Neoadjuvant and Adjuvant Treatments for Early Stage Resectable NSCLC: Consensus Recommendations From the International Association for the Study of Lung Cancer

Journal of Thoracic Oncology, Journal Year: 2024, Volume and Issue: 19(10), P. 1373 - 1414

Published: June 18, 2024

Language: Английский

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A Lung CT Foundation Model Facilitating Disease Diagnosis and Medical Imaging

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 15, 2025

Abstract The concomitant development and evolution of lung computed tomography (CT) artificial intelligence (AI) has allowed non-invasive imaging to be a key part the clinical care patients with major diseases, such as cancer. However, paucity labeled CT data limited training highly efficacious AI models thereby retarded broad-scale adoption deployment AI-based in real-world setting. In this paper, We introduce LCTfound, foundational model that encodes images along correlated information, into neural network. LCTfound used self-supervised learning pre-trained by diffusion using large dataset containing 105,184 scans (totaling more than 28 million images) from multiple centers. was evaluated on 8 categories tasks, ranging scanning-level diagnosis pixel-level image restoration, including segmentation mediastinal neoplasm, pulmonary alveolar proteinosis, prognosis non-small cell cancer, prediction pathological response neoadjuvant chemoimmunotherapy, whole 3D modeling for surgical navigation, virtual angiography(CTA), reconstruction sparse views, enhancement low-dose images. Equipped robust few-shot capability, outperformed previously state-of-the-art all above tasks. is advancements representation CT, laying groundwork operates high efficacy across spectrum low-level high-level tasks serving dual purpose aiding diseases improving quality imaging.

Language: Английский

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Asian Thoracic Oncology Research Group expert consensus statement on the peri-operative management of non-small cell lung cancer

Lung Cancer, Journal Year: 2025, Volume and Issue: 200, P. 108076 - 108076

Published: Jan. 2, 2025

The peri-operative management of non-small cell lung cancer (NSCLC) in earlier stage disease has seen significant advances recent years with the incorporation immune checkpoint inhibitors and targeted therapy. However, many unanswered questions challenges remain, including application clinical trial data to routine practice. Recognising unique demographic profile Asian patients NSCLC heterogeneous healthcare systems, Thoracic Oncology Research Group (ATORG) convened a consensus meeting Singapore on 26 April 2024 discuss relevant issues spanning diagnostic testing post-neoadjuvant treatment considerations future directions. An interdisciplinary group 19 experts comprising medical oncologists, thoracic surgeons, radiation pulmonologists pathologists from Singapore, Hong Kong, Mainland China, Korea, Japan, Taiwan, India, Malaysia, Thailand, Vietnam Australia met emerging data, identify existing gaps care develop multidisciplinary, multinational expert statement tailored Asia-Pacific region.

Language: Английский

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Evidence for a reduction in number of cycles of immune checkpoint inhibitors

The Lancet Oncology, Journal Year: 2025, Volume and Issue: 26(1), P. 9 - 11

Published: Jan. 1, 2025

Language: Английский

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Real-World Treatment Patterns and Outcomes Among Patients with Early Non-Small Cell Lung Cancer

Current Oncology, Journal Year: 2025, Volume and Issue: 32(4), P. 239 - 239

Published: April 19, 2025

Worldwide, about two million people are diagnosed with lung cancer each year, 85% of whom have non-small cell (NSCLC). Recent progress in treating advanced/metastatic NSCLC targeted therapies has shifted attention to early (Stages I–IIIA) and perioperative (neoadjuvant adjuvant) systemic therapies. However, our comprehension how therapeutics incorporated into care their impact on patient outcomes is just starting unfold. Methods: This retrospective observational study used a US nationwide electronic health record-derived deidentified database spanning January 2019–March 2024 aimed describe (1) eNSCLC demographic clinical characteristics, (2) real-world neoadjuvant adjuvant use, (3) outcomes. Results: The population included 4841 Stage IB–IIIA patients mean age 70.9 ± 8.6 years. majority (69.9%) received definitive treatment: surgery (n = 2280), radiation 320), or chemoradiation 783), while 30.1% 1458) did not. Many treatment some therapy (surgery: 52.6%, radiation: 52.2%, chemoradiation: 75.5%). Neoadjuvant use was limited all groups 8.2%, 6.1%, 11.6%). Among the 54.6% receiving adjuvant, immune checkpoint inhibitors were most common choice for (39.1%) (73.7%) patients, surgical predominantly platinum-doublet (37.0%). Surgical similar across groups, without had lower survival rates. Conclusions: In this study, we found that although underwent form treatment, limited, rarely care. A crucial initial step improving understand address underutilization neoadjuvant/adjuvant patients.

Language: Английский

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Stage I and II nonsmall cell lung cancer treatment options

Breathe, Journal Year: 2024, Volume and Issue: 20(2), P. 230219 - 230219

Published: June 1, 2024

Chest radiography, computed tomography (CT) and positron emission (PET)-CT are required for staging nonsmall cell lung cancers. Stage I cancers may be up to 4 cm in maximal diameter, with stage IA tumours being 3 IB cm. A cancer becomes II if the tumour is between ≤5 (stage IIA), or it spreads ipsilateral peribronchial hilar lymph nodes IIB). should surgically resected, ideally using minimally invasive methods. Lobectomy usually performed, although some studies have shown good outcomes sublobar resections. If surgery not possible, stereotactic body radiotherapy a alternative. This involves delivering few high-dose radiation treatments at very high precision. For IIB disease, combinations of surgery, chemotherapy immunotherapy used. There evidence that neoadjuvant treatment (immunotherapy nivolumab II) optimises outcomes. Adjuvant platinum-based doublet (typically cisplatin+vinorelbine) offered resected considered IIA tumours. pembrolizumab used IB–IIIA following resection adjuvant chemotherapy. Osimertinib IIIA which relevant mutations (epidermal growth factor receptor exon 19 deletions 21 (L858R) substitution). no fixed guidelines follow-up, but most centres recommend 6-monthly CT scanning first 2–3 years after definitive treatment, followed by annual scans.

Language: Английский

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Cytokine profile of bronchoalveolar lavage in patients with and without checkpoint inhibitor pneumonitis

Cancer Immunology Immunotherapy, Journal Year: 2025, Volume and Issue: 74(2)

Published: Jan. 3, 2025

Checkpoint inhibitor pneumonitis (CIP) that develops following immune checkpoint (ICI) treatment can be difficult to distinguish from other common etiologies of lung inflammation in cancer patients. Here, we evaluate the bronchoalveolar lavage fluid (BAL) for potential biomarkers specific CIP. We conducted a retrospective study patients who underwent standard care bronchoscopy compare cytokines interest between with and without CIP immune-mediated pulmonary diseases. Pulmonary diagnoses were determined by treating clinician at time retroactively reviewed agreement team. Thirty-seven included, 24 (64.9%) had infection, 2 (5.4%) edema, 6 (16.2%) non-CIP drug-induced pneumonitis, 3 (8.1%) CIP, 5 (13.5%) ILD or autoimmune vasculitis, 4 (10.8%) progression, nonimmune-mediated interstitial disease (ILD). IL-6 BAL was significantly higher compared those progression ILD, diseases infection. distinguished common, important causes infiltrates cancer, suggesting it may give insight into pathophysiology has as biomarker.

Language: Английский

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Pilot clinical trial of neoadjuvant toll-like receptor 7 agonist (Imiquimod) immunotherapy in early-stage oral squamous cell carcinoma

Frontiers in Immunology, Journal Year: 2025, Volume and Issue: 16

Published: Jan. 27, 2025

Background There is no neoadjuvant immunotherapy for early-stage oral cancer patients. We report a single-arm, open-label, pilot clinical trial assessing the efficacy and safety of topical toll-like receptor-7 (TLR-7) agonist, imiquimod, utilized in setting squamous cell carcinoma (OSCC). Methods The primary endpoint reduction tumor counts assessed by quantitative multiplex immunofluorescence immune-related pathologic response. secondary safety. Results 60% patients experienced 50% or greater count post-treatment (95% CI = 32% to 84%). Similarly, had major response (irMPR) with two complete responses, 40% partial (PR) percent residual viable ranging from 25% 65%. An increase functional helper cytotoxic T-cells significantly contributed (R=0.54 0.55, respectively). treatment was well tolerated application site mucositis being most common adverse event (grades 1-3), grade 4 life-threatening event. median follow-up time 17 months 16 - not reached), one-year recurrence-free survival 93% evaluable Conclusion Neoadjuvant imiquimod could be safe promising regimen cancer. Trial registration ClinicalTrials.gov, Identifier NCT04883645.

Language: Английский

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A stage IIIA lung adenocarcinoma case achieving pathological response with only one cycle of preoperative nivolumab combination chemotherapy

General Thoracic and Cardiovascular Surgery Cases, Journal Year: 2025, Volume and Issue: 4(1)

Published: Feb. 3, 2025

Abstract Background Preoperative nivolumab combination chemotherapy has shown its efficacy in resectable stage II–III non-small cell lung cancer and become one of the standard treatments. While preoperative is generally a regimen three cycles, when treatment prematurely discontinued remains unclear. Case presentation An 81-year-old man was diagnosed as adenocarcinoma (cT3N1M0, cStage IIIA). A computed tomography (CT) showed 58 mm mass left upper lobe with an intrapulmonary metastasis, positron-emission tomography/CT suggested metastatic lymph nodes at pulmonary hilum. + carboplatin paclitaxel were administered; however, after first cycle, due to grade 3 anorexia, 1 body weight loss, 4 neutropenia. It affair that continuation therapy made him unsuitable for surgery, CT scan reduction tumor size 20 mm. Then, we decided discontinue perform surgery. Video-assisted thoracoscopic lobectomy node dissection performed, postoperative course uneventful. The pathological examination revealed 15% residual primary lesion no diagnosed. patient did not undergo adjuvant chemotherapy, recurrence observed 1.5 years surgery Conclusions In this case, combined only cycle adverse events; significant effect achieved. Therefore, even it unable continue therapy, important miss chance good may have been

Language: Английский

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Osimertinib in the Treatment of Epidermal Growth Factor Receptor-Mutant Early and Locally Advanced Stages of Non-Small-Cell Lung Cancer: Current Evidence and Future Perspectives

Cancers, Journal Year: 2025, Volume and Issue: 17(4), P. 668 - 668

Published: Feb. 16, 2025

The treatment of epidermal growth factor receptor (EGFR)-mutant non-small-cell lung cancer (NSCLC) patients was dramatically revolutionized by the introduction EGFR tyrosine kinase inhibitors in clinical practice, both advanced and locally advanced/early stages. present work focuses on osimertinib use early NSCLC Phase 3 trials have supported as new standard care, adjuvant setting disease. ADAURA study reported an overall survival (OS) advantage for completely resected stage II-IIIA EGFR-mutant tumors, while LAURA proved a statistically significant benefit progression-free (PFS) delay central nervous system metastasis development treated with maintenance after concurrent chemoradiotherapy In neoadjuvant setting, data osimertinib’s efficacy are conflicting; therefore, Neo-ADAURA is evaluating safety alone or combination chemotherapy II-IIIB common mutations. We discuss several issues that need to be clarified, such drug uncommon mutations, long-term impact survival, management resistance mechanisms. Moreover, we report studies trying identify potential biomarkers response, circulating tumor DNA (ctDNA), aim selecting who will most from osimertinib.

Language: Английский

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