Seminars in respiratory and critical care medicine
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The noninvasive diagnosis of lung cancer remains a formidable challenge. Although tissue diagnosis will remain the gold standard for the foreseeable future, questions pertaining to the risks and costs associated with invasive diagnostic procedures are of prime relevance. ⋯ We discuss how biomarkers could assist in distinguishing benign from malignant nodules and aggressive from indolent tumors. The field of biomarkers is rapidly expanding and progressing, and efforts are well underway to apply molecular diagnostics to address the shortcomings of current lung cancer diagnostic tools.
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Semin Respir Crit Care Med · Oct 2016
ReviewMetastatic Lung Cancer: Emerging Therapeutic Strategies.
Advanced stage nonsmall cell lung cancer had been treated mainly with platinum-based doublet chemotherapy, and other cytotoxic agents that offered significant survival advantage over best supportive care, until recently. Modest improvements were achieved with the addition of antibodies targeting the vascular endothelial growth factor, and the introduction of maintenance chemotherapy. Improvements in our knowledge of lung cancer biology have shifted the current treatment paradigm from being based on histology to one based on molecular biomarkers. ⋯ For certain other mutations such as MET exon 14 and BRAF, promising inhibitory strategies are being investigated. In addition, the recent emergence of immune checkpoint inhibitors to reverse exhaustion of T cells has been a major breakthrough in rapidly changing the therapeutic landscape for lung cancer. This article reviews the role of systemic therapy in advanced stage lung cancer.
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Small cell lung cancer (SCLC) is a high-grade neuroendocrine tumor characterized by rapid growth, early metastatic spread, and initial responsiveness to therapy. Although the incidence of SCLC is declining, it remains one of the common causes of cancer-related mortality. Initial evaluation of patients with SCLC should focus on determining the extent of disease and the ability of the patient to tolerate specific therapy. ⋯ Many chemotherapeutic drugs have activity in SCLC, but little progress has been made in the systemic treatment of SCLC in almost three decades. Although many potential molecular targets have been identified in the preclinical studies of SCLC, molecularly targeted therapy has yet to demonstrate consistent clinical activity. Nevertheless, future advances in SCLC will depend on the development of rational therapeutic strategies which target the molecular mechanisms that drive cellular proliferation, survival, and immunological avoidance.
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Semin Respir Crit Care Med · Oct 2016
ReviewObstacles to and Solutions for a Successful Lung Cancer Screening Program.
Lung cancer screening with a low radiation dose chest CT scan has been shown to reduce the number of people, in a well-defined very high-risk cohort, who die from lung cancer. Many potential screening-related harms have been identified, including anxiety and morbidity related to the evaluation of screen-detected findings. ⋯ For each obstacle, an approach is suggested, based on evidence and mandates as well as practicality and lessons learned. The approach to each of these obstacles highlights the multi-disciplinary nature of lung cancer screening, and the value of considering lung cancer screening a program rather than a test.
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Each year, more than 1 million persons worldwide are found to have a lung nodule that carries a risk of being malignant. In reality, the vast majority of lung nodules are benign, whether identified by screening or incidentally. ⋯ The challenge for the clinician caring for these patients is to differentiate between benign and malignant nodules with the least harm possible. In this review, we will discuss management strategies of the indeterminate pulmonary nodule and will review recent advances and harm-reduction strategies.