Lung Cancer最新文献

{"title":"Proposal of real-world solutions for the implementation of predictive biomarker testing in patients with operable non-small cell lung cancer","authors":"Paul Hofman ,&nbsp;Petros Christopoulos ,&nbsp;Nicky D’Haene ,&nbsp;John Gosney ,&nbsp;Nicola Normanno ,&nbsp;Ed Schuuring ,&nbsp;Ming-Sound Tsao ,&nbsp;Christine Quinn ,&nbsp;Jayne Russell ,&nbsp;Katherine E Keating ,&nbsp;Fernando López-Ríos","doi":"10.1016/j.lungcan.2025.108107","DOIUrl":"10.1016/j.lungcan.2025.108107","url":null,"abstract":"<div><div>The implementation of biomarker testing for targeted therapies and immune checkpoint inhibitors is a cornerstone in the management of metastatic and locally advanced non-small cell lung cancer (NSCLC), playing a pivotal role in guiding treatment decisions and patient care. The emergence of precision medicine in the realm of operable NSCLC has been marked by the recent approvals of osimertinib, atezolizumab, nivolumab, pembrolizumab and alectinib for early-stage disease, signifying a shift towards more tailored therapeutic strategies. Concurrently, the landscape of this disease is rapidly evolving, with several further pending approvals and numerous clinical trials in progress.</div><div>To harness the benefits of these innovative neo-adjuvant and adjuvant therapies, the integration of predictive biomarker testing into standard clinical protocols is imperative for patients with operable NSCLC. A multidisciplinary international consortium has identified three primary obstacles impeding the effective testing of patients with operable NSCLC. These challenges encompass the limited number of test requests by physicians, the inadequacy of tissue samples for comprehensive testing, and the prevalence of cost-reduction measures leading to suboptimal testing practices.</div><div>This review delineates the aforementioned challenges and proposed solutions, and strategic recommendations aimed at enhancing the testing process. By addressing these issues, we strive to optimize patient outcomes in operable NSCLC, ensuring that individuals receive the most appropriate and effective care based on their unique disease profile.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"201 ","pages":"Article 108107"},"PeriodicalIF":4.5,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143163966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-line nivolumab plus platinum chemotherapy and bevacizumab for advanced nonsquamous non-small cell lung cancer: A 3-year follow-up of the phase 3 randomized TASUKI-52 trial","authors":"Ki Hyeong Lee ,&nbsp;Jong-Seok Lee ,&nbsp;Shunichi Sugawara ,&nbsp;Jin Hyoung Kang ,&nbsp;Hye Ryun Kim ,&nbsp;Naoki Inui ,&nbsp;Toyoaki Hida ,&nbsp;Tatsuya Yoshida ,&nbsp;Hiroshi Tanaka ,&nbsp;Cheng-Ta Yang ,&nbsp;Takako Inoue ,&nbsp;Makoto Nishio ,&nbsp;Yuichiro Ohe ,&nbsp;Tomohide Tamura ,&nbsp;Nobuyuki Yamamoto ,&nbsp;Chong-Jen Yu ,&nbsp;Hiroaki Akamatsu ,&nbsp;Shigeru Takahashi ,&nbsp;Kazuhiko Nakagawa","doi":"10.1016/j.lungcan.2025.108109","DOIUrl":"10.1016/j.lungcan.2025.108109","url":null,"abstract":"<div><h3>Objectives</h3><div>In the randomized phase III TASUKI-52 trial, nivolumab with carboplatin, paclitaxel, and bevacizumab significantly prolonged the progression-free survival (PFS) of treatment-naive patients with advanced or recurrent nonsquamous non-small cell lung cancer (NSCLC). Here, we report the long-term outcomes of patients treated with nivolumab plus carboplatin, paclitaxel, and bevacizumab with 3 years of follow-up.</div></div><div><h3>Methods</h3><div>Patients with stage IIIB/IV or recurrent nonsquamous NSCLC without sensitizing <em>EGFR</em>, <em>ALK</em>, or <em>ROS1</em> mutations were randomized (1:1) to receive either nivolumab or placebo, in addition to carboplatin, paclitaxel, and bevacizumab, every 3 weeks. Treatment was continued for a maximum of six cycles. The endpoints included PFS, overall survival (OS), and safety. Exploratory analyses included efficacy and safety in subgroups.</div></div><div><h3>Results</h3><div>A total of 550 patients were randomized to the nivolumab arm (n = 275) and placebo arm (n = 275). At the minimum follow-up of 36.1 months, PFS was consistently longer in the nivolumab arm than in the placebo arm (median, 10.6 vs. 8.2 months; hazard ratio [HR], 0.59; 95 % confidence interval [CI], 0.47–0.73; <em>P &lt;</em> 0.0001), with PFS rates of 20.2 % vs. 4.9 %. The median OS was 31.6 months (95 % CI, 26.8–36.5) in the nivolumab arm and 24.7 months (95 % CI, 21.1–28.0) in the placebo arm (HR, 0.71; 95 % CI, 0.57–0.88), with OS rates of 44.2 % and 32.3 %, respectively. Of note, PFS and OS favored the nivolumab arm across patients with different PD-L1 expression levels, and regardless of baseline brain metastasis status. Grade 3–4 treatment-related adverse events occurred in 76.2 % and 74.9 % of the patients in the nivolumab and placebo arms, respectively, while no new safety concerns were identified.</div></div><div><h3>Conclusion</h3><div>Nivolumab, in addition to carboplatin, paclitaxel, and bevacizumab, remained to demonstrate significantly longer PFS and long-term OS benefit compared with placebo in the first-line treatment of patients with nonsquamous NSCLC. The extended follow-up identified no new safety signals.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"201 ","pages":"Article 108109"},"PeriodicalIF":4.5,"publicationDate":"2025-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143080587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term outcome of chemoimmunotherapy for extensive-stage small-cell lung cancer according to key clinical trial eligibility: 3-year outcomes from a prospective cohort study","authors":"Jun Sugisaka ,&nbsp;Daichi Fujimoto ,&nbsp;Motohiro Tamiya ,&nbsp;Akito Hata ,&nbsp;Hirotaka Matsumoto ,&nbsp;Toshihide Yokoyama ,&nbsp;Yoshihiko Taniguchi ,&nbsp;Junji Uchida ,&nbsp;Yuki Sato ,&nbsp;Takashi Kijima ,&nbsp;Hisashi Tanaka ,&nbsp;Naoki Furuya ,&nbsp;Takeshi Masuda ,&nbsp;Yoshihiko Sakata ,&nbsp;Eisaku Miyauchi ,&nbsp;Go Saito ,&nbsp;Satoru Miura ,&nbsp;Teppei Yamaguchi ,&nbsp;Haruko Daga ,&nbsp;Shinya Sakata ,&nbsp;Hiroaki Akamatsu","doi":"10.1016/j.lungcan.2024.108056","DOIUrl":"10.1016/j.lungcan.2024.108056","url":null,"abstract":"<div><h3>Background</h3><div>Chemoimmunotherapy is the standard first-line treatment for extensive-stage small-cell lung cancer (ES-SCLC); however, its real-world long-term outcomes associated with patient backgrounds are still unclear. We explored this association using an updated large real-world prospective cohort with a minimum follow-up of 3 years.</div></div><div><h3>Methods</h3><div>This prospective cohort study, conducted across 32 hospitals, enrolled patients with ES-SCLC receiving carboplatin, etoposide, and atezolizumab between September 1, 2019 and September 30, 2020. Updated data with a minimum 3-year follow-up period were analyzed. Patients who met eligibility criteria for pivotal phase 3 clinical trials were considered “trial-eligible.”</div></div><div><h3>Results</h3><div>The median (range) time from the treatment initiation to data cutoff (September 30, 2023) was 42.2 (35.8–48.2) months for the enrolled 207 patients. Most patients (89 %) had an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients fulfilling the inclusion criteria (132 [64 %]) were categorized as trial-eligible. The 3-year progression-free survival (PFS) probability and overall survival (OS) were 6.1 % and 20.9 %, respectively. The 3-year OS probabilities for trial-eligible and trial-ineligible patients were 26.7 and 9.5 %, respectively. The trial-eligible cohort had a larger percentage of patients achieving a 3-year OS (30/132, 22.7 %) than the trial-ineligible cohort (5/75, 6.7 %) (<em>P</em> = 0.003)</div></div><div><h3>Conclusions</h3><div>Our study provides the first documentation of the long-term outcomes following chemoimmunotherapy in a large prospective real-world cohort of patients with ES-SCLC. Key eligibility criteria significantly influenced the long-term effectiveness. These findings provide valuable insights into the practical effectiveness of chemoimmunotherapy and clinical decision-making for patients with ES-SCLC.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108056"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An open-label, randomized phase III study of early switch maintenance vs delayed second-line nivolumab in advanced stage squamous non-small cell lung cancer (NSCLC) patients after standard first-line platinum-based chemotherapy-EDEN trial GOIRC 04–2016","authors":"Francesco Gelsomino ,&nbsp;Luca Boni ,&nbsp;Marcello Tiseo ,&nbsp;Serena Ricciardi ,&nbsp;Danilo Rocco ,&nbsp;Diego L Cortinovis ,&nbsp;Manuela Proietto ,&nbsp;Alessio Cogoni ,&nbsp;Giulia Pasello ,&nbsp;Andrea Camerini ,&nbsp;Francesca Sperandi ,&nbsp;Ida Colantonio ,&nbsp;Giulio Metro ,&nbsp;Francesca Mazzoni ,&nbsp;Editta Baldini ,&nbsp;Antonello Veccia ,&nbsp;Elisa Bennicelli ,&nbsp;Anna Cecilia Bettini ,&nbsp;Michele Tognetto ,&nbsp;Andrea Ardizzoni","doi":"10.1016/j.lungcan.2024.108059","DOIUrl":"10.1016/j.lungcan.2024.108059","url":null,"abstract":"<div><h3>Background</h3><div>As for squamous (Sq)-NSCLC, Checkmate-017 trial showed a significant overall survival (OS) improvement in favor of Nivolumab (Nivo) over Docetaxel in 2nd-line. We hypothesized that anticipating Nivo use, as early switch maintenance after 1st-line chemotherapy (CHT), might have improved survival as compared to delayed 2nd-line treatment.</div></div><div><h3>Methods</h3><div>EDEN was an open-label, 2-arm, phase III study which randomized (1:1) stage IIIB/IV Sq-NSCLC pts non-progressive after 1st-line platinum-based CHT, to receive early Nivo as switch maintenance (Arm A) or standard best supportive care followed by 2nd-line Nivo at disease progression (Arm B). In both arms, Nivo was administered at the dose of 240 mg i.v. every 2 weeks until progressive disease, intolerable toxicity, or for a maximum of 2 years. The primary endpoint was OS.</div></div><div><h3>Results</h3><div>From Sep 2017 to Aug 2020 125 patients (62 Arm A vs 63 Arm B) were randomized from 32 Italian centers. Accrual was stopped early, before the planned sample size (388 pts) was reached, because of registration of ICPIs in 1st-line. Most patients were male (79.2 %), current/former smokers (93.6 %), had stage IV (74.4 %), performance status 0–1 (98.4 %). mOS (95 % CI) was 14.9 (10.4–18.6) months in arm A vs 18.8 (14.4–21.1) months in arm B (HR 1.09, 95 %CI 0.74–1.62, p = 0.659).</div></div><div><h3>Conclusions</h3><div>In advanced Sq-NSCLC, the use of Nivo as switch maintenance after 1st-line CHT, does not improve OS compared to its use as 2nd-line. Although the optimal use of ICPIs remains in 1st-line, its role as maintenance has to be better investigated.</div><div><span><span><strong>ClinicalTrials.gov</strong></span><svg><path></path></svg></span><strong>:</strong> registration number: NCT03542461.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108059"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142864308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining the needle in a haystack: A compendium of genomic, pathologic, and clinical characteristics of rare pulmonary tumors","authors":"Misty D. Shields ,&nbsp;Katherine G. Minton ,&nbsp;Mya Tran ,&nbsp;Peter R. Gunderman ,&nbsp;Lisbeth G. Larsson ,&nbsp;Shunhua Guo ,&nbsp;Christopher M. Kniese ,&nbsp;Cynthia X. Wei ,&nbsp;Julian A. Marin-Acevedo ,&nbsp;Rohan Maniar ,&nbsp;Greg A. Durm ,&nbsp;Weston He ,&nbsp;Nasser H. Hanna","doi":"10.1016/j.lungcan.2024.108035","DOIUrl":"10.1016/j.lungcan.2024.108035","url":null,"abstract":"<div><div>A major paradigm shift in the diagnosis, management, and survival outcomes of early and advanced non-small cell lung cancer has transpired over the past few decades in thoracic oncology with the incorporation of molecular testing, targeted therapy, immunotherapy, neoadjuvant, and adjuvant approaches. However, transformation in the management and survival outcomes of rare lung tumors is lacking. Given the scarcity of these tumor types, randomized trials are rarely performed, and treatment is extrapolated from case series, tumor-agnostic trials, or cancers with similar histology. Literature informing the management of rare pulmonary tumors is typically limited to a single histology, unique features, or extraordinary responses to therapy. Few resources detailing genomic characteristics and delineating features of these tumors are available, often resulting in suboptimal treatment. Here, we explore the clinical, histopathologic, genomic features and potential therapies of five rare pulmonary tumors, namely adenosquamous, basaloid squamous, mucoepidermoid, carcinosarcoma, and NUT carcinoma, to build a resource for rare histological subtypes of the lung and emphasize knowledge gaps in the management of these tumors. Our recommendations are based on a comprehensive review of case reports and series, clinical trials, and the “Indiana University Experience.”</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108035"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142895709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding KRAS mutation in non-small cell lung cancer patients receiving immunotherapy: A retrospective institutional comparison and literature review","authors":"S. Berenice Urtecho ,&nbsp;Leonardo Provenzano ,&nbsp;Andrea Spagnoletti ,&nbsp;Achille Bottiglieri ,&nbsp;Chiara Pircher ,&nbsp;Giacomo Massa ,&nbsp;Caterina Sposetti ,&nbsp;Claudia Proto ,&nbsp;Marta Brambilla ,&nbsp;Mario Occhipinti ,&nbsp;Laura Mazzeo ,&nbsp;Teresa Beninato ,&nbsp;Rita Leporati ,&nbsp;Claudia Giani ,&nbsp;Chiara Cavalli ,&nbsp;Roberta Serino ,&nbsp;Marco Meazza Prina ,&nbsp;Anna Bassetti ,&nbsp;Vincenzo Nasca ,&nbsp;Rosa Maria di Mauro ,&nbsp;Arsela Prelaj","doi":"10.1016/j.lungcan.2024.108051","DOIUrl":"10.1016/j.lungcan.2024.108051","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;KRAS mutation the most common molecular alteration in advanced non-small cell lung cancer (NSCLC) and is associated with an unfavourable prognosis, largely due to the lack of targeted therapeutic options for the majority of the KRAS mutated isoforms. The landscape of NSCLC treatment has expanded with the introduction of immune checkpoint inhibitors (ICIs). Nonetheless, data regarding the efficacy of ICI in NSCLC patients harbouring KRAS mutations are conflicting. This study aimed to compare clinical outcomes of ICIs in advanced NSCLC with different isoforms of KRAS mutations.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;A retrospective study was conducted on 143 patients with advanced NSCLC harbouring different KRAS mutation and treated with immune checkpoint inhibitors (ICI) between December 2020 and July 2022 at “Fondazione IRCCS Istituto Nazionale dei Tumori” in Milan. Log-rank and Cox Hazard methods were used for survival analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;We evaluated 143 patients with advanced non-small cell lung cancer (NSCLC) harboring KRAS mutations. The most common mutation was G12C (41 %), followed by G12V (23.7 %) and G12D (11.8 %). The G12C mutation was notably associated with a higher incidence of bone metastases (42 %). Immunotherapy was administered as monotherapy in 54.5 % of cases, while 69 % received it as part of a first-line combination with chemotherapy. Co-mutations were detected in 52 % of patients, with Q61 (63 %) and G12C (58 %) being the most prevalent. Among these, 24 % had STK11 co-mutations, and 29 % had TP53 co-mutations. No significant differences in overall survival (OS) or progression-free survival (PFS) were observed across different KRAS subtypes. The longest OS was seen in patients with Q61 (46.5 months), 13X (31.8 months), and G12C (28.7 months). The highest overall response rate (ORR) of 73 % was observed in the G12D group, particularly with the combination of chemoimmunotherapy, where stable disease was the most common outcome at 40 %. The median duration of response (DOR) was 7.4 months across both treatments. The longest DOR was seen in the G12V group at 10.2 months, with no significant difference between treatments. In contrast, the shortest DOR was in the G12A group, with 1.54 months in those treated with combination therapy compared to 2.57 months with single-agent therapy. Regarding co-mutations, patients with STK11 co-mutations had a higher median OS than those without (39.7 vs. 26.1 months), but this was not statistically significant (p = 1). Similarly, TP53 co-mutations were associated with a lower median OS (19.1 vs. 26.1 months, p = 0.7), though this too was not statistically significant. Importantly, bone metastases emerged as a significant adverse prognostic factor, nearly doubling the risk of mortality (HR: 2.81, p &lt; 0.001), regardless of KRAS subtype or co-mutation status.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;KRAS mutation subtypes demonstrate varying ","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108051"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Professional-patient discrepancies in assessing lung cancer radiotherapy symptoms: An international multicentre study","authors":"Miguel E. Aguado-Barrera ,&nbsp;Carlos Lopez-Pleguezuelos ,&nbsp;Antonio Gómez-Caamaño ,&nbsp;Patricia Calvo-Crespo ,&nbsp;Begoña Taboada-Valladares ,&nbsp;David Azria ,&nbsp;Pierre Boisselier ,&nbsp;Erik Briers ,&nbsp;Clara Chan ,&nbsp;Jenny Chang-Claude ,&nbsp;Carla Coedo-Costa ,&nbsp;Ana Crujeiras-González ,&nbsp;John J. Cuaron ,&nbsp;Gilles Defraene ,&nbsp;Rebecca M. Elliott ,&nbsp;Corinne Faivre-Finn ,&nbsp;Marzia Franceschini ,&nbsp;Olivia Fuentes-Rios ,&nbsp;Javier Galego-Carro ,&nbsp;Sara Gutiérrez-Enríquez ,&nbsp;Ana Vega","doi":"10.1016/j.lungcan.2024.108072","DOIUrl":"10.1016/j.lungcan.2024.108072","url":null,"abstract":"<div><h3>Background and purpose</h3><div>We investigate discrepancies in the assessment of treatment-related symptoms in lung cancer between healthcare professionals and patients, and factors contributing to these discrepancies.</div></div><div><h3>Materials and methods</h3><div>Data from 515 participants in the REQUITE study were analysed. Five symptoms (cough, dyspnoea, bronchopulmonary haemorrhage, chest wall pain, dysphagia) were evaluated both before and after radiotherapy. Agreement between healthcare professionals and people with lung cancer was quantified using Gwet’s-AC₂ coefficient. The influence of clinical variables, comorbidities, and quality-of-life outcomes on agreement was examined through stratified analyses.</div></div><div><h3>Results</h3><div>We found varying levels of agreement between healthcare professionals and people with lung cancer. Bronchopulmonary haemorrhage and dysphagia exhibited very good agreement (meanAC₂ &gt; 0.81), while cough and chest wall pain showed substantial agreement (meanAC₂ = 0.64 and 0.76, respectively). Dyspnoea had the lowest agreement (meanAC₂ = 0.59), with prior chemotherapy significantly reducing agreement levels. Chronic obstructive pulmonary disease (COPD) and early cancer stages also contributed to discrepancies in dyspnoea assessments. Regarding quality-of-life, the most relevant factor was fatigue, which reduced agreement in the assessment of dyspnoea (AC₂ = 0.55 vs 0.70), dysphagia (AC₂ = 0.48 vs 0.69), cough (AC₂ = 0.58 vs 0.82), and chest wall pain (AC₂ = 0.77 vs 0.91).</div></div><div><h3>Conclusions</h3><div>Our findings indicate strong alignment between healthcare professionals’ and people with lung cancer evaluations of observable treatment-related symptoms, but less consistency for subjective symptoms such as dyspnoea. Factors such as prior chemotherapy, COPD, and cancer stage should be considered when interpreting symptom assessments. Furthermore, our study underscores the importance of integrating quality-of-life considerations, particularly fatigue, into symptom evaluations to mitigate potential biases in symptom perception.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108072"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The DETECTION project part 1: An international Delphi survey about diagnostics and treatment of anterior mediastinal cystic lesions","authors":"Florit Marcuse ,&nbsp;Daphne Dumoulin ,&nbsp;Koen Hartemink ,&nbsp;Monique Hochstenbag ,&nbsp;Sjaak Burgers ,&nbsp;Hester A. Gietema ,&nbsp;Ties A. Mulders ,&nbsp;Elvin Eryigit ,&nbsp;Jos Maessen ,&nbsp;Lex Maat ,&nbsp;Myrurgia Abdul Hamid ,&nbsp;Jan von der Thüsen ,&nbsp;Kim Monkhorst ,&nbsp;Anne-Marie C. Dingemans ,&nbsp;Nicolas Girard","doi":"10.1016/j.lungcan.2024.108055","DOIUrl":"10.1016/j.lungcan.2024.108055","url":null,"abstract":"<div><h3>Background</h3><div>Differentiating benign anterior mediastinal cysts from malignancies is challenging in clinical practice. International guidelines on optimal diagnostics and treatment for anterior mediastinal cystic lesions are lacking. The first part of the DETECTION project focuses on possible heterogeneity in diagnostics and treatment of anterior mediastinal cystic lesions among international thoracic medical experts.</div></div><div><h3>Methods</h3><div>A Delphi-survey was created by 14 multidisciplinary panel members, affiliated with three Dutch tertiary referral hospitals for thymic tumours. The survey contained 55 questions and was reviewed by international experts of the International Thymic Malignancy Interest Group (ITMIG) and Réseau tumeurs THYMiques et Cancer (RYTHMIC). The survey was launched online for members of the ITMIG and RYTHMIC from May 26th, 2023 till July 18th, 2023.</div></div><div><h3>Results</h3><div>The survey was completed by 21 thoracic surgeons, 15 radiologists, 15 medical oncologists, 11 pathologists, 9 pulmonologists, and 4 radiation oncologists from 24 countries. Heterogeneity was observed in performed diagnostic radiological imaging, laboratory tests, indications for surgery and follow-up of anterior mediastinal cysts. Cystic wall thickness of anterior mediastinal cysts was reported as clinical relevant in decision making more frequently by thoracic surgeons (76.2 %) than pulmonologists (44.4 %) and medical oncologists (15.4 %) (p = 0.015).</div></div><div><h3>Conclusions</h3><div>The survey outcomes showed heterogeneity in the diagnostics and indication for resection of anterior mediastinal cysts among thoracic medical experts. A large variation in radiological imaging, laboratory tests, surgery, pathological analyses, and follow-up of anterior mediastinal cysts was observed. The development of evidence-based clinical practice guidelines may guide clinicians.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108055"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimum diagnostic pathway and pathologic confirmation rate of early stage lung cancer: Results from the VIOLET randomised controlled trial","authors":"Rosie A. Harris ,&nbsp;Elizabeth A. Stokes ,&nbsp;Tim J.P. Batchelor ,&nbsp;Eveline Internullo ,&nbsp;Doug West ,&nbsp;Simon Jordan ,&nbsp;Andrew G. Nicholson ,&nbsp;Ian Paul ,&nbsp;Charlotte Jacobs ,&nbsp;Michael Shackcloth ,&nbsp;Sarah Feeney ,&nbsp;Vladimir Anikin ,&nbsp;Niall McGonigle ,&nbsp;Richard Steyn ,&nbsp;Maninder Kalkat ,&nbsp;Dionisios Stavroulias ,&nbsp;May Havinden Williams ,&nbsp;Syed Qadri ,&nbsp;Karen Dobbs ,&nbsp;Vipin Zamvar ,&nbsp;Eric Lim","doi":"10.1016/j.lungcan.2024.108070","DOIUrl":"10.1016/j.lungcan.2024.108070","url":null,"abstract":"<div><h3>Background</h3><div>Pathologic confirmation of lung cancer influences treatment selection for suspected early-stage lung cancer. High pre-treatment tissue confirmation rates are recommended. We sought to define management and outcomes of patients undergoing surgery for primary lung cancer in a UK multi-centre clinical trial.</div></div><div><h3>Methods</h3><div>VIOLET compared minimally invasive video-assisted thoracic surgery versus open surgery for known or suspected lung cancer. Diagnostic patient pathways were identified and methods of tissue confirmation were documented. The outcome of inappropriate lobectomy for benign disease or inappropriate wedge resection for primary lung cancer was compared with respect to the pathologic diagnosis.</div></div><div><h3>Findings</h3><div>From July 2015 to February 2019, 502 patients were randomised and underwent surgery; 262 (52%) had a pre-operative pathologic confirmed diagnosis of primary lung cancer, 205 did not have a pre-operative biopsy and 35 had a non-diagnostic pre-operative biopsy.</div><div>Of the 240 participants without pre-operative pathologic confirmation of primary lung cancer, intraoperative biopsy and frozen section analysis was undertaken in 144 (60%). The remaining 96 underwent direct surgical resection without tissue confirmation (19% of the entire cohort). Confirmation of histologic diagnosis before surgery was less costly than diagnosis in the operating theatre. The inappropriate surgery rate was 3.6% (18/502 participants, 7 lobectomy for benign disease, 11 wedge resection for lung cancer).</div></div><div><h3>Interpretation</h3><div>Low levels of inappropriate resection can be achieved at pre-operative tissue confirmation rates of 50% through a combination of intra-operative confirmatory biopsy and correct risk estimation of lung cancer. Practice needs to be monitored to ensure acceptable levels are consistently achieved.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108070"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A combined model of circulating tumor DNA methylated SHOX2/SCT/HOXA7 and clinical features facilitates the discrimination of malignant from benign pulmonary nodules","authors":"Lu He ,&nbsp;Biao Zhang ,&nbsp;Chu Zhou ,&nbsp;Qi Zhao ,&nbsp;Yongsheng Wang ,&nbsp;Yuan Fang ,&nbsp;Zijian Hu ,&nbsp;Ping Lv ,&nbsp;Liyun Miao ,&nbsp;Rusong Yang ,&nbsp;Jun Yang","doi":"10.1016/j.lungcan.2024.108064","DOIUrl":"10.1016/j.lungcan.2024.108064","url":null,"abstract":"<div><h3>Background</h3><div>Despite the advancements in early lung cancer detection attributed to the widespread use of low-dose computed tomography (LDCT), this technology has also led to an increasing number of pulmonary nodules (PNs) of indeterminate significance being identified. Therefore, this study was aimed to develop a model that leverages plasma methylation biomarkers and clinical characteristics to distinguish between malignant and benign PNs.</div></div><div><h3>Methods</h3><div>In a training cohort of 210 patients with PNs, we evaluated plasma circulating tumor DNA (ctDNA) for the presence of three lung cancer-specific methylation markers: SHOX2, SCT, and HOXA7. Subsequently, we constructed a combined model utilizing methylated SHOX2/SCT/HOXA7 (mSHOX2/SCT/HOXA7) ctDNA levels, the largest nodule size measured by LDCT, and age, employing the binary logistic regression algorithm. Furthermore, we compared the diagnostic performances of the combined model with the Mayo Clinic model and the single mSHOX2/SCT/HOXA7 model by analyzing the area under the receiver operating characteristic curve (AUC) for each.</div></div><div><h3>Results</h3><div>The combined model demonstrated an impressive AUC of 0.87 and an accuracy of 0.75 in the training cohort, using pathologic diagnoses as the gold standard. This performance was significantly superior to that of the single mSHOX2/SCT/HOXA7 panel (AUC = 0.81, <em>P</em> &lt; 0.0001) and the Mayo model (AUC = 0.65, <em>P</em> = 0.0005). Further validation in a cohort of 82 patients with PNs confirmed the diagnostic value of the combined model. Additionally, we observed that as the size of the nodule increased, the diagnostic accuracy of the combined model also improved.</div></div><div><h3>Conclusions</h3><div>A combined model incorporating the ctDNA-based methylation status of SHOX2/SCT/HOXA7 genes, the largest nodule size measured by LDCT, and age can serve as a supplementary approach to LDCT for lung cancer. This model enhances the precision in identifying high-risk individuals and optimizes the clinical management strategies for PNs detected by CT.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"199 ","pages":"Article 108064"},"PeriodicalIF":4.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}