Moving beyond disease-focused decision making: understanding competing risks to personalize lung cancer treatment for older adults

Taylor, Lauren J.; Maloney, James D.

doi:10.21037/jtd.2017.01.36

Cited by 5 publications

(3 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This would allow doctors to make better educated guesses on treatment plan when individualized genetic testing is not available/feasible 13 , 82 . Luckily, due to our realization of the importance of personalized medicine, endeavors to improve the precision and scope of personalized lung cancer treatment are plentiful 83 , 84 , 85 , 86 . As some patients may have mutations that confer a high degree of natural resistance to the drugs that their specific types of lung cancers require, perhaps a good future step is to develop derivatives of these drugs with tailored binding sites optimized to target the altered ATP-binding pockets.…”

Section: Discussionmentioning

confidence: 99%

Personalized medicine in non-small cell lung cancer: a review from a pharmacogenomics perspective

Jiang

Cai

et al. 2018

Acta Pharmaceutica Sinica B

View full text Add to dashboard Cite

Non-small cell lung cancer is a prevalent and rapidly-expanding challenge to modern medicine. While generalized medicine with traditional chemotherapy yielded comparatively poor response rates and treatment results, the cornerstone of personalized medicine using genetic profiling to direct treatment has exalted the successes seen in the field and raised the standard for patient treatment in lung and other cancers. Here, we discuss the current state and advances in the field of personalized medicine for lung cancer, reviewing several of the mutation-targeting strategies that are approved for clinical use and how they are guided by patient genetic information. These classes include inhibitors of tyrosine kinase (TKI), anaplastic lymphoma kinase (ALK), and monoclonal antibodies. Selecting from these treatment plans and determining the optimal dosage requires in-depth genetic guidance with consideration towards not only the underlying target genes but also other factors such as individual metabolic capability and presence of resistance-conferring mutations both directly on the target gene and along its cascade(s). Finally, we provide our viewpoints on the future of personalized medicine in lung cancer, including target-based drug combination, mutation-guided drug design and the necessity for data of population genetics, to provide rough guidance on treating patients who are unable to get genetic testing.

show abstract

Section: Discussionmentioning

confidence: 99%

Personalized medicine in non-small cell lung cancer: a review from a pharmacogenomics perspective

Jiang

Cai

et al. 2018

Acta Pharmaceutica Sinica B

View full text Add to dashboard Cite

show abstract

“…We also demonstrated that, in contrast with lobectomy, sublobar resection is associated with a lower incidence of severe postoperative morbidity and, in particular respiratory events, is perhaps influenced by the selection bias of choosing sublobar resection for patients with diminished pulmonary function and higher comorbidities. Taylor and Maloney highlighted the potential contribution of our study results in personalizing treatment decisions for elderly patients through consideration of competing risks in those patients (2). Our published results are derived from an analysis of patients treated at a single institution in the United States.…”

Section: Invited Responsementioning

confidence: 98%

Competing risks analysis in the prognostic assessment of patients undergoing lung resection

Eguchi¹,

Adusumilli²

2017

J. Thorac. Dis.

View full text Add to dashboard Cite

Invited responseBased on a competing risk analysis of cause-specific mortality, we recently (1) demonstrated that noncancer-specific mortality is a significant competing event against lung cancer-specific mortality in patients who have undergone curative intent lung resection for stage I non-small cell lung cancer (NSCLC). We have demonstrated that elderly patients ≥65 years of age had a higher noncancer-specific cumulative incidence of death (CID) compared with lung cancer-specific CID for as long as 2.5 years after resection. This early-phase mortality was relatively higher in patients ≥75 years of age compared with patients 65 to 74 years of age. We also demonstrated that, in contrast with lobectomy, sublobar resection is associated with a lower incidence of severe postoperative morbidity and, in particular respiratory events, is perhaps influenced by the selection bias of choosing sublobar resection for patients with diminished pulmonary function and higher comorbidities. Taylor and Maloney highlighted the potential contribution of our study results in personalizing treatment decisions for elderly patients through consideration of competing risks in those patients (2). Our published results are derived from an analysis of patients treated at a single institution in the United States. In order to broadly apply our approach of using competing risks analysis in the prognostic assessment of patients who will undergo surgical resection for early-stage NSCLC we will compare our study cohort with publications that were focused on cohorts of NSCLC patients from developing nations and Asian countries. We also emphasized the need to consider cardiopulmonary and functional status rather than only age when deciding between sublobar resection and lobectomy for elderly patients.A recent analysis of global cancer incidence and mortality demonstrated that lung cancer ranked highest in the elderly patient population compared with other cancers; this is based on data from 32 cancer groups in 195 countries between 1990 and 2015 (3). Our study demonstrated the importance of competing risks, causespecific mortality analysis that is based on individual patient preoperative variables such as smoking status, comorbidity, and pulmonary function. While applying this analysis to patient cohorts from developing nations and Asian countries, differences in smoking status, air pollution, and incidence of chronic lung comorbidities, such as chronic obstructive lung disease (COPD) and tuberculosis, should be taken into account (4). Clinicians should also consider the potential differences in "aging" including the physical and social disparities between elderly patients in developed and developing countries. In our study, COPD and smoking history were independent risk factors for severe postoperative morbidity and lung cancer-specific mortality,

show abstract

“…There is a pressing need to develop the evidence base for defining the role of treatments such as chemoradiotherapy and immunotherapy in older patients, especially vulnerable and frail individuals. Not age, but comorbidity, life expectancy, and patient preferences should be decisive factors when offering treatment [63]. • Patients with lung cancer living in more socioeconomically deprived circumstances may be less likely to receive treatment, including surgery and chemotherapy [64].…”

Section: Inequalitiesmentioning

confidence: 99%

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer

et al. 2020

View full text Add to dashboard Cite

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give patients, health professionals, managers and policymakers a guide to essential care throughout the patient journey. Lung cancer is the leading cause of cancer mortality and has a wide variation in treatment and outcomes in Europe. It is a major healthcare burden and has complex diagnosis and treatment challenges. Care must only be carried out in lung cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals detailed here. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship.

show abstract

Moving beyond disease-focused decision making: understanding competing risks to personalize lung cancer treatment for older adults

Cited by 5 publications

References 26 publications

Personalized medicine in non-small cell lung cancer: a review from a pharmacogenomics perspective

Personalized medicine in non-small cell lung cancer: a review from a pharmacogenomics perspective

Competing risks analysis in the prognostic assessment of patients undergoing lung resection

European Cancer Organisation Essential Requirements for Quality Cancer Care (ERQCC): Lung cancer

Contact Info

Product

Resources

About