Lung cancer screening: what is new since the NLST results?
Abstract
In 2011, the investigators of the National Lung Cancer Screening Trial reported significant decreases in lung cancer mortality (20 %) and overall mortality (6.7 %) in a selected high-risk population screened by annual low-dose computed tomography. In so doing, they relaunched the debate on lung cancer screening. In this review, we report on what has changed in this field since the publication of the NLST. We analyze results from ongoing or recent randomized trials, present data on screening optimization (such as population selection or nodule management), and discuss the practical aspects of sc...
Source: Current Respiratory Care Reports - February 18, 2016 Category: Respiratory Medicine Source Type: research
Harnessing the antitumor immunity cycle to treat lung cancer
We report on the main strategies of enhancing antigen presentation, priming, and T cell activation, with a special focus on drugs that target the PD1/PD-L1 axis. This last option shows the best results and has undoubtedly become a new standard of care to treat lung cancer. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - February 11, 2016 Category: Respiratory Medicine Source Type: research
New oncogenes drivers in lung cancer—new therapeutic targets
Abstract
Many advances have been achieved during the last decade in the field of lung cancer molecular biology, leading to the identification of potential new oncogene drivers and new therapeutic targets. However, only two targetable biomarkers are currently approved for lung cancer treatment: EGFR activating mutations and EML4-ALK rearrangements. Adenocarcinoma is the most common type of non-small cell lung cancer and was the first to be studied. Indeed, most of lung adenocarcinoma biomarkers were identified several years ago. Nevertheless, new therapies targeting these biomarkers are still investigated....
Source: Current Respiratory Care Reports - February 4, 2016 Category: Respiratory Medicine Source Type: research
ROS-1 rearrangements in non-small cell lung cancer (NSCLC): a new target for a small subset of patients but a giant leap in therapeutics
Abstract
ROS1 is a membrane tyrosine kinase receptor of which encoding gene has recently been found rearranged in non-small cell lung cancer (NSCLC), leading to constitutive activation of the ROS1 kinase activity. The ROS1 gene rearrangement has been described in roughly 1 % of patients with NSCLC and such rearrangement needs to be assessed by a FISH break-apart assay (CD74-ROS1) with ROS1 immunohistochemistry as a screening tool in tumor histological samples. The clinical and histological features of patients with ROS1-rearranged NCSCL include adenocarcinoma histology with TTF-1 expression, predominantl...
Source: Current Respiratory Care Reports - February 4, 2016 Category: Respiratory Medicine Source Type: research
Pleural disease in infants and children: management updates
This article addresses new treatments for congenital hydrothorax and chylothorax, parapneumonic effusions, and spontaneous pneumothoraces in children. Invasive fetal surgical methods to drain pleural fluid in utero improve survival and reduce the chance of postnatal pulmonary hypoplasia. Video-assisted thoracoscopic surgery and intrapleural instillation of fibrinolytic agents produce similar outcomes for children with empyema and/or parapneumonic effusions. Spontaneous primary pneumothoraces in older children and young adults are increasingly treated with drainage methods that prevent or reduce hospitalizations. Newer trea...
Source: Current Respiratory Care Reports - January 28, 2016 Category: Respiratory Medicine Source Type: research
Nutrition, exercise, and complementary medicine: potential role in mesothelioma?
Abstract
Malignant pleural mesothelioma (MPM) is an aggressive malignancy arising from the pleura and caused predominantly by inhaled asbestos fibers. Prognosis is poor and treatment options are with a palliative intent. Patients with MPM have a high symptom burden; therefore, the relief or control of these symptoms is paramount to improving quality of life (QoL). Malnutrition is also a common concern in this group and may have prognostic significance. Alternative approaches such as nutritional intervention, physical activity, and complementary medicine may have further benefits as adjuncts to current bes...
Source: Current Respiratory Care Reports - January 19, 2016 Category: Respiratory Medicine Source Type: research
New insights on pleural fluid formation: potential translational targets
Abstract
Pleural effusion is a very common clinical problem associated with a multitude of different underlying conditions, including infection, heart failure, and cancer. Current treatments for pleural effusion often aim at symptom relief rather than at treating its underlying cause. Recent investigations have provided new insights into the mechanisms of fluid accumulation in the pleural space and hence hope for clinical translation of the novel therapy to stop fluid formation. Here, we discuss the major mechanistic findings of recent basic, translational, and clinical studies that have aimed at tackling...
Source: Current Respiratory Care Reports - January 18, 2016 Category: Respiratory Medicine Source Type: research
Manometry in pleural drainage: essential practice or over-rated gadget?
Abstract
About 1.5 million people are diagnosed with pleural effusion each year in the USA with approximately 180,000 thoracenteses performed each year. The measurement of pleural pressure during therapeutic thoracentesis has been proposed as a useful benchmark to guide therapeutic thoracentesis. The proposed benefits of pleural manometry include diagnosis of unexpandable lung, prevention of re-expansion pulmonary edema (REPE), and pneumothorax ex vacuo, as well as prediction of successful pleurodesis in malignant effusions. Although pleural manometry undeniably offers insights into pleural space physiolo...
Source: Current Respiratory Care Reports - January 15, 2016 Category: Respiratory Medicine Source Type: research
Measurement of breathlessness in patients with malignant pleural effusions
Abstract
Breathlessness is the main symptom experienced by patients with malignant pleural effusions (MPEs). Measuring breathlessness is important for clinical trials, assessment of treatment efficacy in individual patients and service evaluation. Patient-reported outcome measures (PROMs) used for this purpose need to be appropriate, acceptable, feasible, interpretable, precise, reliable, valid, responsive and have a minimal important difference (MID) determined for this specific patient group. In this article, I describe and assess PROMs which have been used to measure dyspnoea in patients with MPEs and ...
Source: Current Respiratory Care Reports - January 14, 2016 Category: Respiratory Medicine Source Type: research
BAP1 mutations in mesothelioma: advances and controversies
Abstract
Malignant mesothelioma (MM) is a fatal cancer of the pleural and peritoneal cavities caused predominantly by exposure to asbestos. Cohort studies suggest a genetic component to MM susceptibility. BAP1 is a tumour suppressor gene located at 3p21 and is one of the most commonly somatically lost or mutated genes in MM, occurring in approximately 40–60 % of tumours. Germline mutations in BAP1 appear to increase susceptibility to asbestos-induced MM. However, the frequency of germline BAP1 mutation is rare, not being observed in over 300 sporadic MM cases. Germline BAP1 mutation is characteristic o...
Source: Current Respiratory Care Reports - January 13, 2016 Category: Respiratory Medicine Source Type: research
Diagnostic approach to bronchiectasis
Abstract
Bronchiectasis has been noted at increasing rates in recent years. It is associated with significant morbidity and mortality, although there is a wide range in the severity of bronchiectasis in different patients. There are many different potential causes of bronchiectasis. The aim of this review is to provide a structured approach to the clinical assessment of patients with known or suspected bronchiectasis, including evaluation of severity, airway microbiology, and potential causes of bronchiectasis. The discussion includes a rationale for each component of the diagnostic workup, including how ...
Source: Current Respiratory Care Reports - October 29, 2015 Category: Respiratory Medicine Source Type: research
Computed tomography of smoking-related lung disease: review and update
Abstract
Traditionally recognized smoking-related lung diseases include chronic obstructive pulmonary disease (COPD), respiratory bronchiolitis/interstitial lung disease, desquamative interstitial pneumonitis, and pulmonary Langerhans cell histiocytosis. More recently described smoking-related entities include combined pulmonary fibrosis and emphysema and respiratory bronchiolitis with fibrosis. We review the important past and current literature pertaining to these diseases, including recent developments in quantitative imaging of COPD and in CT characterization of smoking-related fibrosis. (Source: Curr...
Source: Current Respiratory Care Reports - October 13, 2015 Category: Respiratory Medicine Source Type: research
Inhaled antibiotics for bronchiectasis: are we there yet?
Abstract
Chronic infection in non-CF bronchiectasis is an important risk factor for disease progression, poor quality life, admission to hospital and perhaps reduced life expectancy. The use of long-term oral and inhaled antibiotics has been included in expert consensus-based guidelines but until recently supporting evidence has been weak. The design, duration and size of adequately powered clinical trials remain challenging, and this has been reflected in some of the reported outcomes. In addition, the tolerability of nebulised antibiotics remains an issue. Despite this, it is now possible to include inh...
Source: Current Respiratory Care Reports - September 9, 2015 Category: Respiratory Medicine Source Type: research
Waterpipe tobacco-smoking: a new smoking epidemic among the young?
Abstract
Waterpipe (hookah, narghile) tobacco smoking (WTS) is becoming prevalent worldwide and is one of the most popular forms of tobacco use among youth. WTS prevalence has increased dramatically among youth in the USA within the past decade. Misperceived as less harmful than cigarette smoking, WTS is associated with many of the same chronic health effects such as lung cancer, chronic obstructive pulmonary disease, cardiovascular disease, bronchitis, and asthma. Much of this risk is due to the fact that a single WTS session exposes users to large volumes of smoke that contain toxic chemicals such as ca...
Source: Current Respiratory Care Reports - September 4, 2015 Category: Respiratory Medicine Source Type: research
Pharmacological therapies in smoking cessation: an evidence-based update
Abstract
Smoking cessation presents a daunting challenge for clinicians; tobacco use impacts every major organ system and is responsible for considerable morbidity and mortality. Despite significant reductions in the rate of smoking over the past 50 years, tobacco use continues to burden the healthcare system. First-line therapies for smoking cessation include nicotine replacement, novel partial nicotinic agonists as well as antidepressant therapy. Herein, we review recent updates to the literature regarding nicotine replacement, bupropion, and varenicline. Re-emerging therapies such as cytisine are revi...
Source: Current Respiratory Care Reports - September 4, 2015 Category: Respiratory Medicine Source Type: research
