scholarly journals Recent Advances in the Diagnosis and Management of Multiple Primary Lung Cancer

Cancers ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 242
Author(s):  
Chi-Lu Chiang ◽  
Ping-Chung Tsai ◽  
Yi-Chen Yeh ◽  
Yuan-Hung Wu ◽  
Han-Shui Hsu ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Primary Lung Cancer ◽  
Lung Cancer Screening ◽  
Stereotactic Ablative Radiotherapy ◽  
Early Stage Lung Cancer ◽  
Local Ablation ◽  
Diagnosis And Management ◽  
Recent Advances ◽  
Multiple Primary

With the wide application of computed tomography in lung cancer screening, the incidence of multiple primary lung cancer (MPLC) has been increasingly reported. Despite the established criteria, the differentiation between MPLC and intrapulmonary metastasis remains challenging. Although histologic features are helpful in some circumstances, a molecular analysis is often needed. The application of next-generation sequencing could aid in distinguishing MPLCs from intrapulmonary metastasis, decreasing ambiguity. For MPLC management, surgery with lobectomy is the main operation method. Limited resection does not appear to negatively affect survival, and it is a reasonable alternative. Stereotactic ablative radiotherapy (SABR) has become a standard of care for patients refusing surgery or for those with medically inoperable early-stage lung cancer. However, the efficacy of SABR in MPLC management could only be found in retrospective series. Other local ablation techniques are an emerging alternative for the control of residual lesions. Furthermore, systemic therapies, such as targeted therapy for oncogene-addicted patients, and immunotherapy have shown promising results in MPLC management after resection. In this paper, the recent advances in the diagnosis and management of MPLC are reviewed.

scholarly journals Stereotactic ablative radiotherapy: A potentially curable approach to early stage multiple primary lung cancer

Cancer ◽  
2013 ◽  
Vol 119 (18) ◽  
pp. 3402-3410 ◽  
Author(s):  
Joe Y. Chang ◽  
Yung-Hsien Liu ◽  
Zhengfei Zhu ◽  
James W. Welsh ◽  
Daniel R. Gomez ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Primary Lung Cancer ◽  
Stereotactic Ablative Radiotherapy ◽  
Multiple Primary

The efficacy of PD-1 antibody sintilimab on ground glass opacity lesions in patients with early-stage multiple primary lung cancer (CCTC-1901, NCT04026841).

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 8545-8545
Author(s):  
Bo Cheng ◽  
Bo Cheng ◽  
Caichen Li ◽  
Yi Zhao ◽  
Jianxing He
Keyword(s):  
Lung Cancer ◽  
Checkpoint Inhibitors ◽  
Early Stage ◽  
Objective Response ◽  
Primary Lung Cancer ◽  
Ground Glass Opacity ◽  
Early Stage Lung Cancer ◽  
Immune Biomarkers ◽  
Multiple Primary ◽  
Stage Lung Cancer

8545 Background: Immune checkpoint inhibitors (ICIs) targeting programmed cell death protein 1 (PD-1) have been proven its significant efficacy on advanced non-small cell lung cancer (NSCLC). However, it remains unknown and is of great interest whether the PD-1 antibody affects early-stage lung cancer. Here, we reported the preliminary efficacy and safety outcomes of sintilimab on these early-stage GGO lesions in patients (pts) with multiple primary lung cancer in the CCTC-1901 study, the first trial evaluating PD-1 antibody in preinvasive or low invasive lung cancer worldwide. Methods: This single-center, phase II, Simon's two-stage design trial included pts who had a pathological diagnosis of resected lung cancer and at least one unresectable GGO lesion suspicious malignant which evaluated by a multidisciplinary team's consensus. The enrolled pts received 4 cycles of intravenous sintilimab 200 mg every 3 weeks. The primary endpoint is the objective response rate (ORR) of unresectable GGO lesions. For persistent GGO lesions that did not respond to treatment, either observation or second operation was taken. Also, immune biomarkers (T/B/NK subpopulation etc.) were monitored during treatment to validate the immune activity. Results: A total of 36 pts were included, with median age 59.5 (53.5-69), 66.7% females, 80.6% never smokers. All resected lesions were adenocarcinomas, of which 52.8% were EGFR mutated. 49 unresected GGOs (pure 11[22.4%], mixed 38[77.6%]) were defined as target lesions from 36 enrolled pts, with a mean size of 13.20±5.06 mm. The ORR (RECIST v1.1) was 5.6% (2/36, 1 PR and 1 CR); none of the pts had PD. Additionally, 3 non-target lesions (unresected solid lesions) from 3 included pts showed PR after the treatment of sintilimab, and the rest lesions (target or non-target) of 31 pts performed SD. Grade 1-2 fatigue (13, 36%), rash (13, 36%) and arthralgia (8, 22%) were the most common treatment-related adverse events (TrAEs), and no grade 3-5 TrAEs occurred. The proportion of CD8+ T-cell and the ratio of CD8+/CD4+ in 5 patients who showed PR of unresected lesions were significantly higher compared to those with SD lesions at baseline (CD8+ 36.6% vs 24.6%, p < 0.01; CD8+/CD4+ 1.09±0.18 vs 0.64±0.22, p < 0.01). Conclusions: This study is the first to confirm that PD-1 antibody sintilimab has immune-related antitumor activity on GGO-featured lung cancer and could be well tolerated among pts with early-stage lung cancer. Clinical trial information: NCT04026841.

scholarly journals Outcomes of Stereotactic Ablative Radiotherapy for Centrally Located Early-Stage Lung Cancer

2011 ◽  
Vol 6 (12) ◽  
pp. 2036-2043 ◽  
Author(s):  
Cornelis J.A. Haasbeek ◽  
Frank J. Lagerwaard ◽  
Ben J. Slotman ◽  
Suresh Senan
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Stereotactic Ablative Radiotherapy ◽  
Early Stage Lung Cancer ◽  
Stage Lung Cancer

scholarly journals Molecular Identification and Genetic Characterization of Early-Stage Multiple Primary Lung Cancer by Large-Panel Next-Generation Sequencing Analysis

2021 ◽  
Vol 11 ◽  
Author(s):  
Guotian Pei ◽  
Mingwei Li ◽  
Xianjun Min ◽  
Qiang Liu ◽  
Dasheng Li ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Next Generation Sequencing ◽  
Early Stage ◽  
Primary Lung Cancer ◽  
Advanced Stage ◽  
Next Generation ◽  
Molecular Method ◽  
Multiple Primary ◽  
Large Panel ◽  
Generation Sequencing

ObjectiveThe incidence of early stage multiple primary lung cancer (MPLC) has been increasing in recent years, while the ideal strategy for its diagnosis and treatment remains controversial. The present study conducted genomic analysis to identify a new molecular classification method for accurately predicting the diagnosis and therapy for patients with early stage MPLC.MethodsA total of 240 tissue samples from 203 patients with multiple-non-small-cell lung cancers (NSCLCs) (n = 30), early stage single-NSCLC (Group A, n = 94), and advanced-stage NSCLC (Group B, n = 79) were subjected to targeted multigene panel sequencing.ResultsThirty patients for whom next-generation sequencing was performed on &gt;1 tumor were identified, yielding 45 tumor pairs. The frequencies of EGFR, TP53, RBM10, ERBB2, and CDKN2A mutations exhibited significant differences between early and advanced-stage NSCLCs. The prevalence of the EGFR L858R mutation in early stage NSCLC was remarkably higher than that in advanced-stage NSCLC (P = 0.047). The molecular method classified tumor pairs into 26 definite MPLC tumors and four intrapulmonary metastasis (IM) tumors. A high rate of discordance in driver genetic alterations was found in the different tumor lesions of MPLC patients. The prospective Martini histologic prediction of MPLC was discordant with the molecular method for three patients (16.7%), particularly in the prediction of IM (91.7% discordant).ConclusionsComprehensive molecular evaluation allows the unambiguous delineation of clonal relationships among tumors. In comparison, the Martini and Melamed criteria have notable limitations in the recognition of IM. Our results support the adoption of a large panel to supplement histology for strongly discriminating NSCLC clonal relationships in clinical practice.

scholarly journals Surgical treatment to multiple primary lung cancer patients: a systematic review and meta-analysis

BMC Surgery ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ting-Fei Chen ◽  
Chun-Ying Xie ◽  
Bing-Yu Rao ◽  
Shi-Chao Shan ◽  
Xin Zhang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Early Stage ◽  
Wedge Resection ◽  
Meta Analysis ◽  
Primary Lung Cancer ◽  
Systemic Review ◽  
Sublobar Resection ◽  
Resection Group ◽  
Standard Resection ◽  
Multiple Primary

Abstract Background As there is no consensus on the optimal surgery strategy for multiple primary lung cancer (MPLC), we conducted this study to address this issue by comparing the prognosis of MPLC patients underwent different surgical strategies including sublobar resection and the standard resection through a systemic review and meta-analysis. Methods Relevant literature was obtained from three databases including PubMed, Embase and Web of Science. Inclusion and exclusion criteria were set for the screening of articles to be selected for further conduction of systemic review and meta-analysis. The HRs of OS of the sublobar group compared with standard resection group were extracted directly or calculated indirectly from included researches. Results Ten researches published from 2000 to 2017 were included in this study, with 468 and 445 MPLC cases for the standard resection group and sublobar resection group respectively. The result suggested that OS of MPLC patients underwent sublobar resection (segmentectomy or wedge resection for at least one lesion) was comparable with those underwent standard resection approach (lobectomy or pneumonectomy for all lesions), with HR 1.07, 95% CI 0.67–1.71, p = 0.784. Further analysis found no difference in subgroups of synchronous and metachronous (from second metachronous lesion), different population region and dominant sex type. Conclusions This study may reveal that sublobar resection is acceptable for patients with MPLC at an early stage, because of the equivalent prognosis to the standard resection and better pulmonary function preservation. Further research is needed to validate these findings.

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