Lung cancer remains the leading cause of cancer deaths in the United States. In the past decade, significant advances have been made in the science of non-small cell lung cancer (NSCLC). Screening ...has been introduced with the goal of early detection. The National Lung Screening Trial found a lung cancer mortality benefit of 20% and a 6.7% decrease in all-cause mortality with the use of low-dose chest computed tomography in high-risk individuals. The treatment of lung cancer has also evolved with the introduction of several lines of tyrosine kinase inhibitors in patients with EGFR, ALK, ROS1, and NTRK mutations. Similarly, immune checkpoint inhibitors (ICIs) have dramatically changed the landscape of NSCLC treatment. Furthermore, the results of new trials continue to help us understand the role of these novel agents and which patients are more likely to benefit; ICIs are now part of the first-line NSCLC treatment armamentarium as monotherapy, combined with chemotherapy, or after definite chemoradiotherapy in patients with stage III unresectable NSCLC. Expression of programmed cell death protein-ligand 1 in malignant cells has been studied as a potential biomarker for response to ICIs. However, important drawbacks exist that limit its discriminatory potential. Identification of accurate predictive biomarkers beyond programmed cell death protein-ligand 1 expression remains essential to select the most appropriate candidates for ICI therapy. Many questions remain unanswered regarding the proper sequence and combinations of these new agents; however, the field is moving rapidly, and the overall direction is optimistic.
To provide evidence-based recommendations updating the 2020 ASCO and Ontario Health (Cancer Care Ontario) guideline on systemic therapy for patients with stage IV non-small-cell lung cancer without ...driver alterations.
ASCO updated recommendations on the basis of an ongoing systematic review of randomized clinical trials from 2018 to 2021.
This guideline update reflects changes in evidence since the previous update. Five randomized clinical trials provide the evidence base. Outcomes of interest include efficacy and safety.
In addition to 2020 options for patients with high programmed death ligand-1 (PD-L1) expression (tumor proportion score TPS ≥ 50%), nonsquamous cell carcinoma (non-SCC), and performance status (PS) 0-1, clinicians may offer single-agent atezolizumab. With high PD-L1 expression (TPS ≥ 50%), non-SCC, and PS 0-1, clinicians may offer nivolumab and ipilumumab alone or nivolumab and ipilimumab plus chemotherapy. With negative (0%) and low positive PD-L1 expression (TPS 1%-49%), non-SCC, and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or nivolumab and ipilimumab plus chemotherapy. With high PD-L1 expression, SCC, and PS 0-1, clinicians may offer single-agent atezolizumab. With high PD-L1 expression, squamous cell carcinoma (SCC), and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy. With negative and low positive PD-L1 expression, SCC, and PS 0-1, clinicians may offer nivolumab and ipilimumab alone or in combination with two cycles of platinum-based chemotherapy. With non-SCC who received an immune checkpoint inhibitor and chemotherapy as first-line therapy, clinicians may offer second-line paclitaxel plus bevacizumab. With non-SCC, who received chemotherapy with or without bevacizumab and immune checkpoint inhibitor therapy, clinicians should offer the options of third-line single-agent pemetrexed, docetaxel, or paclitaxel plus bevacizumab.Additional information is available at www.asco.org/thoracic-cancer-guidelines.
Female physicians and scientists represent less than one third of first and senior authors in oncology journals. Equal opportunities and training in gender bias are necessary to level out the playing ...field for current and future female physicians and scientists.
A disease of women Duma, Narjust
Nature (London),
11/2020, Letnik:
587, Številka:
7834
Journal Article
Recenzirano
...in the 30-49-year age group, the incidence of lung cancer is now higher in white and Hispanic women than it is in men - a remarkable reversal of the historical pattern. Unfortunately, most of the ...data regarding sexual dysfunction in both women and men with lung cancer is out of date because it preceded the approval of immunotherapy and targeted therapies. ...much of the information gathered regarding sexual dysfunction in cancer relates to breast and gynaecological cancers. ...women often suffer in silence, and consider this to be the price they have to pay for their cancers to be treated effectively.
In a cross-country comparison between the United States and Canada, foreign-born individuals in both countries reported lower utilization of primary and preventive care services (2). Without a better ...understanding of any potential differences in the studied population and other foreign-born individuals, findings from hospital-based study populations may be difficult to interpret. Mitigate barriers to care among foreign-born residents: from a health system perspective, more work is needed to make healthcare accessible for this growing population.
Feld poignantly identifies the medical importance of parental leave, how institutional variation and nonstandardized approaches in leave policies perpetuate gender biases, and calls attention to the ...heterogeneity in understanding and interpreting accreditation body's leave policies. In addition to the suggestions on improving flexibility in parental leave for trainees provided by the author, we also add migration toward competency-based medical education (CBME) as an avenue for exploration. CBME endeavors to shift from a volume- or time-based apprenticeship training model to active assessments of milestones and skills along the educational path that address a learner's needs more appropriately and lends itself to earlier, targeted intervention—either by acceleration or attention to deficient areas.
One concern with the use of immune checkpoint inhibitors in the early‐stage cancer setting is the effect of these agents on fertility and subsequent pregnancies. This commentary focuses on the ...treatment‐related risk of infertility and summarizes the available data.
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