scholarly journals Highlights on the morphology, prognostic factors, diagnostics, and treatment (chemotherapy, chemotherapy + radiation, targeted therapy, immunotherapy, and surgery) in small cell lung cancer

2020 ◽  
Vol 25 (4) ◽  
pp. 127-135
Author(s):  
Mark B. Bychkov ◽  
A. E. Kuzminov
Keyword(s):  
Lung Cancer ◽  
Prognostic Factors ◽  
Targeted Therapy ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Treatment Algorithm ◽  
Genetic Alterations ◽  
Small Cell ◽  
Line Treatment ◽  
Small Cell Lung

The article present a review and experience from a a single institution on the morphology, diagnostics, and treatment (chemotherapy, radiation, targeted therapy, and immunotherapy)) of small cell lung cancer (SCLC). The characteristic molecular, genetic, histological, and immunohistochemical features of NSCLC and SCLC are compared. An important issue of SCLC histogenesis is highlighted, taking into account its neuroendocrine characteristics. Paraneoplastic syndromes associated with SCLC and other clinical features of SCLC are discussed. The algorithm of examination of a patient with histologically or cytologically confirmed SCLC, staging schemes, and main prognostic factors are presented. The following aspects of chemoradiotherapy of localized SCLC are considered: features of early, late, simultaneous, and sequential therapy, and the need for whole brain radiotherapy in patients with localized and extensive SCLC. The article discusses the treatment algorithm for extensive disease SCLC, taking into account the recent success of chemoimmunotherapy in the first-line treatment of SCLC. As is known, the combinations of atezolizumab, etoposide, carboplatin and durvalumab, etoposide, cisplatin, or carboplatin showed a real benefit compared to chemotherapy alone. Although the second line treatment has not changed, it is now possible to prescribe a third line therapy because of the proven effectiveness of immunotherapy. Targeted therapy, although not shown to be effective in SCLC, is discussed in terms of the key features of genetic alterations as a possible target for therapy. An important issue in the treatment of patients with superior vena cava syndrome is considered separately. The tasks of future prospective research in SCLC are described.

scholarly journals Algorithm for the treatment of advanced or metastatic squamous non-small-cell lung cancer: an evidence-based overview

2018 ◽  
Vol 25 ◽  
pp. 77 ◽  
Author(s):  
N. Daaboul ◽  
G. Nicholas ◽  
S. A. Laurie
Keyword(s):  
Lung Cancer ◽  
Growth Factor ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Treatment Algorithm ◽  
Growth Factor Receptor ◽  
Genetic Alterations ◽  
Small Cell ◽  
Current Evidence ◽  
Small Cell Lung

The treatment of squamous non-small-cell lung cancer (nsclc) is evolving. In the past, the backbone of treatment was chemotherapy, with very few other options available. Fortunately, that situation is changing, especially with a better understanding of tumour biology. Various strategies have been tried to improve patient outcomes. The most notable advance must be immunotherapy, which has revolutionized the treatment paradigm for lung cancer in patients without a driver mutation. Immunotherapy is now the treatment of choice in patients who have progressed after chemotherapy and is replacing chemotherapy as upfront therapy in a selected population. Other strategies have also been tried, such as the addition of targeted therapy to chemotherapy. Targeted agents include ramucirumab, an inhibitor of vascular endothelial growth factor receptor 2, and necitumumab, a monoclonal antibody against epithelial growth factor receptor. Recently, advances in molecular profiling have also been applied to tumours of squamous histology, in which multiple genetic alterations, including mutations and amplifications, have been described. Research is actively seeking targetable mutations and testing various therapies in the hopes of further improving prognosis for patients with squamous nsclc. Here, we review the various advances in the treatment of squamous nsclc and present a proposed treatment algorithm based on current evidence.

MET second-site mutations in EGFR-mutant, MET-amplified non-small cell lung cancer after resistance to combinatorial targeted therapy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20730-e20730
Author(s):  
Jia-Tao Cheng ◽  
Jinji Yang ◽  
Yilong Wu
Keyword(s):  
Lung Cancer ◽  
Targeted Therapy ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Genetic Alterations ◽  
Subsequent Treatment ◽  
Small Cell ◽  
Small Cell Lung ◽  
Egfr Mutant

e20730 Background: MET second-site mutations were previously reported in a few cases of MET-amplified or exon 14-mutant advanced non-small-cell lung cancer (NSCLC) treated with MET inhibitors. However, both the frequency of MET second-site mutations and clinical outcome of patients with such genetic alterations have not been investigated, particularly in EGFR-mutant, MET-amplified advanced NSCLC treated with combinatorial targeted therapy. Methods: Retrospectively, from November 2016 to January 2019, 22 patients with EGFR-mutant, MET-amplified advanced NSCLC had sufficient tumor samples after resistance to a combinatorial therapy with both EGFR and MET inhibitors. All tissue samples were detected using Next-generation sequencing (NGS). The progression-free survival (PFS) was calculated the start of subsequent treatment to progressive disease or death from any cause. The overall survival (OS) was calculated from the start of subsequent treatment to death from any cause. Last follow-up was on January 31, 2019. Results: Five kinds of MET second-site mutations were found in 7 patients: D1246N D1228N, D1228H, D1231Y and Y1230H. The frequency of MET second-site mutations was 31.8% (7/22). The median PFS and OS were 3.7 (95%CI: 1.13-6.3) months and 6.9 (95%CI: 0.2-13.7) months respectively. The ORR of EGFR TKIs plus cabozantinib for suchsecond-site mutaant patients was 50% (2/4). However, the ORR of other treatments was 0% (0/3), Two of them received single agent cabozantinib, and PFS was 0.7 and 1.7 months respectively. One had a PFS of 2.5 months with pemetrexed/carboplatin plus bevacizumab. Conclusions: MET second-site mutation might be one of the commonly-seen molecular mechanisms of acquired resistance to combinatorial targeted therapy in EGFR-mutant, MET-amplified advanced NSCLC. Patients with such mutations could respond to cabozantinib plus EGFR TKI. Further more investigations are warranted to improve the efficacy.

Second-line Treatment of Advanced Non-small Cell Lung Cancer Non-oncogene Addicted: New Treatment Algorithm in the Era of Novel Immunotherapy

2018 ◽  
Vol 13 (2) ◽  
pp. 76-84 ◽  
Author(s):  
Cesare Gridelli ◽  
Paolo Antonio Ascierto ◽  
Francesco Grossi ◽  
Editta Baldini ◽  
Adolfo Favaretto ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Treatment Algorithm ◽  
Small Cell ◽  
Line Treatment ◽  
Second Line ◽  
Small Cell Lung ◽  
New Treatment

Economic burden of immunotherapy as second-line treatment of patients with advanced non-small-cell lung cancer at a Latin American oncology center.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18376-e18376
Author(s):  
Feliciano Barron Barron ◽  
Luis Antonio Cabrera ◽  
Andres Felipe Cardona Zorrilla ◽  
Oscar Gerardo Arrieta Rodriguez
Keyword(s):  
Lung Cancer ◽  
Adverse Events ◽  
Small Cell Lung Cancer ◽  
Latin American ◽  
Cell Lung Cancer ◽  
Genetic Alterations ◽  
Small Cell ◽  
Line Treatment ◽  
Second Line ◽  
Small Cell Lung

e18376 Background: Lung cancer is the leading cause of cancer-related mortality in México and worldwide. More than 80 percent of lung cancers are classified as non-small cell lung cancer (NSCLC). Immunotherapy has become integrated into the treatment of patients with specific genetic alterations, which has led to improvements in survival and quality of life. Pembrolizumab is a new drug approved in several countries for second-line therapy in non-small cell lung cancer (NSCLC) being programmed cell death ligand (PD-L1) positive. Methods: A retrospective study of medical records of 60 patients treated with immunotherapy as second-line treatment of advanced non-small-cell lung cancer was conducted at the National Institute of Cancerology (INCAN) in Mexico during 2016-2018. PD-L1 biomarker was not mandatory for receiving immunotherapy. The costs associated with the total costs of tretament were estimated as a mean value with confidence intervals of 95% confidence by costing the elements of treatment of the disease and adverse events as well the frequency of consultations, hospital stays, and monitoring obtained in the records. Costs are presented in US dollars. Results: The total mean monthly cost during immunotherapy was $1,649 (95% confidence interval [CI] = $1,484–$1,814), of which 93.8% represented immunotherapy costs, 5.4% drug application and monitoring, 0.8% adverse events treatment. We identified 30 potential patients per year candidates to receive immunotherapy as second line. From which the expected costs of treatment will be $49,476 [CI] = $44,528–$57,392), of which $41,766 are immunotherapy costs, application and monitoring represent $2,400 and the rest for adverse events. Conclusions: The therapeutic approach for the second-line treatment of patients with advanced non-small cell lung cancer (NSCLC) without actionable mutations has been revolutionized by the approval of new more efficacious drugs like pembrolizumab. Healthcare costs during immunotherapy treatment with pembrolizumab were largely attributed to anti-cancer therapy and less for adverse events. Pembrolizumab as second-line treatment of patients with advanced non-small-cell lung cancer, prolong overall survival, leading to fewer adverse events than chemotherapy.

Landmark Studies of Targeted Therapies for Advanced Non-Small Cell Lung Cancer: A Guide for Pulmonologists

2020 ◽  
Vol 16 (1) ◽  
pp. 5-10
Author(s):  
Adrien Costantini ◽  
Theodoros Katsikas ◽  
Clementine Bostantzoglou
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Standard Of Care ◽  
Genetic Alterations ◽  
Small Cell ◽  
Extensive Literature ◽  
Small Cell Lung ◽  
Anaplastic Lymphoma ◽  
Mutational Status

Over the past decade, major breakthroughs in the understanding of lung cancer histology and mutational pathways have radically changed diagnosis and management. More specifically, in non-small cell lung cancer (NSCLC), tumour characterisation has shifted from differentiating based solely on histology to characterisation that includes genetic profiling and mutational status of Epidermal Growth Factor (EGFR), Anaplastic Lymphoma Kinase (ALK), c-ros oncogene 1 (ROS1) and BRAF. These genetic alterations can be targeted by specific drugs that result in improved progression-free survival, as well as higher response rates and are currently standard of care for NSCLC patients harbouring these mutations. In this a narrative, non-systematic review we aim to handpick through the extensive literature and critically present the ground-breaking studies that lead to the institution of tailored treatment options as the standard of care for the main targetable genetic alterations.

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