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.
AbstractNovel approaches with checkpoint inhibitors in immunotherapy continue to be essential in the treatment of non-small cell lung cancer (NSCLC). However, the low rate of primary response and the development of acquired resistance during the immunotherapy limit their long-term effectiveness. The underlying cause of acquired resistance is poorly understood; potential management strategies for patients with acquired resistance are even less clear. Here, we report the case of a 75-year-old female smoker with cough, fatigue, and weight loss that was found to have an 8.6 cm right upper lobe lung lesion with local in...
A banner year for immunotherapy and targeted therapy, Published online: 11 December 2018; doi:10.1038/s41571-018-0138-4In 2018, advances in the treatment of non-small-cell lung cancer (NSCLC) have been observed both in trials of immunotherapies and targeted agents, leading to dramatically improved options for patients with metastatic and stage III NSCLC.
The immunotherapy has received FDA approval for an expanded indication for use in combination in nonsmall cell lung cancer.News Alerts
Recently, many combination therapies involving an immune checkpoint inhibitor targeting the programmed cell death-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) pathway and another treatment option such as chemotherapy, radiation therapy, and various immunotherapy agents have been explored to improve the response rate and clinical outcomes in various solid tumors including non-small cell lung cancer (NSCLC) [1 –8]. Especially, combination therapy with an indoleamine 2,3-dioxygenase 1 (IDO1) inhibitor and a PD-1/PD-L1 inhibitor is expected to be a novel and effective treatment option and is currently attracting a lot of attention.
The FDA has awarded Roche an accelerated review of its immunotherapy drug, Tecentriq, to treat non small-cell lung cancer.
This study aims to provide a comprehensive report of the haem-irAEs induced by anti-PD-1 or anti-PD-L1.MethodsIn this descriptive observational study, we included consecutive patients aged at least 18 years with grade 2 or worse haem-irAEs induced by anti-PD-1 or anti-PD-L1 immunotherapy registered in three French pharmacovigilance databases: the Registre des Effets Indésirables Sévères des Anticorps Monoclonaux Immunomodulateurs en Cancérologie (REISAMIC; a prospective registry of patients treated with anti-PD-1 or anti-PD-L1 at a single centre), the ImmunoTOX committee of Gustave Roussy (a nat...
Lung large-cell neuroendocrine carcinoma (L-LCNEC) accounts for 2 –3 % of all lung cancers. It is a high-grade neuroendocrine carcinoma with some cytological features of non-small-cell lung cancer (NSCLC), but it also has biological, clinical, and prognostic characteristics of small-cell lung cancer (SCLC). Diagnosis is based on histological features consistent with NSCLC and identification, by immunohistochemistry (IHC), of at least one neuroendocrine marker. The prognosis is poor, with 5-year overall survival rates of 13–57% for all, 27–62% for early, and
We present a comprehensive knowledge of immune therapy through PD-1/PD-L1 blockade that argues how efficient the process is, in colon cancer carcinoma. In this review, we discuss the responsiveness of immunotherapy on PD-1/PD-L1 blockade and various tactics for overcoming weak responses to these checkpoint inhibitors in CRC. More research using controlled trials is required to enable new discoveries to provide continued success with immune-based therapies and grounds for optimism about the future of CRC patients.Graphical abstractThe mechanism of interaction between PD-1+ T-cells and PD-L1/2+ tumor cells.
ConclusionsDurvalumab plus olaparib has acceptable toxicity, and the combination demonstrates efficacy, particularly in men with DDR abnormalities.Trial registrationClinicalTrials.gov identifier:NCT02484404.
AbstractRecent randomized phase III trials (KEYNOTE-407 and IMpower131) reported that adding anti-programmed death (ligand) 1 (anti-PD-(L)1) antibodies in combination with taxane-platinum improve the therapeutic efficacy for advanced squamous non-small-cell lung cancer (NSCLC). However, there is no head-to-head comparison of pembrolizumab (anti-PD-1) plus chemotherapy vs. atezolizumab (anti-PD-L1) plus chemotherapy. Therefore, we performed an indirect comparison to explore the optimal choice of anti-PD-(L)1 treatment for advanced squamous NSCLC in combination with chemotherapy. The clinical outcomes were overall survival (...