The diagnostic pathway in lung cancer patients with best supportive care decisions: are there lessons to be learnt?

King, Jenny; Shah, Dinakshi; Hewitt, Kath; Punjabi, Anshu; Marshall, Kelly; Balata, Haval; Brockelsby, C.; Sinnott, Nicola; Lyons, Judith; Martin, Julie; Crosbie, Philip; Booton, Richard; Ng, Cassandra; Cove-Smith, Laura; Evison, Matthew

doi:10.7861/clinmed.2021-0160

Cited by 4 publications

(2 citation statements)

References 3 publications

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“…Additionally, King et al described in a UK series that patients that received BSC were older (average age 79 years), frail (70% clinical frailty score ≥6), functionally limited (80% World Health Organization Performance Status: 3–4), and 68% had stage IV lung cancer. 18 In our series, that included only stage IV NSCLC patients, the median age of the patients that received BSC was 70 years (IQR=61-74) and 62.1% had ECOG ≥2. However, the interpretation of these data needs careful attention to histology, since BSC was the only treatment received by 54.8% of patients with SCC compared to 27.7% of patients with ADC.…”

Section: Discussionmentioning

confidence: 84%

Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country

et al. 2023

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Objective To describe the survival outcomes of metastatic non-small cell lung cancer patients with limited access to immunotherapy and targeted therapy in a cancer reference center in Colombia. Methods A retrospective analysis of metastatic non-small cell lung cancer patients treated between 2013 and 2018 was performed, majority diagnosed with adenocarcinoma. It was carried out in a public cancer reference center that provides care to patients of low and middle socioeconomic status. Overall survival and progression-free survival were evaluated by Kaplan–Meier analysis and log-rank test. A Cox regression model was performed for univariate and multivariate analysis. Results 209 patients were included with majority of adenocarcinoma (79.5%). First-line treatment was cytotoxic chemotherapy (50.2%), EGFR-targeted therapy (14.8%), chemoimmunotherapy (1.9%), and ALK-targeted therapy (1.4%). 31.6% received best supportive care. Median time of follow-up was 13 months, median overall survival was 11.2 months (95% CI, 7.9–14.4), 13 months for adenocarcinoma (95% CI, 8.1–17.9), and 2.5 months for squamous cell carcinoma (95% CI, 0.6–4.4) ( P < .001). Median progression-free survival was 9.3 months (95% CI, 7.9–10.7) without differences according to the type of first-line therapy. Median time-to-treatment was 55 days and only 54% of patients with a tested actionable mutation in EGFR received an EGFR-targeted therapy as the first-line treatment. Multivariate analysis showed that squamous cell carcinoma histology and receiving best supportive care were independent factors for worse overall survival ((HR:1.8, 95% CI, 1.076–3.082, P=.026) and (HR:14.6, 95% CI, 8.921–24.049, P < .001), respectively). Meanwhile, squamous cell carcinoma histology was an independent factor for worse progression-free survival (HR:3.4, 95% CI, 1.540-7.464, P=.002). Conclusions Despite advances in precision medicine, during the study period, cytotoxic chemotherapy was the most used treatment in our patients. Furthermore, about a third of them received best supportive care. The use of targeted therapies has been restricted by access to molecular diagnosis and remained low until 2018. Access to immunotherapy should be prioritized.

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Section: Discussionmentioning

confidence: 84%

Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country

et al. 2023

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“…A standardised strategy for staging and diagnosis is a fundamental component of lung cancer management. However, there is little doubt that molecular tissue diagnosis approaches are critical for many patients' outcomes (2,3).…”

Section: Introductionmentioning

confidence: 99%

In EBUS Signo Vinces: New Indications in Thoracic Oncology for Mediastinal Lymph Node Staging Using Endobronchial Ultrasound

2022

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Revamping Non-Small Cell Lung Cancer Treatments in Stages II and III: Preparing Healthcare for Cutting-Edge Immuno-Oncology Regimens

Bertolaccini,

Casiraghi,

Bardoni

et al. 2024

Cancers

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Non-small cell lung cancer (NSCLC) poses a significant challenge in clinical oncology, necessitating continual refinement of treatment approaches in stages II and III. Recent advancements have highlighted the potential of neoadjuvant therapy in optimising patient outcomes. Biomarker testing guides neoadjuvant therapy decisions, including epidermal growth factor receptor (EGFR) mutation and programmed death-ligand 1 (PD-L1) expression testing. Neoadjuvant therapy aims to improve oncological outcomes by treating micrometastatic disease and assessing tumour response before surgery. Disease-free survival is a surrogate endpoint for overall survival in both neoadjuvant and adjuvant settings. Multidisciplinary collaboration is crucial for individualised treatment planning and optimising patient care. The management of NSCLC requires a comprehensive approach, integrating expertise across disciplines and tailoring treatment strategies to individual patient needs. Neoadjuvant therapy shows promise in improving long-term outcomes, with biomarker testing guiding treatment decisions. Challenges such as defining borderline resectability and differentiating pseudoprogression highlight the need for ongoing research and collaboration.

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The diagnostic pathway in lung cancer patients with best supportive care decisions: are there lessons to be learnt?

Cited by 4 publications

References 3 publications

Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country

Survival Outcomes of Metastatic Non-small Cell Lung Cancer Patients With Limited Access to Immunotherapy and Targeted Therapy in a Cancer Center of a Low- and Middle-Income Country

In EBUS Signo Vinces: New Indications in Thoracic Oncology for Mediastinal Lymph Node Staging Using Endobronchial Ultrasound

Revamping Non-Small Cell Lung Cancer Treatments in Stages II and III: Preparing Healthcare for Cutting-Edge Immuno-Oncology Regimens

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