Revue des Maladies Respiratoires Actualites最新文献

{"title":"Sommaire","authors":"","doi":"10.1016/S1877-1203(25)00051-5","DOIUrl":"10.1016/S1877-1203(25)00051-5","url":null,"abstract":"","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages v-viii"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarqueurs tissulaires dans les CBNPC","authors":"A. Mansuet-Lupo ,&nbsp;K. Leroy ,&nbsp;M. Wislez","doi":"10.1016/S1877-1203(25)00058-8","DOIUrl":"10.1016/S1877-1203(25)00058-8","url":null,"abstract":"<div><div>Tissue biomarkers play a central role in the management of non-small cell lung cancer (NSCLC). The evaluation of predictive biomarkers guides therapeutic decisions by enabling access to targeted therapies or immunotherapy, and forms the foundation of personalized medicine in oncology. The number of biomarkers has increased significantly since the discovery of <em>EGFR</em> gene mutations, due to the development of therapies targeting oncogenic drivers and antibody drug conjugates. These predictive biomarkers include, molecular alterations identified through sequencing <em>(EGFR, BRAF, KRAS, ALK, ROSI, RET, MET, HER2, NTRK, NRG1),</em> and protein biomarkers whose expression is assessed by immunohistochemistry (PD-L1, ALK, ROS1, NTRK, HER2, HER3, MET, TROP2, MTAP, CEACAM5). Testing recommendations in NSCLC are constantly evolving, and it is essential to stay up to date in order to propose the best treatment to each patient.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S30-2S37"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Le TNM : la 9e édition pour l'oncologie thoracique","authors":"A. Agrafiotis ,&nbsp;B. Grigoriu ,&nbsp;P. Van Schil","doi":"10.1016/S1877-1203(25)00060-6","DOIUrl":"10.1016/S1877-1203(25)00060-6","url":null,"abstract":"<div><div>The 9^th TNM edition for lung cancer is based on a database of 124,581 cases, of which 18.9% were entered prospectively. Regarding the T component no changes are implemented as the 8^th edition descriptors performed well in the new database. Concerning the N component, N2 is subdivided into N2a and N2b representing single station and multiple stations N2 involvement, respectively. Individual lymph nodes in each station are not counted. With regard to the M component, M1c is subdivided into M1c1 and M1c2 when multiple extrathoracic metastases are present in a single organ system or multiple organ systems, respectively. Bone and muscle are counted as a single organ system. Especially the new N descriptors have an impact on the overall stage groupings, whereby e.g. T1N1 belongs to stage IIA and T1N2a to stage IIB. M1c1 and M1c2 both belong to stage IVB.</div><div>For staging of thymic epithelial tumours comprising thymoma and thymic carcinoma, the 9^th edition is based on analysis of 9,147 cases. Changes are only proposed in the T component: T1a characterizes tumors until 5 cm and T1b tumors larger than 5 cm in greatest dimension. T2 denotes partial or full-thickness pericardial invasion but also direct invasion into lung parenchyma or phrenic nerve. Invasion of mediastinal pleura is now separately considered as additional histologic descriptor. There are no changes in the stage groupings with both T1a and T1b belonging to stage I.</div><div>Regarding pleural mesothelioma, after analysis of a database of 3,481 cases, important changes are proposed for the clinical T descriptors and no changes are implemented for the N and M descriptors. Maximal pleural thickness is now measured at 3 levels on axial CT slices: at upper, middle and lower chest and a sum of the 3 measurements is made (Psum). On a sagittal image maximal pleural thickness in the fissure is measured as Fmax. Cut-off values for Psum are 12 and 30 mm, and for Fmax 5 mm. These will finally determine the specific T-category. For a pathologist it is not possible to perform exactly the same measurements on a resected specimen and for this reason, only the clinical stage groupings were redefined without any changes in the pathological stage groupings. 1877-1203/© 2025 SPLF. Published by Elsevier Masson SAS. All rights reserved.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S46-2S59"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236487","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer bronchique non à petites cellules avec autres mutations actionnables (BRAF, MET, HER2)","authors":"A. Mogenet ,&nbsp;A. Cortot ,&nbsp;P. Abdayem ,&nbsp;D. Planchard ,&nbsp;L. Greillier","doi":"10.1016/S1877-1203(25)00079-5","DOIUrl":"10.1016/S1877-1203(25)00079-5","url":null,"abstract":"<div><div>Non-Small Cell Lung Cancer (NSCLC) outcomes has been significantly improved since the discovery of oncogenic driver alterations and implementation of targeted therapies such as tyrosine kinase inhibitors, antibody drug conjugates or bispecific antibodies. Nowadays, wild molecular profiling, preferably with next-generation sequencing panels is crucial before starting treatment in patients with non-squamous NSCLC regardless of their smoking status, and in those with squamous NSCLC who are little or non-smokers, on tissue samples but also liquid biopsies that can tremendously helpful despite their lack of sensitivity. In this review, we will present the latest evidence on some rare molecular alterations, <em>BRAF, MET</em> and <em>HER2,</em> with constant innovation pipeline. Even if many of these new drugs are still not funded in Europe, clinical trials enrollment allows our patients to benefit from innovative treatments and generate data. Translational research programs with repeat samples are also important to explore mechanisms of resistance to these new drugs.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S230-2S236"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prise en charge des cancers bronchiques à petites cellules de stade localisé : actualisation","authors":"S. Thureau ,&nbsp;E. Nicolas ,&nbsp;C. Faivre-Finn ,&nbsp;E. Giroux Leprieur ,&nbsp;S. Ocak ,&nbsp;P. Fournel ,&nbsp;E. Negre ,&nbsp;B. Roch ,&nbsp;C. Le Péchoux","doi":"10.1016/S1877-1203(25)00081-3","DOIUrl":"10.1016/S1877-1203(25)00081-3","url":null,"abstract":"<div><div>Limited-stage small cell lung cancer (LS-SCLC) represents 10-15% of all lung cancers, and because of its rapid tumor kinetics, less than a third of SCLC are discovered at limited stage. It has benefited less from therapeutic advances than non-small cell lung cancer (NSCLC). The different steps and modalities of its management are well defined and codified. They involve a comprehensive staging assessment using CT scans of the chest, abdomen, and pelvis, PET-CT scans, and ideally brain imaging using MRI to avoid missing a more extensive stage of the disease, which would significantly alter the treatment strategy. The treatment consists of a combination of chemotherapy with platinum/ etoposide and radiotherapy, possibly delivered in a hyperfractionated schedule with two daily sessions followed by immunotherapy. SCLC is particularly both chemosensitive and radiosensitive, so that the initial evaluation shows frequently a complete response, and prophylactic cranial irradiation (PCI) is then recommended. Even if hyperfractionated accelerated radiotherapy (HFART) at the dose of 45Gy in 30 fractions has given the best results, most clinicians use once-daily chemoradiation regimen (60-70Gy). Studies have evaluated dose escalation either with HFRAT or with conventional fractionation (66 to 70Gy). Several trials are currently investigating the addition of immunotherapy to chemoradiation, hippocampus sparing PCI or the omission of PCI.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S245-2S252"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Place de l'immunothérapie dans les CBNPC de stade III non résécables","authors":"E. Giroux Leprieur ,&nbsp;M. Pérol ,&nbsp;J. Khalifa","doi":"10.1016/S1877-1203(25)00068-0","DOIUrl":"10.1016/S1877-1203(25)00068-0","url":null,"abstract":"<div><div>Treatment of unresectable stage III non-small cell lung cancer is currently based on a combination of chemotherapy and radiotherapy, ideally concurrent, followed by consolidation with durvalumab administered for 1 year. Although this new therapeutic standard illustrates the technical progress of thoracic irradiation and the positive impact of anti-PD-L1 in the context of locally advanced disease, the results (progression-free survival of 34% at 5 years and overall survival of 43% at 5 years, no survival benefit in the absence of PD-L1 expression or in case of <em>EGFR</em> mutation) underline the need for further therapeutic improvement. This could involve optimizing strategies for combining immunotherapy with chemoradiotherapy, redefining the parameters of thoracic radiotherapy to promote synergy with immunotherapy, and integrating targeted therapies into the therapeutic strategy in cases of oncogenic addiction.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S113-2S120"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Le dépistage du cancer du poumon","authors":"S. Couraud ,&nbsp;E. Grolleau ,&nbsp;B. Milleron ,&nbsp;V. Gounant ,&nbsp;O. Leleu","doi":"10.1016/S1877-1203(25)00062-X","DOIUrl":"10.1016/S1877-1203(25)00062-X","url":null,"abstract":"<div><div>Several randomized trials have demonstrated that a low-dose thoracic CT scan screening strategy without contrast injection reduces both lung cancer mortality and overall mortality in a high-risk population. In France and Europe, several scientific societies have advocated for this screening to be performed in eligible individuals. In France, the eligibility criteria are: age between 50 and 75 years, a smoking history of more than 20 pack-years, either current smokers or those who have quit within the last 15 years. The IMPULSION national pilot study will begin in 2025 in 5 regions and in the whole territory in 2026.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S68-2S74"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Populations particulières : Patients de Performance Status 2 et plus","authors":"V. Gounant ,&nbsp;L. Alvarez ,&nbsp;Y.M. Xu ,&nbsp;C. Mehlman ,&nbsp;L. Nicolas ,&nbsp;S. Guillerm ,&nbsp;P. Mordant ,&nbsp;G. Zalcman","doi":"10.1016/S1877-1203(25)00091-6","DOIUrl":"10.1016/S1877-1203(25)00091-6","url":null,"abstract":"<div><div>Performance status (PS) is a measure of the patient's overall condition. Karnofsky and ECOG (Eastern Cooperative Oncology Group) are the most widely used scales. A three-point conversion scale allows a strong correlation between both scores: ECOG 0-1 = Karnofsky 100-80%, ECOG 2 = Karnofsky 60-70%, ECOG 3-4 = Karnofsky 50-10%. Numerous factors, whether linked to cancer or to comorbidities, can affect PS. PS remains a major independent prognostic factor in NSCLC (non small cell lung cancer) and SCLC (small cell lung cancer), despite its flawed reproducibility and the heterogeneity of cancer patients with poor PS. As a matter of fact, PS should be regarded as a stratification factor in research. All guidelines take PS into account as a therapeutic decision making tool, especially in the case of chemotherapy for metastatic NSCLC. Targeted therapy should be considered in case of metastatic disease with molecular targets regardless of PS, for its high effectiveness and good safety profile. Data regarding immunotherapy are rather sketchy. Tolerance seems to be fine. Findings regarding efficacy warrant careful selection of patients who might benefit from this therapy. In light of the European Medicines Agency call, let us build studies dedicated to patients as frail as they come and enroll them in clinical trials in such a way that they benefit, among others, from therapeutic advances. In order to apply clinical research findings to the general population, specific groups of patients should be more involved.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S329-2S340"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Algorithme thérapeutique en 2025 des cancers bronchiques non à petites cellules avec mutation de l'EGFR","authors":"M. Ferreira ,&nbsp;V. Fallet ,&nbsp;S. Baldacci ,&nbsp;A.B. Cortot ,&nbsp;J. Cadranel","doi":"10.1016/S1877-1203(25)00076-X","DOIUrl":"10.1016/S1877-1203(25)00076-X","url":null,"abstract":"<div><div>EGFR mutations remain the most frequently observed targetable oncogenic driver in non-small cell lung cancer (NSCLC), accounting for 12% of adenocarcinomas and 44% of NSCLC cases in non-smokers in France. The «common» EGFR mutations—exon 19 deletions and the exon 21 L858R mutation—are found in 89% of cases. The use of new molecular biology techniques has led to the identification of «rare» EGFR mutations, particularly exon 20 insertions, and has also revealed molecular heterogeneity both at diagnosis and during follow-up. This heterogeneity partly explains the variability in the efficacy of EGFR tyrosine kinase inhibitors (EGFR-TKIs) and contributes to the emergence of resistant clones. Osimertinib has been the standard first-line therapy for several years. However, the role of combined chemotherapy and the emergence of amivantamab—a bispecific EGFR-MET antibody—are changing the landscape of first-line treatment options, whether in combination or not, as well as the sequencing of therapies, with the goal of improving overall survival.</div><div>These advances, however, come with increased toxicities and a risk of impaired quality of life, underscoring the need to carefully select patients who are most likely to benefit from each therapeutic option. Finally, the indications for osimertinib are expanding, with its use now approved in the adjuvant post-surgical setting and its anticipated arrival in neoadjuvant (pre-operative) and consolidation therapy after chemoradiation for patients with localized or locally advanced unresectable NSCLC.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S192-2S212"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Algorithme thérapeutique des cancers bronchiques non à petites cellules avec fusion ALK, ROSI et RET","authors":"A. Swalduz ,&nbsp;A. Cortot ,&nbsp;M. Duruisseaux","doi":"10.1016/S1877-1203(25)00077-1","DOIUrl":"10.1016/S1877-1203(25)00077-1","url":null,"abstract":"<div><div><em>ALK</em> (3-7%), <em>ROS1</em> (1-2%), and <em>RET</em> (1-2%) rearrangements differ epidemiologically from other non-small cell lung cancers. They are more frequently observed in younger patients, light or never smokers, and are predominantly associated with adenocarcinoma histology. Several fusion partners have been identified for each of these genes, with some partners shared across targets. Identifying these genomic alterations at the time of initial diagnosis in advanced non-small cell lung cancer patients is essential to guide first-line treatment decisions, direct patients toward effective targeted therapies, and avoid ineffective strategies such as immune checkpoint inhibitors in monotherapy or potentially toxic treatment sequences. In patients with <em>ALK</em> rearrangements, lorlatinib is the first-line standard, with a 5-year progression-free survival (PFS) rate of 60% and remarkable intracranial efficacy. Post-lorlatinib resistance mechanisms in first-line therapy appear to be ALK-independent, and chemotherapy currently remains the standard second-line option. In patients previously treated with brigatinib or alectinib, secondline therapy should be guided by the identification of resistance mechanisms. Neladalkib, a fourth-generation ALK inhibitor, is currently available through an early access program. For ROSI-rearranged non-small cell lung cancers, crizotinib is the only approved targeted therapy to date, although agents such as taletrectinib and zidesamtinib (also available through early access) show promising activity. Finally, for <em>RET</em>-rearranged non-small cell lung cancers, selpercatinib is now the standard of care from the first-line setting, offering significant clinical benefit.</div></div>","PeriodicalId":53645,"journal":{"name":"Revue des Maladies Respiratoires Actualites","volume":"17 2","pages":"Pages 2S213-2S220"},"PeriodicalIF":0.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145236544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}