Intratumoral Treatment with Chemotherapy and Immunotherapy for NSCLC with EBUS-TBNA 19G

Abstract

Introduction: Immunotherapy is being used for the past five years either as first line or second line treatment with great results. Chemotherapy and radiotherapy have been also used as combination to immunotherapy to further enhance this type of treatment. Intratumoral treatment has been previously proposed as a treatment option for certain non-small cell lung cancer patients. Patients and Methods: We recruited in total seventy four patients with non-small cell lung cancer in their second line treatment who received only chemotherapy in their first line treatment with programmed death-ligand-1 ≤ 50. Only adenocarcinoma or squamous cell carcinoma, and all negative for epidermal growth factor receptor, anaplastic lymphoma kinase, proto-oncogene tyrosine-protein kinase-1 and proto-oncogene B-Raf. Data were first examined with descriptive statistics choosing frequencies for categorical variables and histograms for the continuous ones. Twenty five received only intravenous immunotherapy and forty-nine intravenous cisplatin with immunotherapy. Data were first examined with descriptive statistics choosing frequencies for categorical variables and histograms for the continuous ones.

Clinical Applications of Endobronchial Ultrasound (EBUS) Scope: Challenges and Opportunities

“…More recently, this technique has been applied to deliver both standard chemotherapy [106][107][108] and immunotherapy [109]. This technique might be further improved by preoperative stratification of dose and site of injection according to computational modeling, which allows planning of the procedure according to the precise estimation of tumor size and localization [110].…”

Airway local endoscopic pharmacological treatment; current applications and future concepts

“…Needles with pores on their sides exist to facilitate absorption of more cells during biopsy. Such needles can also be used to deliver more drug in different parts of a lesion when they are used for drug delivery [12,37].…”

“…In a recently published multicenter study immunotherapy was administered locally with the help of 19G needles under the guidance of endobronchial ultrasound with a convex probe. The patients were stage four NSCLC and the safety and efficiency of their treatment was evaluated with positron emission tomography (PET-CT) and next genera-tion sequencing (NGS) [12]. Indeed, the combination of intratumoral chemotherapy and immunotherapy improved survival rates in patients with ≤50% PD-L1 expression and in total to all patients that received intratumoral treatment versus only intravenous treatment (Nivolumab 10 mg/mL was purchased from Bristol-Myers-Squibb with the dosage being administered at 3 mg/kg, and calculated according to the weight).…”

“…Biopsy needles exist that can be used to administer drugs locally within a tumor. These needles come in different sizes: 22G, 21G and 19G [12] (Figs. 3,4,5,6).…”

“…The endoscopic microwave ablation system can identify vessels and lesions using the ARCHEMEDES ® navigation system [10,11]. Biopsy needles, such the 19G Olympus ® , have been used to apply chemotherapeutic agents in large lung cancer lesions and lymphnodes [12].…”