Clinical lung cancer最新文献

{"title":"Small Cell Lung Cancer in Norway: Patterns of Care by Health Region and Survival Trends","authors":"Yngvar Nilssen ,&nbsp;Odd Terje Brustugun ,&nbsp;Lars Fjellbirkeland ,&nbsp;Bjørn Henning Grønberg ,&nbsp;Per Magnus Haram ,&nbsp;Nina Helbekkmo ,&nbsp;Åslaug Helland ,&nbsp;Sissel Gyrid Freim Wahl ,&nbsp;Marianne Aanerud ,&nbsp;Steinar Solberg","doi":"10.1016/j.cllc.2024.04.002","DOIUrl":"10.1016/j.cllc.2024.04.002","url":null,"abstract":"<div><h3>Introduction/Background</h3><p>There has been a marked survival improvement for patients with non–small-cell lung cancer. We describe the national trends in characteristics and survival, and geographical differences in diagnostic workup, treatment, and survival for patients with small-cell lung cancer (SCLC).</p></div><div><h3>Materials and Methods</h3><p>Patients registered with SCLC at the Cancer Registry of Norway in 2002 to 2022 were included. Trends in overall survival were estimated for all SCLC patients, patients with limited stage SCLC, patients undergoing surgery, and by health region. Adjusting for case-mix, a multivariable Cox regression was performed examining the association between health region and death.</p></div><div><h3>Results</h3><p>The study included 8374 patients. The stage distribution remained unchanged during the study period. The 5-year overall survival increased from 7.7% to 22.8% for patients with limited stage. The use of multidisciplinary team meetings varied from 62.5% to 85.7%, and the use of positron emission tomography-computer tomography varied from 70.4% to 86.2% between the health regions. Treatment patterns differed markedly between the health regions, with the proportion dying without any registered treatment ranging from 1.2% to 10.9%. For limited stage patients in 2018 to 2022, the median overall survival ranged from 16.5 to 25.5 months across health regions, and the 5-year overall survival ranged from 18.7% to 28.7% (<em>P</em> = .019).</p></div><div><h3>Conclusion</h3><p>The survival for patients with SCLC remains poor. The use of diagnostic procedures, treatment modalities, and survival differed between regions, warranting investigations to further explore the reasons.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 5","pages":"Pages e221-e228.e3"},"PeriodicalIF":3.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525730424000469/pdfft?md5=4ee53d36e5d86b95a9831a336a40e19c&pid=1-s2.0-S1525730424000469-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140773956","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":"Risk of Venous Thromboembolism in Patients With Stage III and IV Non–Small-Cell Lung Cancer: Nationwide Descriptive Cohort Study","authors":"Anne Gulbech Ording ,&nbsp;Thomas Decker Christensen ,&nbsp;Flemming Skjøth ,&nbsp;Simon Noble ,&nbsp;Anette Arbjerg Højen ,&nbsp;Amalie Lambert Mørkved ,&nbsp;Torben Bjerregaard Larsen ,&nbsp;Rene Horsleben Petersen ,&nbsp;Peter Meldgaard ,&nbsp;Erik Jakobsen ,&nbsp;Mette Søgaard","doi":"10.1016/j.cllc.2024.04.004","DOIUrl":"10.1016/j.cllc.2024.04.004","url":null,"abstract":"<div><h3>Background</h3><p>Venous thromboembolism (VTE) is a common complication in patients starting cancer therapies for non–small-cell lung cancer (NSCLC). We examined the risk and timing of VTE in patients with stage IIIA, IIIB to C, and stage IV NSCLC according to received cancer treatments.</p></div><div><h3>Materials and Methods</h3><p>A nationwide registry-based cohort study of patients recorded in the Danish Lung Cancer Registry (2010-2021) followed for 1 year after entry into the registry to assess the incidence of VTE. The Aalen–Johansen estimator was used to calculate the risk of VTE after treatment commencement with chemotherapy, radiotherapy, chemoradiation, immunotherapy, and targeted therapy.</p></div><div><h3>Results</h3><p>Among the 3475 patients with stage IIIA, 4047 with stage IIIB to C, and 18,082 patients with stage IV cancer, the 1-year risk of VTE was highest in the first 6 months and varied markedly by cancer stage and cancer treatment. In stage IIIA, VTE risk was highest with chemotherapy (3.9%) and chemoradiation (4.1%). In stage IIIB to C, risks increased with chemotherapy (5.2%), immunotherapy (9.4%), and targeted therapy (6.0%). Stage IV NSCLC showed high risk with targeted therapy (12.5%) and immunotherapy (12.2%). The risk was consistently higher for pulmonary embolism than deep vein thrombosis.</p></div><div><h3>Conclusion</h3><p>VTE risks vary substantially according to cancer treatments and cancer stages. The highest risk was observed in the initial 6 months of therapy initiation. These insights emphasize the need for tailored risk assessment and vigilance in managing VTE complications in patients with NSCLC. Further research is needed to optimize individual thromboprophylaxis strategies for patients with unresectable and metastatic NSCLC.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 5","pages":"Pages 407-416.e1"},"PeriodicalIF":3.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525730424000470/pdfft?md5=49daabe52b189d14e59cff5d3bb3859a&pid=1-s2.0-S1525730424000470-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140810275","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":"Barriers to Completing Low Dose Computed Tomography Scan for Lung Cancer Screening","authors":"Lye-Yeng Wong ,&nbsp;Sania Choudhary ,&nbsp;Ntemena Kapula ,&nbsp;Margaret Lin ,&nbsp;Irmina A. Elliott ,&nbsp;Brandon A. Guenthart ,&nbsp;Douglas Z. Liou ,&nbsp;Leah M. Backhus ,&nbsp;Mark F. Berry ,&nbsp;Joseph B. Shrager ,&nbsp;Natalie S. Lui","doi":"10.1016/j.cllc.2024.04.014","DOIUrl":"10.1016/j.cllc.2024.04.014","url":null,"abstract":"<div><h3>Introduction</h3><p>Annual low-dose computed tomography (LDCT) screening has been shown to reduce lung cancer mortality in high-risk individuals by detecting the disease at an earlier stage. This study aims to assess the barriers to completing LDCT in a cohort of patients who were determined eligible for lung cancer screening (LCS).</p></div><div><h3>Methods</h3><p>We performed a single institution, mixed methods, cross-sectional study of patients who had a LDCT ordered from July to December 2022. We then completed phone surveys with patients who did not complete LDCT to assess knowledge, attitude, and perceptions toward LCS.</p></div><div><h3>Results</h3><p>We identified 380 patients who met inclusion criteria, including 331 (87%) who completed LDCT and 49 (13%) who did not. Patients who completed a LDCT and those who did not were similar regarding age, sex, race, primary language, household income, body mass index, median pack years, and quit time. Positive predictors of LDCT completion were: meeting USPSTF guidelines (97.9% vs 81.6%), being married (58.3% vs 44.9%), former versus current smokers (55% vs 41.7%), personal history of emphysema (60.4% vs 42.9%), and family history of lung cancer (13.9% vs 4.1%) (all <em>P</em> &lt; .05). Of the patients who participated in the phone survey, only 7% of respondents thought they were high risk for developing lung cancer despite attending a shared decision-making visit and only 10% wanted to re-schedule their LDCT.</p></div><div><h3>Conclusion</h3><p>There exist barriers to completing LDCT even after patients are identified as eligible and complete a shared decision-making visit secondary to knowledge barriers, misperceptions, and patient disinterest.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 5","pages":"Pages 424-430"},"PeriodicalIF":3.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525730424000706/pdfft?md5=9857917bc79dd90e0582b4b357ae06cf&pid=1-s2.0-S1525730424000706-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140928508","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":"Machine Learning-Based Prediction of Pathological Responses and Prognosis After Neoadjuvant Chemotherapy for Non–Small-Cell Lung Cancer: A Retrospective Study","authors":"Zhaojuan Jiang ,&nbsp;Qingwan Li ,&nbsp;Jinqiu Ruan ,&nbsp;Yanli Li ,&nbsp;Dafu Zhang ,&nbsp;Yongzhou Xu ,&nbsp;Yuting Liao ,&nbsp;Xin Zhang ,&nbsp;Depei Gao ,&nbsp;Zhenhui Li","doi":"10.1016/j.cllc.2024.04.006","DOIUrl":"10.1016/j.cllc.2024.04.006","url":null,"abstract":"<div><h3>Background</h3><p>Neoadjuvant chemotherapy has variable efficacy in patients with non–small-cell lung cancer (NSCLC), yet reliable noninvasive predictive markers are lacking. This study aimed to develop a radiomics model predicting pathological complete response and postneoadjuvant chemotherapy survival in NSCLC.</p></div><div><h3>Materials and Methods</h3><p>Retrospective data collection involved 130 patients with NSCLC who underwent neoadjuvant chemotherapy and surgery. Patients were randomly divided into training and independent testing sets. Nine radiomics features from prechemotherapy computed tomography (CT) images were extracted from intratumoral and peritumoral regions. An auto-encoder model was constructed, and its performance was evaluated. X-tile software classified patients into high and low-risk groups based on their predicted probabilities. survival of patients in different risk groups and the role of postoperative adjuvant chemotherapy were examined.</p></div><div><h3>Results</h3><p>The model demonstrated area under the receiver operating characteristic (ROC) curve of 0.874 (training set) and 0.876 (testing set). The larger the area under curve (AUC), the better the model performance. Calibration curve and decision curve analysis indicated excellent model calibration (Hosmer–Lemeshow test, <em>P</em> = .763, the higher the <em>P</em>-value, the better the model fit) and potential clinical applicability. Survival analysis revealed significant differences in overall survival (<em>P</em> = .011) and disease-free survival (<em>P</em> = .017) between different risk groups. Adjuvant chemotherapy significantly improved survival in the low-risk group (<em>P</em> = .041) but not high-risk group (<em>P</em> = 0.56).</p></div><div><h3>Conclusion</h3><p>This study represents the first successful prediction of pathological complete response achievement after neoadjuvant chemotherapy for NSCLC, as well as the patients’ survival, utilizing intratumoral and peritumoral radiomics features.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 5","pages":"Pages 468-478.e3"},"PeriodicalIF":3.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140841631","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":"Utility of 30-Day Mortality Following Systemic Anti-Cancer Treatment as a Quality Indicator in Advanced Lung Cancer","authors":"Hayley Nicole Roberts,&nbsp;Benjamin Solomon,&nbsp;Susan Harden,&nbsp;Senthil Lingaratnam,&nbsp;Marliese Alexander","doi":"10.1016/j.cllc.2024.04.001","DOIUrl":"10.1016/j.cllc.2024.04.001","url":null,"abstract":"<div><h3>Background</h3><p>30-day mortality after systemic anti-cancer therapy (SACT) has been suggested as a quality indicator primarily for measuring use of chemotherapy towards the end of life. Utility across different cancer types is unclear, especially when using immunotherapy and targeted therapies.</p></div><div><h3>Methods</h3><p>This retrospective study included patients with a diagnosis of lung cancer who received palliative-intent SACT at an Australian metropolitan cancer center between 2015 and 2022. Using a prospectively maintained lung cancer database, patient, disease, and treatment characteristics were evaluated against annual 30-day mortality rates following SACT.</p></div><div><h3>Results</h3><p>1072 patients were identified. Annual 30-day mortality rate after palliative-intent SACT for lung cancer ranged between 9% and 15%, with significant variance between treatment types. Calculated rates of 30-day mortality are higher if longer reporting time periods are used. Patients who died within 30 days of SACT were more likely to have received targeted therapies or immunotherapy as their final line of treatment, have a poorer performance status at diagnosis, and have received multiple lines of treatment.</p></div><div><h3>Conclusions</h3><p>Our data support differential interpretation of 30-day mortality for quality assurance, especially with regard to lung cancer. Consistency in population and reporting time periods, and accounting for treatment type is crucial if 30-day mortality is to be utilized as cancer care performance quality indicator. Relevance to quality care is questionable in the lung cancer setting.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 5","pages":"Pages e211-e220.e1"},"PeriodicalIF":3.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140779772","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":"Real-World Neoadjuvant Treatment Patterns and Outcomes in Resected Non–Small-Cell Lung Cancer","authors":"Jessica Donington ,&nbsp;Xiaohan Hu ,&nbsp;Su Zhang ,&nbsp;Yan Song ,&nbsp;Ashwini Arunachalam ,&nbsp;Diana Chirovsky ,&nbsp;Chi Gao ,&nbsp;Ari Lerner ,&nbsp;Anya Jiang ,&nbsp;James Signorovitch ,&nbsp;Ayman Samkari","doi":"10.1016/j.cllc.2024.03.006","DOIUrl":"10.1016/j.cllc.2024.03.006","url":null,"abstract":"<div><h3>Background</h3><p>Novel neoadjuvant chemoimmunotherapy treatments are being investigated for locally advanced non–small-cell lung cancer (NSCLC), but real-world outcomes for neoadjuvant treatments are poorly understood. This study examined neoadjuvant treatment patterns, real-world event-free survival (rwEFS) and overall survival (OS) in patients with resected, stage II-III NSCLC in the United States (US).</p></div><div><h3>Methods</h3><p>This retrospective study identified patients in the SEER–Medicare database (2007-2019) with newly diagnosed stage II, IIIA, and IIIB (N2) NSCLC (AJCC 8th edition) treated with neoadjuvant chemo/chemoradiotherapy and resection (index date: neoadjuvant therapy initiation). Neoadjuvant treatment regimens were described. rwEFS (time from index to first recurrence or death, whichever occurred first) and OS (time from index to death) were summarized by Kaplan–Meier analysis for overall population, by disease stage at diagnosis, and by neoadjuvant treatment modality.</p></div><div><h3>Results</h3><p>221 patients (stage II, N=70; stage III, N=151) met eligibility criteria. The median follow-up from index was 32.7 months. All patients received neoadjuvant chemotherapy (51%) or chemoradiotherapy (49%) prior to surgery; 97% of patients received platinum-based regimens, among which carboplatin+paclitaxel was the most frequent (45%). In all patients, median rwEFS was 17.6 months and 5-year rwEFS was 20.9%; median OS was 48.5 months and 5-year OS was 44.9%. 71% of patients had disease recurrence during follow-up; among them, 28% developed locoregional recurrence as the first recurrence event.</p></div><div><h3>Conclusions</h3><p>Patients with resected, stage II-III NSCLC who received neoadjuvant chemo/chemoradiotherapy have high rates of disease recurrence and poor survival outcomes, highlighting need for more effective treatments to improve survival rates.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 5","pages":"Pages 440-448"},"PeriodicalIF":3.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S152573042400041X/pdfft?md5=a271e4f45a957a7861a8f26b0ee1ae6e&pid=1-s2.0-S152573042400041X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140271994","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":"Video-Assisted Thoracoscopic Surgery Versus Thoracotomy Following Neoadjuvant Immunochemotherapy in Resectable Stage III Non-Small Cell Lung Cancer Among Chinese Populations: A Multi-Center Retrospective Cohort Study","authors":"Hanbo Pan ,&nbsp;Hang Chen ,&nbsp;Weicheng Kong ,&nbsp;Junwei Ning ,&nbsp;Zhen Ge ,&nbsp;Yu Tian ,&nbsp;Ningyuan Zou ,&nbsp;Hongda Zhu ,&nbsp;Jiaqi Zhang ,&nbsp;Yixing Tao ,&nbsp;Zenan Gu ,&nbsp;Min Zheng ,&nbsp;Guomo Ruan ,&nbsp;Long Jiang ,&nbsp;Ziming Li ,&nbsp;Jia Huang ,&nbsp;Chengwei Zhou ,&nbsp;Guodong Xu ,&nbsp;Qingquan Luo","doi":"10.1016/j.cllc.2024.03.008","DOIUrl":"10.1016/j.cllc.2024.03.008","url":null,"abstract":"<div><h3>Background</h3><p>Immune checkpoint inhibitors have revolutionized non-small cell lung cancer (NSCLC) treatment but may pose greater technical challenges for surgery. This study aims to assess the feasibility and oncological effectiveness of video-assisted thoracoscopic surgery (VATS) for resectable stage III NSCLC after neoadjuvant immunochemotherapy.</p></div><div><h3>Methods</h3><p>Initial stage IIIA-IIIB NSCLC patients with neoadjuvant immunochemotherapy undergoing either VATS or open lobectomy at 6 medical centers during 2019-2023 were retrospectively identified. Perioperative outcomes and 2-year survival was analyzed. Propensity-score matching (PSM) was employed to balance patient baseline characteristics.</p></div><div><h3>Results</h3><p>Among the total 143 patients, PSM yielded 62 cases each for VATS and OPEN groups. Induction-related adverse events were comparable between the 2 groups. VATS showed a 14.5% conversion rate. Notably, VATS decreased numeric rating scales for postoperative pain, shortened chest tube duration (5[4-7] <em>vs.</em> 6[5-8] days, <em>P</em> = .021), reduced postoperative comorbidities (21.0% <em>vs.</em> 37.1%, <em>P</em> = .048), and dissected less N1 lymph nodes (5[4-6] <em>vs.</em> 7[5-9], <em>P</em> = .005) compared with thoracotomy. Even when converted, VATS achieves perioperative outcomes equivalent to thoracotomy. Additionally, over a median follow-up of 29.5 months, VATS and thoracotomy demonstrated comparable 2-year recurrence-free survival (77.20% <em>vs.</em> 73.73%, <em>P</em> = .640), overall survival (87.22% <em>vs.</em> 88.00%, <em>P</em> = .738), cumulative incidences of cancer-related death, and recurrence patterns. Subsequent subgroup comparisons and multivariate Cox analysis likewise revealed no statistical difference between VATS and thoracotomy.</p></div><div><h3>Conclusion</h3><p>VATS is a viable and effective option for resectable stage III NSCLC patients following neoadjuvant immunochemotherapy, leading to decreased surgical-related pain, earlier chest tube removal, reduced postoperative complications, and similar survival outcomes compared to thoracotomy.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 5","pages":"Pages 395-406.e5"},"PeriodicalIF":3.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525730424000421/pdfft?md5=a8b70f17746856a06c16c8317054ee5f&pid=1-s2.0-S1525730424000421-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140626626","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":"Clinical Outcomes of Patients with Non-Small Cell Lung Cancer Leptomeningeal Disease Following Receipt of EGFR-Targeted Therapy, Immune-Checkpoint Blockade, Intrathecal Chemotherapy, or Radiation Therapy Alone","authors":"Matthew N. Mills ,&nbsp;Akihiro Uno ,&nbsp;Pinxue Li ,&nbsp;Casey Liveringhouse ,&nbsp;Youngchul Kim ,&nbsp;Daniel E. Oliver ,&nbsp;Bradford A. Perez ,&nbsp;Benjamin C. Creelan ,&nbsp;Michael Yu ,&nbsp;Peter A. Forsyth ,&nbsp;Yolanda Pina ,&nbsp;Kamran A. Ahmed","doi":"10.1016/j.cllc.2024.04.005","DOIUrl":"10.1016/j.cllc.2024.04.005","url":null,"abstract":"<div><h3>Background</h3><p>EGFR-targeted therapy (ETT) and immune-checkpoint blockade (ICB) have shown promising results in treating NSCLC brain metastases (BM). However, little is known of their effect in treating leptomeningeal disease (LMD).</p></div><div><h3>Patients and Methods</h3><p>This is a retrospective review of 80 patients diagnosed with NSCLC LMD from January 2014 to March 2021. Patients were grouped based on initial LMD treatment: radiotherapy (RT) alone, ETT, ICB, and intrathecal chemotherapy (ITC).</p></div><div><h3>Results</h3><p>EGFR mutation was present in 22 patients (28%). Twenty patients had positive cytology in cerebrospinal fluid, while 60 patients were diagnosed based on MRI with clinical correlation. The RT alone group consisted primarily of whole brain radiation (<em>n =</em> 20; 77%), stereotactic radiation (<em>n =</em> 3; 12%), and palliative spine radiation (<em>n =</em> 2; 7%). There were no significant differences amongst the treatment groups in age, performance status, or neurologic symptoms. Overall, the 6-month overall survival (OS) and craniospinal progression free survival (CS-PFS) were 35% and 24%, respectively. The 6-month OS for the ETT, ICB, ITC, and RT alone groups was 64%, 33%, 57%, and 29% respectively (log-rank <em>P</em> = .026). The 6-month CS-PFS for the ETT, ICB, ITC, and RT alone groups was 43%, 33%, 29%, and 19% respectively (log-rank <em>P</em> = .049). Upon univariate analysis, receipt of ETT compared to RT alone reached significance for OS (HR 0.35, <em>P</em> = .006) and CS-PFS (HR 0.39, <em>P</em> = .013).</p></div><div><h3>Conclusions</h3><p>The prognosis for patients with NSCLC LMD remains poor overall. However, the receipt of ETT for patients with EGFR-positive disease was associated with improved outcomes.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 5","pages":"Pages 417-423.e1"},"PeriodicalIF":3.3,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140774183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment-Switching Adjustment of Overall Survival in CheckMate 227 Part 1 Evaluating First-Line Nivolumab Plus Ipilimumab Versus Chemotherapy for Metastatic Nonsmall Cell Lung Cancer","authors":"Martin Reck ,&nbsp;Tuli De ,&nbsp;Luis Paz-Ares ,&nbsp;Mark Edmondson-Jones ,&nbsp;Yong Yuan ,&nbsp;Georgia Yates ,&nbsp;Roberto Zoffoli ,&nbsp;Mohammad Ashraf Chaudhary ,&nbsp;Adam Lee ,&nbsp;Nebibe Varol ,&nbsp;John R. Penrod","doi":"10.1016/j.cllc.2024.06.005","DOIUrl":"10.1016/j.cllc.2024.06.005","url":null,"abstract":"<div><h3>Objectives</h3><div>CheckMate 227 (NCT02477826) evaluated first-line nivolumab-plus-ipilimumab versus chemotherapy in patients with metastatic nonsmall cell lung cancer (NSCLC) with programmed death ligand 1 (PD-L1) expression ≥ 1% or &lt; 1% and no <em>EGFR</em>/<em>ALK</em> alterations. However, many patients randomized to chemotherapy received subsequent immunotherapy. Here, overall survival (OS) and relative OS benefit of nivolumab-plus-ipilimumab were adjusted for potential bias introduced by treatment switching.</div></div><div><h3>Materials and methods</h3><div>Treatment-switching adjustment analyses were conducted following the NICE Decision Support Unit Technical Support Document 16, for CheckMate 227 Part 1 OS data from treated patients (database lock, July 2, 2019). Inverse probability of censoring weighting (IPCW) was used in the base-case analysis; other methods were explored as sensitivity analyses.</div></div><div><h3>Results</h3><div>Of 1166 randomized patients, 391 (PD-L1 ≥ 1%) and 185 (PD-L1 &lt; 1%) patients received nivolumab-plus-ipilimumab; 387 (PD-L1 ≥ 1%) and 183 (PD-L1 &lt; 1%) patients received chemotherapy, with 29.3-month minimum follow-up. Among chemotherapy-treated patients, 169/387 (43.7%; PD-L1 ≥ 1%) and 66/183 (36.1%; PD-L1 &lt; 1%) switched to immunotherapy poststudy. Among treated patients, median OS was 17.4 months with nivolumab-plus-ipilimumab versus 14.9 months with chemotherapy (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.68-0.95) in the PD-L1 ≥ 1% subgroup and 17.1 versus 12.4 months (HR, 0.62; 95% CI, 0.49-0.80) in the PD-L1 &lt; 1% subgroup. After treatment-switching adjustment using IPCW, the HR (95% CI) for OS for nivolumab-plus-ipilimumab versus chemotherapy was reduced to 0.68 (0.56-0.83; PD-L1 ≥ 1%) and 0.53 (0.40-0.69; PD-L1 &lt; 1%). Sensitivity analyses supported the robustness of the results.</div></div><div><h3>Conclusion</h3><div>Treatment-switching adjustments resulted in a greater estimated relative OS benefit with first-line nivolumab-plus-ipilimumab versus chemotherapy in patients with metastatic NSCLC.</div></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 7","pages":"Pages e362-e368"},"PeriodicalIF":3.3,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141785167","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":"MDT-BRIDGE: Neoadjuvant Durvalumab Plus Chemotherapy Followed by Either Surgery and Adjuvant Durvalumab or Chemoradiotherapy and Consolidation Durvalumab in Resectable or Borderline-resectable Stage IIB–IIIB NSCLC","authors":"","doi":"10.1016/j.cllc.2024.06.007","DOIUrl":"10.1016/j.cllc.2024.06.007","url":null,"abstract":"<div><h3>Introduction</h3><p>In the AEGEAN trial, neoadjuvant durvalumab plus platinum-based chemotherapy (D+CT) followed by adjuvant durvalumab, versus neoadjuvant chemotherapy alone, significantly improved pathological complete response (pCR) rate and event-free survival (EFS) in patients with resectable NSCLC. In the PACIFIC trial, consolidation durvalumab significantly improved progression-free (PFS) and overall survival (OS) for patients with unresectable stage III NSCLC after chemoradiotherapy. Strong pathological and clinical outcomes with chemoimmunotherapy have generated interest in its use to enable patients with borderline-resectable NSCLC to undergo surgery. Additionally, for patients initially deemed resectable but who later become unresectable/inoperable during neoadjuvant treatment, consolidation immunotherapy after chemoradiotherapy should be explored.</p></div><div><h3>Patients and methods</h3><p>MDT-BRIDGE (NCT05925530) is a multicenter, phase II, non-randomized study in ∼140 patients with <em>EGFR</em>/<em>ALK</em> wild-type, stage IIB–IIIB (N2) NSCLC. Following baseline multidisciplinary team (MDT) assessment to determine resectable/borderline-resectable status, all patients receive 2 cycles of neoadjuvant D+CT every 3 weeks, followed by MDT reassessment of resectability. Patients deemed resectable receive 1-2 additional cycles of D+CT followed by surgery (Cohort 1). Patients deemed unresectable receive standard-of-care chemoradiotherapy (Cohort 2). Cohort 1 patients who become ineligible for surgery can enter Cohort 2. Following surgery or chemoradiotherapy, patients receive adjuvant or consolidation durvalumab for 1 year. The primary endpoint is resection rate in all patients. Additional endpoints include resection rates by baseline resectable/borderline-resectable status, resection outcomes, EFS/PFS, OS, pCR rate, circulating tumor DNA dynamics pre- and post-surgery (including correlation with clinical outcomes), and safety.</p></div><div><h3>Conclusion</h3><p>Enrollment began in February 2024; primary completion is anticipated in April 2026.</p></div>","PeriodicalId":10490,"journal":{"name":"Clinical lung cancer","volume":"25 6","pages":"Pages 587-593.e3"},"PeriodicalIF":3.3,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1525730424001323/pdfft?md5=8992a0869feaf0e76611fb529a5462b6&pid=1-s2.0-S1525730424001323-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141566758","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}