Multimodality Treatment of Advanced Non-small Cell Lung Cancer: Where are we with the Evidence?

This article outlines the current and outstanding evidence for the use of multimodality treatment in this group of patients, including in combination with an increasing number of treatment options, such as immunotherapy and genotype-targeted small molecule inhibitors.Recent findingsOptimal therapy for surgically resectable stage III disease remains debatable and currently the choice of treatment reflects each individual patient ’s disease characteristics and the expertise and opinion of the thoracic multi-disciplinary team. Evidence for a distinct oligometastatic state in which improved outcomes can be achieved remains minimal and there is as yet no consensus definition for oligometastatic lung cancer. Whilst there is su pporting evidence for the aggressive management of isolated metastases, the use of consolidative therapy for multiple metastases remains unproven.SummaryEvolution of new RT technologies, improved surgical technique and a plethora of interventional-radiology-guided ablative therapies are widening the choice of available treatment modalities to patients with NSCLC. In the setting of resectable locally advanced disease and the oligometastatic state, there is a growing need for randomised comparison of the available treatment modalities to guide both treatment and patient selection.
Source: Current Surgery Reports - Category: Surgery Source Type: research

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AbstractLung cancer is predominantly a disease of the elderly. This subgroup of patients poses many challenges and an appropriate geriatric assessment is crucial for treatment personalisation in order to reduce the risk of over- or under-treatment. Whilst cytotoxic chemotherapy has been the backbone of advanced non-small cell lung cancer (NSCLC) treatment for decades, the development of targeted agents for driver mutations such asEGFR,ALK,BRAF andROS1 has changed the treatment paradigm and natural history of this disease. More recently, the development of immune checkpoint inhibitors has revolutionised treatment for a larg...
Source: Drugs and Aging - Category: Geriatrics Source Type: research
Lung cancer remains the leading cause of cancer death worldwide [1]. Recently, major advances in the early diagnosis of non-small cell lung cancer and newly developed treatments such as molecular targeted therapy and immunotherapy, have improved the survival of patients with advanced non-small cell lung cancer [2,3]. EGFR tyrosine kinase inhibitors (EGFR-TKIs) have been developed and have revolutionized the treatment of non-small cell lung cancer in patients with EGFR mutations, resulting in the improved survival (3 to 5 years) [4 –11].
Source: Lung Cancer - Category: Cancer & Oncology Authors: Source Type: research
Publication date: Available online 10 August 2018Source: Journal of Geriatric OncologyAuthor(s): Joobin Sattar, Adi Kartolo, Wilma M. Hopman, Joshua Matthew Lakoff, Tara BaetzAbstractImportanceImmunotherapy has emerged as an effective treatment option for the management of advanced cancers. The effects of these immune checkpoint inhibitors in the older patient population has not been adequately assessed.ObjectiveTo understand the impact of aging on CTLA-4 and PDL-1 inhibitors efficacy and immune-related adverse events (irAE) in the context of real-world management of advanced solid cancers.Design, Setting, and Participants...
Source: Journal of Geriatric Oncology - Category: Cancer & Oncology Source Type: research
We examined the use of DNA methylation profiles to determine the efficacy of anti-PD-1 treatment in patients recruited with current stage IV NSCLC.MethodsIn this multicentre study, we recruited adult patients from 15 hospitals in France, Spain, and Italy who had histologically proven stage IV NSCLC and had been exposed to PD-1 blockade during the course of the disease. The study structure comprised a discovery cohort to assess the correlation between epigenetic features and clinical benefit with PD-1 blockade and two validation cohorts to assess the validity of our assumptions. We first established an epigenomic profile ba...
Source: The Lancet Respiratory Medicine - Category: Respiratory Medicine Source Type: research
Purpose of review The advent of immunotherapy significantly improved clinical outcomes in cancer patients, although immune checkpoint blockade (ICB) still lack of efficacy in a consistent proportion of treated patients. The purpose of this article is to review the most innovative and clinically promising ICB-based combinations designed to improve the efficacy of cancer immunotherapy. Recent findings First-line combinatorial treatment with ipilimumab and nivolumab has recently shown to be superior to the standard of care in a subset of metastatic nonsmall cell lung cancer (NSCLC) and renal cell carcinoma (RCC). The com...
Source: Current Opinion in Oncology - Category: Cancer & Oncology Tags: INNOVATIVE AGENTS AND TREATMENT MODALITIES: Edited by Ahmad Awada and Steven T. Rosen Source Type: research
Publication date: Available online 9 August 2018Source: CellAuthor(s): Krijn K. Dijkstra, Chiara M. Cattaneo, Fleur Weeber, Myriam Chalabi, Joris van de Haar, Lorenzo F. Fanchi, Maarten Slagter, Daphne L. van der Velden, Sovann Kaing, Sander Kelderman, Nienke van Rooij, Monique E. van Leerdam, Annekatrien Depla, Egbert F. Smit, Koen J. Hartemink, Rosa de Groot, Monika C. Wolkers, Norman Sachs, Petur Snaebjornsson, Kim MonkhorstSummaryCancer immunotherapies have shown substantial clinical activity for a subset of patients with epithelial cancers. Still, technological platforms to study cancer T-cell interactions for individ...
Source: Cell - Category: Cytology Source Type: research
CONCLUSIONS: ctDNA VAF changes are strongly correlated with duration of treatment, antitumor activity and clinical outcomes in NSCLC and UC. Early on-treatment reduction in ctDNA VAF may be a useful predictor of long-term benefit from immunotherapy. Prospective studies should validate these findings and the value of utilizing early changes in ctDNA for therapeutic decision-making by identifying non-responders to checkpoint inhibitor monotherapies and guiding combination therapies. PMID: 30093454 [PubMed - as supplied by publisher]
Source: Clinical Cancer Research - Category: Cancer & Oncology Authors: Tags: Clin Cancer Res Source Type: research
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Source: Cancer Immunology, Immunotherapy - Category: Cancer & Oncology Source Type: research
Authors: Rybarczyk-Kasiuchnicz A, Ramlau R Abstract Lung cancer is the main cause of cancer-related deaths in Poland. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are a new group of agents for non-small-cell lung cancer (NSCLC) patients. Determining the predictive value of activating mutations in the EGFR and ROS-1 genes and ALK rearrangement in non-small-cell lung cancer has enabled the identification of patients likely to achieve true clinical benefits. EGFR-TKIs may produce objective response in more than 60% of patients and prolong progression-free survival to 10 months in mutation-posit...
Source: Polish Journal of Cardio-Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Tags: Kardiochir Torakochirurgia Pol Source Type: research
Benjamin Philip Levy, MD, talks about the data from Keynote 189, specifically, how chemotherapy should be combined with immunotherapy in the treatment of 1st line non-small cell lung cancer (NSCLC) Author: obr Added: 07/27/2018
Source: Oncology Tube - Category: Cancer & Oncology Source Type: podcasts
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