</em> = 30) is calculated by assuming a threshold response rate of 5% and an expected response rate of 25%. Recruitment began in August 2024.</div></div><div><h3>Results</h3><div>This ongoing study aimed to evaluate the safety and efficacy of cabozantinib after acquired resistance to tepotinib or capmatinib.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 3","pages":"Pages e232-e235"},"PeriodicalIF":3.3,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142913989","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":"Computer Assisted Nodule Analysis and Risk Yield is Associated With Occult Lymph Node Status in Clinical Stage I-IIA Lung Adenocarcinoma Undergoing Resection","authors":"Duy Pham ,&nbsp;Ju Ae Park ,&nbsp;Hongkun Wang ,&nbsp;Melanie Subramanian ,&nbsp;Michael J. Weyant ,&nbsp;Kei Suzuki","doi":"10.1016/j.cllc.2024.11.013","DOIUrl":"10.1016/j.cllc.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Current staging work-up does not capture all occult lymph node (OLN) disease. We sought to determine if Computer Assisted Nodule Analysis and Risk Yield (CANARY) analysis could help distinguish OLN status in early-stage lung adenocarcinoma.</div></div><div><h3>Methods</h3><div>Retrospective review of resected lung cancer patients from 2016 to 2021 was performed. Patients with surgically resected clinical stage I-IIA lung adenocarcinoma were included. Preoperative imaging was entered into the CANARY software, and each lesion was categorized into good, intermediate, and poor risk. OLN status was determined per pathology results. Pearson's Chi-square correlation, univariate and multivariate logistic regression models were used to assess OLN metastases as a function of CANARY risk profile, with statistical significance at <span><math><mrow><mi>α</mi><mo>=</mo><mn>0.05</mn></mrow></math></span>.</div></div><div><h3>Results</h3><div>In total, the study cohort included 228 patients with median age of 70. By clinical stage, 195 (85.5%), 24 (10.5%), and 9 (3.9%) patients were determined to be in IA, IB, and IIA, respectively. 28 (12.3%) patients were found to have OLN metastases. Among them, 1 (3.6%), 3 (10.7%), and 24 (85.7%) patients had a good, intermediate, and poor CANARY risk profile, respectively. CANARY risk profile was significantly associated with OLN metastases (<span><math><mi>χ</mi></math></span>2 = 9.9, <em>P</em> = .007). Relative to the good/intermediate group, patients with poor risk had a more-than 3-fold increase in likelihood of having OLN metastases (odd ratio [OR] = 3.3, 95% confidence interval [CI]:1.6-9.2, <em>P</em> = .007).</div></div><div><h3>Conclusion</h3><div>CANARY analysis was able to risk-stratify the likelihood of OLN metastases in early-stage lung adenocarcinoma. CANARY can provide an adjunctive non-invasive tool to aid in determining an appropriate individualized treatment plan.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 3","pages":"Pages e142-e149"},"PeriodicalIF":3.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142885250","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":"Phase II Parallel Arm Study of Sacituzumab Govitecan-Hziy in Patients With Advanced Thymoma or Thymic Carcinoma","authors":"Jennifer A. Marks ,&nbsp;Jaeil Ahn ,&nbsp;Joshua E. Reuss ,&nbsp;David Barbie ,&nbsp;Mehmet Altan ,&nbsp;Martin E. Gutierrez ,&nbsp;Marina C. Garassino ,&nbsp;Gregory J. Riely ,&nbsp;Heather Wakelee ,&nbsp;Stephen V. Liu ,&nbsp;Chul Kim","doi":"10.1016/j.cllc.2024.12.001","DOIUrl":"10.1016/j.cllc.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Thymic epithelial tumors (TETs), including thymoma and thymic carcinoma, are rare thoracic tumors of the anterior mediastinum. For those with advanced disease, platinum-based chemotherapy is used as first-line treatment. However, there is no standard regimen established for TET at progression after initial therapy, and treatment options for advanced/recurrent TETs are limited. Trop-2, a transmembrane glycoprotein, is overexpressed in solid tumors including thymomas and thymic carcinomas. Sacituzumab govitecan-hziy, a Trop-2-directed antibody-drug conjugate, has shown efficacy and safety in several tumors including breast cancer. The overexpression of Trop-2 in TETs and the clinical efficacy in other malignancies provide rationale for exploring its use in thymoma and thymic carcinoma.</div></div><div><h3>Methods</h3><div>This open-label, single-arm, parallel cohort, multi-center study assesses the safety and efficacy of sacituzumab govitecan-hziy in patients with advanced thymoma (cohort A) and thymic carcinoma (cohort B) who have received at least 1 prior line of systemic therapy (NCT06248515). The study employs a Simon optimal 2-stage design, enrolling patients with adequate performance status, measurable disease, and adequate organ function. Sacituzumab govitecan-hziy is administered at a fixed dose of 10 mg/kg weekly on days 1 and 8 of 21-day cycles until disease progression or unacceptable toxicity. Follow-up continues every 6 months for 2 years postdiscontinuation. Archival tissue is obtained prior to initiation of study treatment with an optional biopsy at the time of progression. In cases where archival tissue is not available, a fresh biopsy is obtained at baseline. The primary endpoint is investigator-assessed response rate using Response Evaluation Criteria in Solid Tumors v1.1 (RECIST) criteria, with tumor imaging assessments every 2 cycles during the first 3 months and every 3 cycles thereafter. Secondary endpoints comprise adverse events by Common Terminology Criteria for Adverse Events v5.0, median and 6-month progression-free survival, duration of response, and overall survival. For each cohort, 9 patients will be enrolled. If 0 of the 9 achieve a response, no further patients will be enrolled in that cohort. If 1 or more of the first 9 patients has a response, accrual will continue until a total of 17 patients have been enrolled in that cohort.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 3","pages":"Pages 165-167"},"PeriodicalIF":3.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142926593","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":"PEARL: A Multicenter Phase 2 Study of Lorlatinib in Patients with ALK-Rearranged NSCLC and Central Nervous System Disease.","authors":"Chang Lu, Hong-Hong Yan, Chan-Yuan Zhang, Shi-Yuan Chen, Yang-Si Li, Bin-Chao Wang, Chong-Rui Xu, Hai-Yan Tu, Wen-Zhao Zhong, Qing Zhou, Xu-Chao Zhang, Yi-Long Wu, Wei-Neng Feng, Guan-Ming Jiang, Jin-Ji Yang","doi":"10.1016/j.cllc.2024.12.002","DOIUrl":"https://doi.org/10.1016/j.cllc.2024.12.002","url":null,"abstract":"<p><strong>Background: </strong>Patients with ALK-rearranged non-small cell lung cancer (ALK+ NSCLC) with symptomatic brain (BM) and leptomeningeal (LM) metastases are underrepresented in clinical trials due to poor performance status. Additionally, the need for improved and validated assessment criteria for evaluating central nervous system (CNS) response remains critical. Lorlatinib has demonstrated systemic activity in patients with ALK+ NSCLC. This ongoing phase II study aims to evaluate the efficacy and safety of lorlatinib in ALK+ NSCLC patients with progressive CNS metastases.</p><p><strong>Patients and methods: </strong>This study is a multicenter, open-label, single-arm, prospective trial. Fifty eligible subjects will be divided into 2 cohorts: BM (progressive or new brain parenchymal; n = 30) and LM (positive cerebrospinal fluid cytology and/or MRI ± brain parenchymal metastasis; n = 20). Key inclusion criteria include ALK status confirmed using FDA-approved tests, at least 1 CNS lesion, with or without CNS-related symptoms, and an ECOG performance status of 0-2 for the BM cohort and 0-3 for the LM cohort. Primary endpoint is intracranial objective response rate based on the modified version of response evaluation criteria in solid tumors v1.1 for BM and modified RANO-LM criteria for LM. Key secondary endpoints include intracranial progression-free survival, overall progression-free survival, objective response rate, overall survival, safety and quality of life. Biomarker analysis of paired pretreatment tumor, blood and optional cerebrospinal fluid will be performed as preplanned exploratory analyses.</p><p><strong>Conclusions: </strong>The PEARL study (CTONG2303) will evaluate efficacy of lorlatinib in CNS metastases in ALK+ NSCLC using refined CNS response evaluation criteria, with biomarker analyses providing insights into response and resistance mechanisms.</p>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142892661","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":"Conversion Surgery for Initially Unresectable Stage Ⅲ Nonsmall Cell Lung Cancer After Induction Treatment of Immunochemotherapy: A Multicenter Study","authors":"Mingliang Wang ,&nbsp;Xiaojun Wang ,&nbsp;Ran Yang ,&nbsp;Mingfei Geng ,&nbsp;Songlin Zhang ,&nbsp;Zebo Yang ,&nbsp;Quanfu Huang ,&nbsp;Sihua Wang ,&nbsp;Shuangbing Xu ,&nbsp;Ke Jiang ,&nbsp;Yongde Liao","doi":"10.1016/j.cllc.2024.11.005","DOIUrl":"10.1016/j.cllc.2024.11.005","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Patients and Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>Conversion surgery following immuno-chemotherapy is feasible and safe, yielding promising pathological responses and favorable survival outcomes for patients with unresectable stage III NSCLC.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"26 3","pages":"Pages e131-e140.e1"},"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}