Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
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Randomized Controlled Trial
Safety and resource utilization by non-small cell lung cancer histology: results from the randomized phase III study of pemetrexed plus cisplatin versus gemcitabine plus cisplatin in chemonaïve patients with advanced non-small cell lung cancer.
A prespecified analysis of the large, randomized, phase III study in advanced non-small cell lung cancer showed significant improvement in survival for nonsquamous patients treated with pemetrexed/cisplatin versus gemcitabine/cisplatin. Selected grade 3/4 toxicities and resource utilization favored pemetrexed in the overall population, but detailed safety results by histology have not been reported. ⋯ Although previous efficacy analyses showed a significant pemetrexed treatment advantage for nonsquamous patients, results of this analysis indicate that safety and resource utilization do not vary by histology and are consistent with the overall population. The safety and resource utilization of patients treated with pemetrexed/cisplatin are predictable, reproducible, and consistent with the established favorable safety profile of pemetrexed, regardless of histology.
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The Masaoka clinical staging classification is the most widely accepted nowadays and is an excellent predictor for the prognosis of thymoma. Nevertheless, an update of this classification is desirable for it to be suitable for all thymic epithelial tumors including thymic carcinoma and carcinoid. The tumor-node metastasis (TNM) system classification and clinical staging system for thymic epithelial tumors have not been established yet. Until now, four TNM staging systems have been proposed: Yamakawa and Masaoka in 1991 (Y-M system), Tsuchiya et al. in National Cancer Center Hospital of Japan in 1994 (NCCHJ system), the World Health Organization Consensus Committee in 2004 (World Health Organization system), and Bedini et al. in National Cancer Institute of Italy in 2005 (NCII system). ⋯ This TNM staging system is an excellent predictor for the prognosis of thymic epithelial tumors including thymic carcinoma. The N and/or M factors influence the prognosis more than T factor. For the subclassification of the N and/or M factors, large-scale studies including the resectable and unresectable tumors are necessary.
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Consensus for EGFR mutation testing in non-small cell lung cancer: results from a European workshop.
Activating somatic mutations of the tyrosine kinase domain of epidermal growth factor receptor (EGFR) have recently been characterized in a subset of patients with advanced non-small cell lung cancer (NSCLC). Patients harboring these mutations in their tumors show excellent response to EGFR tyrosine kinase inhibitors (EGFR-TKIs). The EGFR-TKI gefitinib has been approved in Europe for the treatment of adult patients with locally advanced or metastatic NSCLC with activating mutations of the EGFR TK. Because EGFR mutation testing is not yet well established across Europe, biomarker-directed therapy only slowly emerges for the subset of NSCLC patients most likely to benefit: those with EGFR mutations. ⋯ The recommendations of the workshop will help implement EGFR mutation testing in Europe and, thereby, optimize the use of EGFR-TKIs in clinical practice.
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No comprehensive data are available on the molecular predictors of sensitivity to MET inhibitor in lung carcinomas. ⋯ MET amplification is an excellent predictor of PHA665752 sensitivity but not the sole predictor. High phospho-MET and dependence of the AKT and ERK pathways on MET activation may predict sensitivity to PHA665752, especially in KRAS-mutated cell lines.
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A large group of interacting molecular factors, involved in epithelial-mesenchymal transition, epidermal growth factor receptor (EGFR) signaling, and G1 mitotic phase, are shown to play an important role in cancerogenesis and progression of non-small cell lung cancer (NSCLC). Since success concerning potential correlations, structural and numeric gene aberrations, and biological risk assessment of these molecular factors are still lacking, combined analysis of a multitude of intertwined factors is currently a promising approach. ⋯ The results emphasize that deregulation of controlling factors of the early G1 phase is of significant oncogenic relevance and may represent a potential treatment target in NSCLC.