Seminars in respiratory and critical care medicine
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Traditionally, lung cancer has been treated as an immune-resistant disease with platinum-based chemotherapy serving as the first-line treatment for metastatic disease. The efficacy of immunotherapy has been established for patients with advanced lung cancer in clinical trials, and it has since become the standard of care for patients without targetable mutations, with or without chemotherapy. Previously, lung cancer patients experienced limited responses to immune-based therapy. ⋯ Combination therapies of PD-1/PD-L1 inhibitors and chemotherapy or PD-1/PD-L1 and CTLA-4 checkpoint pathway inhibitors have also demonstrated improved outcomes for patients with NSCLC. Combination therapy with PD-1 or PD-L1 therapy and chemotherapy has shown benefit for small cell lung cancer patients as well. As immunotherapy changes the treatment paradigm of lung cancer, researchers continue to investigate different combinations, timing, duration, and biomarkers to better understand and improve the efficacy of immune-based therapy for patients with lung cancer.
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Semin Respir Crit Care Med · Jun 2020
ReviewSurgery as a Component of Multimodality Care for Known Stage IIIA-N2 Non-small Cell Lung Cancer.
Locally advanced, stage IIIA-N2 Non-small cell lung cancer (NSCLC) represents a heterogeneous patient population. Considerable controversy exists as to the optimal management of these patients. Local therapy alone with a single modality, namely surgery or radiation, is associated with high recurrence rates and low overall survival. ⋯ While it is clear that multimodality therapy is beneficial, the ideal composition of the treatment regimen remains a work in progress. As a result, the optimal management of patients with stage IIIA-N2 NSCLC is widely debated, as is the role for surgery in a multimodality treatment regimen. Herein, we review the current literature supporting multimodality therapy for stage IIIA-N2 NSCLC with an emphasis on the data supporting the role of surgery in resectable and potentially resectable patients.
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Semin Respir Crit Care Med · Jun 2020
ReviewSmall Cell Lung Cancer: Advances in Diagnosis and Management.
Small cell lung cancer (SCLC) is an aggressive subtype of lung cancer characterized by rapid growth and early spread. It is a highly lethal disease that typically is diagnosed at a late stage. Surgery plays a very small role in this cancer, and management typically involves chemotherapy, delivered with thoracic radiation in early-stage disease. ⋯ Incorporating radiation therapy at specific points in patient management may improve disease control. The development of predictive biomarkers and novel targeted therapies will hopefully improve options for patients in the near future. This review focuses on the current standards of care and future directions.
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Semin Respir Crit Care Med · Jun 2020
ReviewThe State of the Science in Patient-Reported Outcomes for Patients with Lung Cancer.
Traditionally, clinicians have assumed the primary responsibility for evaluating disease- and treatment-related outcomes. In the past few decades, however, a series of recommendations and standards promulgated by professional societies and regulatory agencies have resulted in increased use of patient-reported outcome (PRO) measures in cancer clinical trials. ⋯ This article discusses the current state of the science in PRO research for patients with lung cancer, the cancer type with the highest incidence rate and the lowest survival rate worldwide. The discussion focuses on (1) PRO and survival; (2) electronic PRO reporting and interventions; (3) PROs and immunotherapy; (4) PRO, biomarkers, and precision health; (5) key issues in applying PROs in clinical trials; and (6) future directions for research.