Oncology – Lung
RCT: Olanzapine Improves Nausea and Vomiting Control in Moderately Emetogenic Chemotherapy but Increases Somnolence
7 Sep, 2024 | 19:28h | UTCStudy Design and Population: This phase 3, multicenter, open-label randomized clinical trial involved 560 chemotherapy-naive patients aged 18 years or older with solid malignant tumors. The trial, conducted at three institutes in India, compared the efficacy of adding olanzapine to standard antiemetic therapy in patients receiving moderately emetogenic chemotherapy (MEC) based on oxaliplatin, carboplatin, or irinotecan.
Main Findings: The group receiving olanzapine in addition to standard antiemetic therapy showed significantly higher complete response (CR) rates (91% vs 82%, P = .005) compared to the observation group. The olanzapine group also demonstrated superior control of nausea (96% vs 87%, P < .001) and chemotherapy-induced nausea and vomiting (CINV) (96% vs 91%, P = .02). The use of rescue medications was significantly lower in the olanzapine group. Grade 1 somnolence occurred in 10% of patients receiving olanzapine but was absent in the observation group.
Implications for Practice: The results support the inclusion of olanzapine in antiemetic regimens for MEC to improve CINV outcomes. However, mild somnolence should be considered when prescribing olanzapine as part of antiemetic prophylaxis. Further research could explore dose optimization to minimize adverse effects.
Reference: Ostwal, V. et al. (2024). Olanzapine as antiemetic prophylaxis in moderately emetogenic chemotherapy: a phase 3 randomized clinical trial. JAMA Network Open. DOI: http://doi.org/10.1001/jamanetworkopen.2024.26076
Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2822027
Retrospective Cohort Study: Rheumatoid Arthritis Linked to Over 50% Increased Lung Cancer Risk, with a Three-Fold Risk in RA-Associated Interstitial Lung Disease – Arthritis Rheumatol
18 Aug, 2024 | 18:58h | UTCStudy Design and Population: This retrospective matched cohort study examined the risk of lung cancer in 72,795 patients with rheumatoid arthritis (RA) and 757 patients with RA-associated interstitial lung disease (RA-ILD) from the Veterans Health Administration database, compared with 633,937 non-RA controls. The study spanned from 2000 to 2019, with patients matched on age, gender, and enrollment year.
Main Findings: The study found that RA was associated with a 58% increase in lung cancer risk (adjusted hazard ratio [aHR] 1.58). The risk was significantly higher in RA-ILD patients, with a more than three-fold increase (aHR 3.25) compared to non-RA controls. Even among never smokers, RA patients showed a 65% increased lung cancer risk, indicating that factors beyond smoking contribute to the elevated risk.
Implications for Practice: The study underscores the significant increase in lung cancer risk among patients with RA, particularly those with RA-ILD. While this elevated risk is notable, further research is necessary to determine the most effective strategies for monitoring and managing this risk. Clinicians should be aware of these findings and consider them when evaluating the overall health and risk factors of patients with RA, especially those with additional pulmonary complications like ILD. Enhanced awareness and individualized risk assessments may help in early detection and management of lung cancer in this high-risk population.
Systematic Review: Immune Checkpoint Inhibitors Plus Chemotherapy Improves Survival in NSCLC for Patients Aged 65-75 – Cochrane Database Syst Rev
18 Aug, 2024 | 15:24h | UTCStudy Design and Population: This Cochrane systematic review evaluated the efficacy and safety of immune checkpoint inhibitors (ICIs) combined with platinum-based chemotherapy versus platinum-based chemotherapy alone (with or without bevacizumab) in treatment-naïve older adults with advanced non-small cell lung cancer (NSCLC). The review included 17 randomized controlled trials (RCTs) with a total of 4,276 participants, focusing on three age groups: 65 years and older, 65-75 years, and 75 years and older.
Main Findings: The addition of ICIs to chemotherapy likely improves overall survival (HR 0.78, 95% CI 0.70 to 0.88) and progression-free survival (HR 0.61, 95% CI 0.54 to 0.68) in patients aged 65 years and older. For those aged 65-75, the benefits are more pronounced (HR 0.75 for overall survival; HR 0.64 for progression-free survival), although there may be an increase in treatment-related adverse events (RR 1.47). However, in patients over 75, the benefits in overall survival and progression-free survival are unclear, with a low-certainty evidence suggesting no significant improvement (HR 0.90 and HR 0.83, respectively).
Implications for Practice: The findings support the use of ICIs combined with chemotherapy in older adults aged 65-75 with advanced NSCLC, but caution is advised for those over 75 due to the lack of clear survival benefit and the potential for increased toxicity. Further research is needed to better understand the risks and benefits in the oldest patients.
RCT: Osimertinib Significantly Extends Progression-Free Survival in Unresectable Stage III EGFR-Mutated NSCLC After Chemoradiotherapy – N Engl J Med
17 Aug, 2024 | 16:30h | UTCStudy Design and Population: This phase 3, double-blind, placebo-controlled trial enrolled 216 patients with unresectable stage III EGFR-mutated non-small-cell lung cancer (NSCLC) who showed no disease progression during or after chemoradiotherapy. Patients were randomly assigned to receive either osimertinib (143 patients) or a placebo (73 patients) until disease progression.
Main Findings: The study found that osimertinib significantly prolonged progression-free survival (PFS) compared to placebo, with a median PFS of 39.1 months versus 5.6 months, respectively. The hazard ratio for disease progression or death was 0.16, indicating a substantial reduction in risk with osimertinib. At 12 months, 74% of patients in the osimertinib group were alive and progression-free, compared to 22% in the placebo group. Interim overall survival data suggested a modest difference favoring osimertinib, though it was not statistically significant.
Implications for Practice: Osimertinib offers a significant survival benefit as a consolidation therapy following chemoradiotherapy in patients with unresectable stage III EGFR-mutated NSCLC. The findings support the use of osimertinib in this setting, despite an increased incidence of adverse events, highlighting its role in improving long-term outcomes.
Study Shows High Prevalence of Solid Lung Nodules in Nonsmoking Adults – Radiology
14 Aug, 2024 | 13:14h | UTCStudy Design and Population: This cohort study examined the prevalence and size distribution of solid lung nodules in a nonsmoking population from the Northern Netherlands. A total of 10,431 participants aged 45 years and older, predominantly nonsmokers, were included in the Imaging in Lifelines (ImaLife) study. The study utilized low-dose chest CT scans to detect and measure lung nodules.
Main Findings: Lung nodules were present in 42% of participants, with a higher prevalence in males (47.5%) than females (37.7%). The prevalence of clinically relevant nodules (≥100 mm³) was 11.1%, and actionable nodules (≥300 mm³) were found in 2.3% of individuals. Both prevalence and nodule size increased with age, and male participants consistently showed a higher prevalence and larger nodule sizes compared to females.
Implications for Practice: While 42% of nonsmoking adults in this Northern European cohort were found to have solid lung nodules, the incidence of lung cancer within this population is notably low. This suggests that many of the clinically relevant and even actionable nodules identified in nonsmokers are likely benign. These findings highlight the need to refine nodule management strategies for individuals at low risk of lung cancer, potentially reducing unnecessary follow-up and interventions in nonsmoking populations. Future research on lung cancer outcomes in this cohort could further inform and optimize guidelines for nodule management in low-risk groups.
M-A: Neoadjuvant chemoimmunotherapy enhances event-free survival in resectable NSCLC with low PD-L1 expression
28 Apr, 2024 | 20:20h | UTCThis meta-analysis evaluated the impact of neoadjuvant chemoimmunotherapy versus chemotherapy on resectable non-small cell lung cancer (NSCLC) patients, particularly focusing on those with tumor PD-L1 levels below 1%. The study synthesized data from 43 trials, encompassing 5431 patients, to assess clinical outcomes such as overall and event-free survival, alongside major and complete pathological responses. Findings highlighted that neoadjuvant chemoimmunotherapy significantly improved event-free survival (hazard ratio, 0.74; 95% CI, 0.62-0.89) compared to chemotherapy alone, particularly in patients with low PD-L1 expression, though overall survival benefits were not observed. The pooled analysis from randomized clinical trials showed favorable outcomes across all examined endpoints, supporting the superiority of neoadjuvant chemoimmunotherapy in these settings.
Reference (link to free full-text):
RCT: No improvement in OS with atezolizumab plus cabozantinib vs. docetaxel in metastatic NSCLC post Anti-PD-L1/PD-1 therapy
28 Apr, 2024 | 20:15h | UTCIn a phase III trial, 366 patients with metastatic non-small cell lung cancer (NSCLC) were evaluated to determine the efficacy of atezolizumab combined with cabozantinib versus docetaxel following progression after anti–PD-L1/PD-1 and platinum-based chemotherapy. The study randomly assigned patients to receive either atezolizumab 1,200 mg every 3 weeks plus cabozantinib 40 mg daily or docetaxel 75 mg/m2 every 3 weeks. The results showed no significant difference in median overall survival (OS) between the two groups, with 10.7 months for the combination therapy and 10.5 months for docetaxel (HR 0.88, 95% CI, 0.68-1.16; P = .3668). The safety profiles were consistent with the known risks associated with these treatments.
Reference (link to free full-text):
NICE Updated Guideline | Diagnosis and management of lung cancer
4 Aug, 2023 | 12:05h | UTCLung cancer: diagnosis and management – National Institute for Health and Care Excellence
ASCO Guideline Update | Management of Stage III Non–Small-Cell Lung Cancer
4 Aug, 2023 | 12:03h | UTC
RCT | Lazertinib offers 20.6-month of median PFS in EGFR-mutated NSCLC vs 9.7 months with gefitinib
2 Aug, 2023 | 13:55h | UTC
Phase 2 Trial | The addition of immunotherapy to stereotactic ablative radiotherapy may enhance EFS in early-stage NSCLC
25 Jul, 2023 | 13:36h | UTCStereotactic ablative radiotherapy with or without immunotherapy for early-stage or isolated lung parenchymal recurrent node-negative non-small-cell lung cancer: an open-label, randomised, phase 2 trial – The Lancet (link to abstract – $ for full-text)
Systematic Review | Platinum doublet therapy outperforms non-platinum for advanced NSCLC, performance status 2 patients
20 Jul, 2023 | 10:56h | UTC
RCT | Atezolizumab in platinum-ineligible NSCLC elevates median survival to 10.3 months vs. 9.2 months with chemotherapy
10 Jul, 2023 | 13:33h | UTCFirst-line atezolizumab monotherapy versus single-agent chemotherapy in patients with non-small-cell lung cancer ineligible for treatment with a platinum-containing regimen (IPSOS): a phase 3, global, multicentre, open-label, randomised controlled study – The Lancet (link to abstract – $ for full-text)
News Release: Immunotherapy for ‘difficult to treat’ lung cancer patients improves long-term survival – University College London
RCT | Perioperative nivolumab plus chemotherapy increases pathological response vs. chemotherapy alone in stage III NSCLC
10 Jul, 2023 | 13:27h | UTCPerioperative Nivolumab and Chemotherapy in Stage III Non–Small-Cell Lung Cancer – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary: Addition of Neoadjuvant Nivolumab to Platinum-Based Chemotherapy in Stage III NSCLC – The ASCO Post
Commentary on Twitter
Original Article: Perioperative Nivolumab and Chemotherapy in Stage III Non–Small-Cell Lung Cancer https://t.co/DCcs0tkyPN #oncology pic.twitter.com/0zG9SUbqQj
— NEJM (@NEJM) June 30, 2023
Perspective | Early-stage lung cancer: using circulating tumor DNA to get personal
26 Jun, 2023 | 00:38h | UTCEarly-Stage Lung Cancer: Using Circulating Tumor DNA to Get Personal – Journal of Clinical Oncology
Clinical insights into small cell lung cancer: tumor heterogeneity, diagnosis, therapy, and future directions
26 Jun, 2023 | 00:31h | UTC
Cohort Study | Stopping immunotherapy in patients that are progression-free at 2 years seems feasible in advanced NSCLC
21 Jun, 2023 | 13:19h | UTCAssociation Between Duration of Immunotherapy and Overall Survival in Advanced Non–Small Cell Lung Cancer – JAMA Oncology (link to abstract – $ for full-text)
Commentary on Twitter
Study of patients with #NSCLC showed no survival difference between 2-yr fixed duration vs indefinite #immunotherapy, suggesting that IO can be d/c at 2 yrs. @PennCancer @flatironhealth @lovasunMD @Ron_cology @CharuAggarwalMD #ASCO23 https://t.co/EWyneghc8a pic.twitter.com/HkyIwwtJiM
— JAMA Oncology (@JAMAOnc) June 4, 2023
RCT | Perioperative pembrolizumab improves pathological outcomes, event-free survival in early-stage NSCLC
6 Jun, 2023 | 14:36h | UTCPerioperative Pembrolizumab for Early-Stage Non–Small-Cell Lung Cancer – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter
Presented at #ASCO23: In the KEYNOTE-671 trial, pts with resectable lung cancer were assigned to neoadjuvant pembrolizumab or placebo plus chemotherapy followed by adjuvant pembrolizumab or placebo. Two-year event-free survival was 62.4% with pembrolizumab & 40.6% with placebo.
— NEJM (@NEJM) June 3, 2023
RCT | Befotertinib tops Icotinib in NSCLC progression-free survival, but increases serious adverse events
6 Jun, 2023 | 14:13h | UTCBefotertinib (D-0316) versus icotinib as first-line therapy for patients with EGFR-mutated locally advanced or metastatic non-small-cell lung cancer: a multicentre, open-label, randomised phase 3 study – The Lancet Respiratory Medicine (link to abstract – $ for full-text)
RCT | Osimertinib improves overall survival in resected EGFR-mutated NSCLC, but validity of control group questioned on social media
5 Jun, 2023 | 13:46h | UTCOverall Survival with Osimertinib in Resected EGFR-Mutated NSCLC – New England Journal of Medicine (link to abstract – $ for full-text)
Commentary on Twitter by Dr. Vinay Prasad (recommended – click to see the video)
Here is the REAL @Plenary_Session on #ADAURA #ASCO23 #ASCO2023
38.5% of people who had recurrence got OSI (very low!)
That just isn't good enough
Brain staging is suboptimal= occult met disease
Would you let your mother be on the control arm and not get OSI on progression? pic.twitter.com/CU3jtrvFOj— Vinay Prasad MD MPH (@VPrasadMDMPH) June 5, 2023
RCT | Gefitinib plus chemotherapy vs. Gefitinib alone in untreated EGFR-mutant NSCLC with brain metastases
16 May, 2023 | 14:30h | UTC
Commentary on Twitter
RCT: In patients with untreated EGFR-mutated non-small cell lung cancer with brain metastases, gefitinib + chemo improved survival and PFS vs gefitinib, with manageable adverse events, and may be a viable first-line treatment. #NSCLC https://t.co/Oe6zHYVsPV pic.twitter.com/oUvs12pYS7
— JAMA Network Open (@JAMANetworkOpen) February 9, 2023
Clinical Trial Update | Pembrolizumab plus chemotherapy in squamous non–small-cell lung cancer
16 May, 2023 | 14:25h | UTCCommentaries:
Original Study: Pembrolizumab plus Chemotherapy for Squamous Non–Small-Cell Lung Cancer – New England Journal of Medicine
Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options
15 May, 2023 | 12:45h | UTC
ASTRO/ESTRO Guideline | Treatment of oligometastatic non-small cell lung cancer
4 May, 2023 | 13:44h | UTC
Commentary on Twitter
ASTRO & ESTRO partnered to issue the first guideline on local therapy for oligometastatic lung cancer, out today in #PracticalRadOnc https://t.co/ZiM2RWX394 @ESTRO_RT @IyengarPuneeth @Mat_Guc pic.twitter.com/5DV3fRdn1o
— ASTRO (@ASTRO_org) April 25, 2023
Clinical Trial Update | Adjuvant Osimertinib for resected EGFR-mutated stage IB-IIIA non–small-cell lung cancer
4 May, 2023 | 13:33h | UTCOriginal Study: Osimertinib in Resected EGFR-Mutated Non–Small-Cell Lung Cancer – New England Journal of Medicine
News Release: Trial shows significant disease-free survival for patients diagnosed with non-small cell lung cancer – Yale University