Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Oct 2016
ReviewImmunotherapy for Lung Cancer: No Longer an Abstract Concept.
The treatment paradigm for lung cancer has been transformed in recent years by the use of immunotherapy, specifically, immune checkpoint antibodies (mAb), which are agents designed to reinvigorate an immune-mediated anticancer response by releasing the effects of tumor-mediated immunosuppression. Late-phase clinical trials of these agents in patients with advanced lung cancers have translated into improved clinical outcomes compared with standard-of-care chemotherapy for the treatment of metastatic non-small cell lung cancer, and have resulted in FDA approvals for two immune checkpoint mAbs in the second-line setting. ⋯ While the efficacy of these agents is exciting, they have also been associated with a unique profile of immune-mediated toxicity that is distinct from classic cytotoxic therapies. As these agents move into the lung cancer clinic, we must seek to maximize the therapeutic potential of this class of agents through optimization of patient selection, improved response assessments, and exploring rational combinations of immune checkpoint mAbs with other potentially synergistic therapies, to improve response rates and extend the "tail on the curve."
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More than 20% of non-small cell lung cancers (NSCLCs) are classified as stage III disease at diagnosis because they are locoregionally advanced tumors. Local therapy alone (surgery or radiation) leads to poor overall survival in stage III NSCLC because most of the patients with NSCLC die of distant metastases. Therefore, during the past 20 years, studies have focused on developing effective chemotherapy regimens that can be combined with local therapies (surgery and/or radiation). The role of surgery has been extensively evaluated and the selection criteria for resection defined.
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Semin Respir Crit Care Med · Oct 2016
ReviewTobacco Control and Tobacco Cessation in Lung Cancer-Too Little, Too Late?
The lung cancer epidemic of the twentieth century grew out of increasing tobacco consumption in the first half of that century. Tobacco control policies have been instituted in many high-income countries since the mid-1960s. Since then smoking rates have declined in these countries, particularly in men where lung cancer rates have stabilized. ⋯ Tobacco cessation is more successful in countries with stronger tobacco control and confers quality of life and survival benefits in smokers including lung cancer patients. A significant degree of stigma surrounds the diagnosis of lung cancer which is often considered "self-inflicted" even though the tobacco industry promotes smoking uptake and maintenance. Sustained, effective tobacco control and cessation may improve lung cancer outcomes and are key considerations in modern care of lung cancer patients.
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Semin Respir Crit Care Med · Aug 2016
ReviewAdenovirus: Epidemiology, Global Spread of Novel Serotypes, and Advances in Treatment and Prevention.
Adenoviruses (AdVs) are DNA viruses that typically cause mild infections involving the upper or lower respiratory tract, gastrointestinal tract, or conjunctiva. Rare manifestations of AdV infections include hemorrhagic cystitis, hepatitis, hemorrhagic colitis, pancreatitis, nephritis, or meningoencephalitis. AdV infections are more common in young children, due to lack of humoral immunity. ⋯ Treatment of AdV infections is controversial, as prospective, randomized therapeutic trials have not been conducted. Cidofovir is the drug of choice for severe AdV infections, but not all patients require treatment. Live oral vaccines are highly efficacious in reducing the risk of respiratory AdV infection and are in routine use in the military in the United States, but currently are not available to civilians.