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Oncology – Lung

RCT: Telehealth-Delivered Early Palliative Care Equivalent to In-Person Care in Advanced Lung Cancer

26 Sep, 2024 | 15:06h | UTC

Background: Patients with advanced lung cancer often face a high symptom burden and decreased quality of life (QOL), but access to early palliative care, which can improve these outcomes, remains limited. While telehealth has become increasingly utilized due to the COVID-19 pandemic, it is unclear whether virtual palliative care is as effective as in-person care.

Objective: To compare the effect of early palliative care delivered via secure video vs in-person visits on the quality of life of patients with advanced non–small cell lung cancer (NSCLC).

Methods: This multisite, randomized comparative effectiveness trial enrolled 1250 adults with advanced NSCLC from 22 cancer centers in the US between June 2018 and May 2023. Participants were randomized to receive either early palliative care via video visits or in person every four weeks. The primary outcome was QOL measured by the Functional Assessment of Cancer Therapy-Lung (FACT-L) questionnaire at 24 weeks. Secondary outcomes included caregiver participation in palliative care visits and patient and caregiver satisfaction with care, mood symptoms, coping, and prognostic understanding.

Results: By week 24, patients in both groups reported equivalent QOL scores, with the video visit group scoring a mean of 99.7 compared to 97.7 in the in-person group (difference of 2.0 points, 90% CI, 0.1-3.9; P = .04 for equivalence). Both groups experienced similar improvements in QOL from baseline (mean increase of 8.4 points for video visits and 6.9 points for in-person care). Caregiver participation in palliative care visits was lower in the video visit group (36.6% vs 49.7%; P < .001). No significant differences were found between the groups in caregiver QOL, patient or caregiver satisfaction with care, mood symptoms, or coping strategies.

Conclusions: Early palliative care delivered via telehealth was equivalent to in-person visits in improving QOL for patients with advanced NSCLC. This underscores the potential of telehealth to increase access to essential palliative care services for this population without compromising care quality.

Implications for Practice: Telehealth can provide a feasible alternative to in-person palliative care, especially for patients with advanced lung cancer who face barriers to in-person visits, such as transportation challenges. However, strategies to enhance caregiver involvement in virtual visits may need to be developed.

Study Strengths and Limitations: Strengths include the large, multisite randomized design and the use of validated outcome measures. Limitations involve the COVID-19 pandemic’s impact, which caused some intervention contamination due to unavoidable video visits in the in-person group. Additionally, caregiver participation was lower than expected, potentially limiting the generalizability of results regarding caregiver outcomes.

Future Research: Further studies should explore the long-term impact of telehealth on palliative care outcomes and investigate ways to enhance caregiver involvement in virtual care.

Reference: Greer, J. A., et al. (2024). Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer: A Multisite Randomized Clinical Trial. JAMA. DOI: http://doi.org/10.1001/jama.2024.13964

 

RCT: Olanzapine Improves Nausea and Vomiting Control in Moderately Emetogenic Chemotherapy but Increases Somnolence

7 Sep, 2024 | 19:28h | UTC

Study 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 | UTC

Study 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.

Reference: Brooks RT, Luedders B, Wheeler A, et al. (2024). The Risk of Lung Cancer in Rheumatoid Arthritis and Rheumatoid Arthritis–Associated Interstitial Lung Disease. Arthritis & Rheumatology, 0(0), 1-9. DOI: 10.1002/art.42961.

 

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 | UTC

Study 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.

Reference: Orillard E, Adhikari A, Malouf RS, Calais F, Marchal C, Westeel V. (2024). Immune checkpoint inhibitors plus platinum-based chemotherapy compared to platinum-based chemotherapy with or without bevacizumab for first-line treatment of older people with advanced non-small cell lung cancer. Cochrane Database of Systematic Reviews, Issue 8, Art. No.: CD015495. DOI: 10.1002/14651858.CD015495.

 

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 | UTC

Study 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.

Reference: Lu, S., Kato, T., Dong, X., Ahn, M.J., Quang, L.V., Soparattanapaisarn, N., Inoue, T., et al. (2024). Osimertinib after chemoradiotherapy in stage III EGFR-mutated NSCLC. New England Journal of Medicine, 391(7), 585-597. DOI: 10.1056/NEJMoa2402614.

 

Study Shows High Prevalence of Solid Lung Nodules in Nonsmoking Adults – Radiology

14 Aug, 2024 | 13:14h | UTC

Study 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.

Reference: Cai, J., Vonder, M., Pelgrim, G. J., Rook, M., Kramer, G., Groen, H. J. M., de Bock, G. H., & Vliegenthart, R. (2024). Distribution of solid lung nodules: Presence and size by age and sex in a Northern European nonsmoking population. Radiology, 312(2), e231436. DOI: 10.1148/radiol.231436.

 

M-A: Neoadjuvant chemoimmunotherapy enhances event-free survival in resectable NSCLC with low PD-L1 expression

28 Apr, 2024 | 20:20h | UTC

This 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):

Sorin, M., Prosty, C., Ghaleb, L., et al. (2024). Neoadjuvant Chemoimmunotherapy for NSCLC A Systematic Review and Meta-Analysis. JAMA Oncology. doi:10.1001/jamaoncol.2024.0057.

 

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 | UTC

In 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):

Joel Neal et al. (2024). CONTACT-01: A Randomized Phase III Trial of Atezolizumab + Cabozantinib Versus Docetaxel for Metastatic Non–Small Cell Lung Cancer After a Checkpoint Inhibitor and Chemotherapy. Journal of Clinical Oncology. DOI: 10.1200/JCO.23.02166

 

NICE Updated Guideline | Diagnosis and management of lung cancer

4 Aug, 2023 | 12:05h | UTC

Lung 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

Management of Stage III Non–Small-Cell Lung Cancer: ASCO Guideline Rapid Recommendation Update – Journal of Clinical Oncology

Commentary: Rapid Guideline Update Offers Key Evidence-Based Recommendations for Stage III NSCLC Management – ASCO Daily News

 

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

Lazertinib Versus Gefitinib as First-Line Treatment in Patients With EGFR-Mutated Advanced Non–Small-Cell Lung Cancer: Results From LASER301 – Journal of Clinical Medicine

 

Phase 2 Trial | The addition of immunotherapy to stereotactic ablative radiotherapy may enhance EFS in early-stage NSCLC

25 Jul, 2023 | 13:36h | UTC

Stereotactic 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

Best first‐line therapy for people with advanced non‐small cell lung cancer, performance status 2 without a targetable mutation or with an unknown mutation status – Cochrane Library

Summary: Best therapy for people with advanced non-small cell lung cancer who have not been treated without a targetable mutation and moderately impaired performance status – Cochrane Library

 

RCT | Atezolizumab in platinum-ineligible NSCLC elevates median survival to 10.3 months vs. 9.2 months with chemotherapy

10 Jul, 2023 | 13:33h | UTC

First-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 | UTC

Perioperative 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

 

Perspective | Early-stage lung cancer: using circulating tumor DNA to get personal

26 Jun, 2023 | 00:38h | UTC

Early-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

Clinical insights into small cell lung cancer: Tumor heterogeneity, diagnosis, therapy, and future directions – CA: A Cancer Journal for Clinicians

 

Cohort Study | Stopping immunotherapy in patients that are progression-free at 2 years seems feasible in advanced NSCLC

21 Jun, 2023 | 13:19h | UTC

Association Between Duration of Immunotherapy and Overall Survival in Advanced Non–Small Cell Lung Cancer – JAMA Oncology (link to abstract – $ for full-text)

News Release: Real-World Data Suggests Stopping Immunotherapy after Two Years is Reasonable in Patients with Advanced Lung Cancer – Penn Medicine

 

Commentary on Twitter

 

RCT | Perioperative pembrolizumab improves pathological outcomes, event-free survival in early-stage NSCLC

6 Jun, 2023 | 14:36h | UTC

Perioperative Pembrolizumab for Early-Stage Non–Small-Cell Lung Cancer – New England Journal of Medicine (link to abstract – $ for full-text)

 

Commentary on Twitter

 

RCT | Befotertinib tops Icotinib in NSCLC progression-free survival, but increases serious adverse events

6 Jun, 2023 | 14:13h | UTC

Befotertinib (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 | UTC

Overall 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)

 

RCT | Gefitinib plus chemotherapy vs. Gefitinib alone in untreated EGFR-mutant NSCLC with brain metastases

16 May, 2023 | 14:30h | UTC

Gefitinib Plus Chemotherapy vs Gefitinib Alone in Untreated EGFR-Mutant Non–Small Cell Lung Cancer in Patients With Brain Metastases: The GAP BRAIN Open-Label, Randomized, Multicenter, Phase 3 Study – JAMA Network Open

 

Commentary on Twitter

 

Clinical Trial Update | Pembrolizumab plus chemotherapy in squamous non–small-cell lung cancer

16 May, 2023 | 14:25h | UTC

Pembrolizumab Plus Chemotherapy in Squamous Non–Small-Cell Lung Cancer: 5-Year Update of the Phase III KEYNOTE-407 Study – Journal of Clinical Oncology

Commentaries:

At 5-Year Follow-Up, Benefits of Pembrolizumab on Clinical Outcomes in Squamous NSCLC Maintained – ASCO Daily News

Addition of Pembrolizumab to Chemotherapy in First-Line Treatment of Metastatic Squamous NSCLC: 5-Year Update of KEYNOTE-407 – The ASCO Post

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

Post-pneumonectomy syndrome: a systematic review of the current evidence and treatment options – Journal of Cardiothoracic Surgery

 

ASTRO/ESTRO Guideline | Treatment of oligometastatic non-small cell lung cancer

4 May, 2023 | 13:44h | UTC

Treatment of Oligometastatic Non-Small Cell Lung Cancer: An ASTRO/ESTRO Clinical Practice Guideline – Practical Radiation Oncology

News Release: ASTRO and ESTRO issue clinical guideline on local therapy for oligometastatic lung cancer – American Society for Radiation Oncology (ASTRO)

Commentary: ASTRO and ESTRO Issue New Clinical Guidelines on Local Therapy for Patients With Oligometastatic NSCLC – The ASCO Post

 

Commentary on Twitter

 

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