Lung Cancer

Air pollution is a well-established cause of morbidity and mortality. It largely comes from manmade sources such as particulate matter that arises from burning fossil fuels, which is a major contributor of greenhouse gas emissions.

Acute exposure to fine inhalable particles of as little as 2.5 mcm (PM2.5) in diameter can cause a decrease in lung function leading to respiratory and cardiovascular diseases and even death because of cardiopulmonary conditions and lung cancer.

The 2015 Global Burden of Disease study lists air pollution as the fourth highest–ranking global mortality risk factor. The World Health Organization estimated that 4.2 million deaths were caused by outdoor air pollution in 2016, and another 2.3 million from indoor air pollution.

Not all oncologists believe that air pollution is a cancer problem, but air pollution and particulate matters are carcinogens and in fact, they have been deemed level 1 carcinogens by the International Association of Research on Cancer.

The research on the link between air pollution, PM2.5 and lung cancer is robust. Numerous epidemiological studies have shown that people living in highly polluted areas are more likely to die of lung cancer than those who do not. For example, Turner and colleagues in CA: A Cancer Journal for Clinicians performed a Cox proportional hazard regression model adjusting for numerous variables – smoking, passive smoking, occupational exposures (asbestos, coal dust, diesel engine exhaust, etc.), an occupational “dirtiness” index, radon exposure, among others – and found a dose-response relationship between PM2.5 concentration and lung cancer mortality (each 10-mg/m increase in PM2.5 concentrations was associated with a 15%-27% increase in lung cancer mortality).

A similar analysis by Coleman and colleagues in Cancer Causes and Control found lung cancer mortality was adversely associated with increases in PM2.5 not only in the overall population that was studied, but also in a never-smoker cohort. A study reported in Environmental Health Perspectives also showed that exposure to air pollution increases the incidence and mortality from lung cancer, with lung cancer risk associated with PM2.5 exposure being greatest for former smokers (hazard ratio, 1.44; 95% CI, 1.04-2.01), followed by never-smokers (HR, 1.18; 95% CI, 1.00-1.39), and then current smokers (HR, 1.06; 95% CI, 0.97-1.15).

A 2020 study reported in Thorax that patients with COPD who have never smoked were more likely to get lung cancer, compared with never-smokers without COPD (HR, 2.67, 95% CI, 2.09-3.40). Other studies (The Lancet Oncology and The Lancet) confirm these findings. A meta-analysis published in Environmental Research of a large number of cohort studies over the past 25 years reported that the estimated HR, adjusted for age, sex, and smoking status, was 1.13 (95% CI, 1.07-1.20) per 10 mcg/m elevation in PM2.5.

Air pollution also affects patients who already have lung cancer. Air pollution exposures after the diagnosis of lung cancer shortens survival. For example, a 2016 study published in the journal Thorax found the median survival for patients with early-stage lung cancer at diagnosis was 2.4 years for those with high PM2.5 exposure (≥ 16 mcg/m³) and 5.7 years for those with low PM2.5 exposure (< 10 mcg/m³).

What does air pollution have to do with climate change? They both come from the burning of fossil fuels

Although the topic of climate change is generally seen through an environmental (and political) lens, it should also be seen through a health lens. In 2021, the New England Journal of Medicine and 229 other publications simultaneously published an editorial calling climate change a health emergency.

The increase in the earth’s temperature causes extreme weather events, such as heat waves, droughts, floods, and rising sea levels, all of which results in multiple health effects. These include conditions associated with water and food contamination, and increased susceptibility to allergens. There are also changes in vector ecology which leads to expanding areas of vector-borne diseases, such as Lyme disease, West Nile, and Zika.

Extreme weather events also have major impacts on the ability of cancer patients to access care and their medication. For example, a recent study published in JAMA found that poorer survival was associated with patients with non–small cell lung cancer receiving definitive radiation therapy during hurricane disasters, compared with a matched cohort of patients who underwent treatment in the absence of a hurricane disaster.

Reducing our dependence on fossil fuels will have two important health benefits: mitigating climate change and its associated effects on health, and decreasing air pollution and its subsequent oncologic consequences.

Dr. Schiller is a medical oncologist and founding member of Oncologists United for Climate and Health. She is a former board member of the International Association for the Study of Lung Cancer and a current board member of the Lung Cancer Research Foundation.

Air pollution is a well-established cause of morbidity and mortality. It largely comes from manmade sources such as particulate matter that arises from burning fossil fuels, which is a major contributor of greenhouse gas emissions.

Acute exposure to fine inhalable particles of as little as 2.5 mcm (PM2.5) in diameter can cause a decrease in lung function leading to respiratory and cardiovascular diseases and even death because of cardiopulmonary conditions and lung cancer.

The 2015 Global Burden of Disease study lists air pollution as the fourth highest–ranking global mortality risk factor. The World Health Organization estimated that 4.2 million deaths were caused by outdoor air pollution in 2016, and another 2.3 million from indoor air pollution.

Not all oncologists believe that air pollution is a cancer problem, but air pollution and particulate matters are carcinogens and in fact, they have been deemed level 1 carcinogens by the International Association of Research on Cancer.

The research on the link between air pollution, PM2.5 and lung cancer is robust. Numerous epidemiological studies have shown that people living in highly polluted areas are more likely to die of lung cancer than those who do not. For example, Turner and colleagues in CA: A Cancer Journal for Clinicians performed a Cox proportional hazard regression model adjusting for numerous variables – smoking, passive smoking, occupational exposures (asbestos, coal dust, diesel engine exhaust, etc.), an occupational “dirtiness” index, radon exposure, among others – and found a dose-response relationship between PM2.5 concentration and lung cancer mortality (each 10-mg/m increase in PM2.5 concentrations was associated with a 15%-27% increase in lung cancer mortality).

A similar analysis by Coleman and colleagues in Cancer Causes and Control found lung cancer mortality was adversely associated with increases in PM2.5 not only in the overall population that was studied, but also in a never-smoker cohort. A study reported in Environmental Health Perspectives also showed that exposure to air pollution increases the incidence and mortality from lung cancer, with lung cancer risk associated with PM2.5 exposure being greatest for former smokers (hazard ratio, 1.44; 95% CI, 1.04-2.01), followed by never-smokers (HR, 1.18; 95% CI, 1.00-1.39), and then current smokers (HR, 1.06; 95% CI, 0.97-1.15).

A 2020 study reported in Thorax that patients with COPD who have never smoked were more likely to get lung cancer, compared with never-smokers without COPD (HR, 2.67, 95% CI, 2.09-3.40). Other studies (The Lancet Oncology and The Lancet) confirm these findings. A meta-analysis published in Environmental Research of a large number of cohort studies over the past 25 years reported that the estimated HR, adjusted for age, sex, and smoking status, was 1.13 (95% CI, 1.07-1.20) per 10 mcg/m elevation in PM2.5.

Air pollution also affects patients who already have lung cancer. Air pollution exposures after the diagnosis of lung cancer shortens survival. For example, a 2016 study published in the journal Thorax found the median survival for patients with early-stage lung cancer at diagnosis was 2.4 years for those with high PM2.5 exposure (≥ 16 mcg/m³) and 5.7 years for those with low PM2.5 exposure (< 10 mcg/m³).

What does air pollution have to do with climate change? They both come from the burning of fossil fuels

Although the topic of climate change is generally seen through an environmental (and political) lens, it should also be seen through a health lens. In 2021, the New England Journal of Medicine and 229 other publications simultaneously published an editorial calling climate change a health emergency.

The increase in the earth’s temperature causes extreme weather events, such as heat waves, droughts, floods, and rising sea levels, all of which results in multiple health effects. These include conditions associated with water and food contamination, and increased susceptibility to allergens. There are also changes in vector ecology which leads to expanding areas of vector-borne diseases, such as Lyme disease, West Nile, and Zika.

Extreme weather events also have major impacts on the ability of cancer patients to access care and their medication. For example, a recent study published in JAMA found that poorer survival was associated with patients with non–small cell lung cancer receiving definitive radiation therapy during hurricane disasters, compared with a matched cohort of patients who underwent treatment in the absence of a hurricane disaster.

Reducing our dependence on fossil fuels will have two important health benefits: mitigating climate change and its associated effects on health, and decreasing air pollution and its subsequent oncologic consequences.

Dr. Schiller is a medical oncologist and founding member of Oncologists United for Climate and Health. She is a former board member of the International Association for the Study of Lung Cancer and a current board member of the Lung Cancer Research Foundation.

Air pollution is a well-established cause of morbidity and mortality. It largely comes from manmade sources such as particulate matter that arises from burning fossil fuels, which is a major contributor of greenhouse gas emissions.

Acute exposure to fine inhalable particles of as little as 2.5 mcm (PM2.5) in diameter can cause a decrease in lung function leading to respiratory and cardiovascular diseases and even death because of cardiopulmonary conditions and lung cancer.

The 2015 Global Burden of Disease study lists air pollution as the fourth highest–ranking global mortality risk factor. The World Health Organization estimated that 4.2 million deaths were caused by outdoor air pollution in 2016, and another 2.3 million from indoor air pollution.

Not all oncologists believe that air pollution is a cancer problem, but air pollution and particulate matters are carcinogens and in fact, they have been deemed level 1 carcinogens by the International Association of Research on Cancer.

The research on the link between air pollution, PM2.5 and lung cancer is robust. Numerous epidemiological studies have shown that people living in highly polluted areas are more likely to die of lung cancer than those who do not. For example, Turner and colleagues in CA: A Cancer Journal for Clinicians performed a Cox proportional hazard regression model adjusting for numerous variables – smoking, passive smoking, occupational exposures (asbestos, coal dust, diesel engine exhaust, etc.), an occupational “dirtiness” index, radon exposure, among others – and found a dose-response relationship between PM2.5 concentration and lung cancer mortality (each 10-mg/m increase in PM2.5 concentrations was associated with a 15%-27% increase in lung cancer mortality).

A similar analysis by Coleman and colleagues in Cancer Causes and Control found lung cancer mortality was adversely associated with increases in PM2.5 not only in the overall population that was studied, but also in a never-smoker cohort. A study reported in Environmental Health Perspectives also showed that exposure to air pollution increases the incidence and mortality from lung cancer, with lung cancer risk associated with PM2.5 exposure being greatest for former smokers (hazard ratio, 1.44; 95% CI, 1.04-2.01), followed by never-smokers (HR, 1.18; 95% CI, 1.00-1.39), and then current smokers (HR, 1.06; 95% CI, 0.97-1.15).

A 2020 study reported in Thorax that patients with COPD who have never smoked were more likely to get lung cancer, compared with never-smokers without COPD (HR, 2.67, 95% CI, 2.09-3.40). Other studies (The Lancet Oncology and The Lancet) confirm these findings. A meta-analysis published in Environmental Research of a large number of cohort studies over the past 25 years reported that the estimated HR, adjusted for age, sex, and smoking status, was 1.13 (95% CI, 1.07-1.20) per 10 mcg/m elevation in PM2.5.

Air pollution also affects patients who already have lung cancer. Air pollution exposures after the diagnosis of lung cancer shortens survival. For example, a 2016 study published in the journal Thorax found the median survival for patients with early-stage lung cancer at diagnosis was 2.4 years for those with high PM2.5 exposure (≥ 16 mcg/m³) and 5.7 years for those with low PM2.5 exposure (< 10 mcg/m³).

What does air pollution have to do with climate change? They both come from the burning of fossil fuels

Although the topic of climate change is generally seen through an environmental (and political) lens, it should also be seen through a health lens. In 2021, the New England Journal of Medicine and 229 other publications simultaneously published an editorial calling climate change a health emergency.

The increase in the earth’s temperature causes extreme weather events, such as heat waves, droughts, floods, and rising sea levels, all of which results in multiple health effects. These include conditions associated with water and food contamination, and increased susceptibility to allergens. There are also changes in vector ecology which leads to expanding areas of vector-borne diseases, such as Lyme disease, West Nile, and Zika.

Extreme weather events also have major impacts on the ability of cancer patients to access care and their medication. For example, a recent study published in JAMA found that poorer survival was associated with patients with non–small cell lung cancer receiving definitive radiation therapy during hurricane disasters, compared with a matched cohort of patients who underwent treatment in the absence of a hurricane disaster.

Reducing our dependence on fossil fuels will have two important health benefits: mitigating climate change and its associated effects on health, and decreasing air pollution and its subsequent oncologic consequences.

Dr. Schiller is a medical oncologist and founding member of Oncologists United for Climate and Health. She is a former board member of the International Association for the Study of Lung Cancer and a current board member of the Lung Cancer Research Foundation.

Key clinical point: NFE2L2 and KEAP1 mutations account for 31.6% of all advanced squamous cell non-small cell lung cancer (NSCLC) cases, and these mutations are associated with worse real-world progression-free survival (PFS) after first-line therapy.

Major finding: NFE2L2 and KEAP1 mutations were detected in 31.6% of patients. Patients harboring these mutations had a shorter real-world PFS after first-line therapy (4.54 vs 6.25 months with wild-type disease; P = .0027).

Study details: The data come from a retrospective cohort study of 703 patients with advanced squamous cell NSCLC from a real-world US clinicogenomic database.

Disclosures: The study was funded by Takeda Development Center Americas, Inc. Y Wu, Y Yin, V Crossland, S Vincent, N Lineberry, and DV Faller are employees of Takeda Development Center Americas, Inc. PK Paik reported ties with various pharmaceutical companies.

Source: Wu Y et al. Survival outcomes and treatment patterns in patients with NFE2L2 and/or KEAP1 mutation-positive advanced squamous cell NSCLC using a real-world clinico-genomic database. Clin Lung Cancer. 2022 (May 10). Doi: 10.1016/j.cllc.2022.05.008

Key clinical point: NFE2L2 and KEAP1 mutations account for 31.6% of all advanced squamous cell non-small cell lung cancer (NSCLC) cases, and these mutations are associated with worse real-world progression-free survival (PFS) after first-line therapy.

Major finding: NFE2L2 and KEAP1 mutations were detected in 31.6% of patients. Patients harboring these mutations had a shorter real-world PFS after first-line therapy (4.54 vs 6.25 months with wild-type disease; P = .0027).

Study details: The data come from a retrospective cohort study of 703 patients with advanced squamous cell NSCLC from a real-world US clinicogenomic database.

Disclosures: The study was funded by Takeda Development Center Americas, Inc. Y Wu, Y Yin, V Crossland, S Vincent, N Lineberry, and DV Faller are employees of Takeda Development Center Americas, Inc. PK Paik reported ties with various pharmaceutical companies.

Source: Wu Y et al. Survival outcomes and treatment patterns in patients with NFE2L2 and/or KEAP1 mutation-positive advanced squamous cell NSCLC using a real-world clinico-genomic database. Clin Lung Cancer. 2022 (May 10). Doi: 10.1016/j.cllc.2022.05.008

Key clinical point: NFE2L2 and KEAP1 mutations account for 31.6% of all advanced squamous cell non-small cell lung cancer (NSCLC) cases, and these mutations are associated with worse real-world progression-free survival (PFS) after first-line therapy.

Major finding: NFE2L2 and KEAP1 mutations were detected in 31.6% of patients. Patients harboring these mutations had a shorter real-world PFS after first-line therapy (4.54 vs 6.25 months with wild-type disease; P = .0027).

Study details: The data come from a retrospective cohort study of 703 patients with advanced squamous cell NSCLC from a real-world US clinicogenomic database.

Disclosures: The study was funded by Takeda Development Center Americas, Inc. Y Wu, Y Yin, V Crossland, S Vincent, N Lineberry, and DV Faller are employees of Takeda Development Center Americas, Inc. PK Paik reported ties with various pharmaceutical companies.

Source: Wu Y et al. Survival outcomes and treatment patterns in patients with NFE2L2 and/or KEAP1 mutation-positive advanced squamous cell NSCLC using a real-world clinico-genomic database. Clin Lung Cancer. 2022 (May 10). Doi: 10.1016/j.cllc.2022.05.008

Key clinical point: A new breath biomarker-based diagnostic method shows promise by identifying 16 cancer-derived volatile organic compounds (VOC) that have high sensitivity and specificity in patients with lung cancer.

Major finding: In the discovery phase, 16 VOC with peak intensity most altered before vs after surgery were identified. In the validation phase, the 16 VOC-based diagnostic model demonstrated an area under the curve of 0.952, sensitivity of 89.2%, specificity of 89.1%, and accuracy of 89.1%.

Study details: The discovery phase involved a prospective cohort study of 84 patients with lung cancer who were tested for 28 VOC before and after surgery. The promising VOC were further assessed in the validation phase which included 157 patients with lung cancer and 368 healthy controls.

Disclosures: The research was funded by the National Natural Science Foundation of China and others. The authors declared no competing interests.

Source: Wang P et al. Identification of lung cancer breath biomarkers based on perioperative breathomics testing: A prospective observational study. EClinicalMedicine. 2022;47:101384 (Apr 26). Doi: 10.1016/j.eclinm.2022.101384

Key clinical point: A new breath biomarker-based diagnostic method shows promise by identifying 16 cancer-derived volatile organic compounds (VOC) that have high sensitivity and specificity in patients with lung cancer.

Major finding: In the discovery phase, 16 VOC with peak intensity most altered before vs after surgery were identified. In the validation phase, the 16 VOC-based diagnostic model demonstrated an area under the curve of 0.952, sensitivity of 89.2%, specificity of 89.1%, and accuracy of 89.1%.

Study details: The discovery phase involved a prospective cohort study of 84 patients with lung cancer who were tested for 28 VOC before and after surgery. The promising VOC were further assessed in the validation phase which included 157 patients with lung cancer and 368 healthy controls.

Disclosures: The research was funded by the National Natural Science Foundation of China and others. The authors declared no competing interests.

Source: Wang P et al. Identification of lung cancer breath biomarkers based on perioperative breathomics testing: A prospective observational study. EClinicalMedicine. 2022;47:101384 (Apr 26). Doi: 10.1016/j.eclinm.2022.101384

Key clinical point: A new breath biomarker-based diagnostic method shows promise by identifying 16 cancer-derived volatile organic compounds (VOC) that have high sensitivity and specificity in patients with lung cancer.

Major finding: In the discovery phase, 16 VOC with peak intensity most altered before vs after surgery were identified. In the validation phase, the 16 VOC-based diagnostic model demonstrated an area under the curve of 0.952, sensitivity of 89.2%, specificity of 89.1%, and accuracy of 89.1%.

Study details: The discovery phase involved a prospective cohort study of 84 patients with lung cancer who were tested for 28 VOC before and after surgery. The promising VOC were further assessed in the validation phase which included 157 patients with lung cancer and 368 healthy controls.

Disclosures: The research was funded by the National Natural Science Foundation of China and others. The authors declared no competing interests.

Source: Wang P et al. Identification of lung cancer breath biomarkers based on perioperative breathomics testing: A prospective observational study. EClinicalMedicine. 2022;47:101384 (Apr 26). Doi: 10.1016/j.eclinm.2022.101384

Key clinical point: In patients with stage I lung cancer treated with stereotactic body radiation therapy (SBRT), a model incorporating noncancerous imaging features on chest computed tomography (CT) and clinical features vs clinical features alone performed better at predicting overall survival (OS).

Major finding: The model that incorporated both clinical and imaging features vs the model that incorporated only clinical features performed better at predicting 5-year OS (area under the curve 0.75 vs 0.61; P < .01). Independent risk factors for shorter OS were elevated coronary artery calcium score, increased pulmonary artery-to-aorta ratio, and decreased thoracic skeletal muscle index.

Study details: The data come from a retrospective study involving 282 patients with stage I lung cancer treated with SBRT. Several clinical markers were assessed from pretreatment chest CT images.

Disclosures: No funding information was available. The corresponding author FJ Fintelmann reported no relevant financial relationships.

Source: Tahir I et al. Utility of noncancerous chest CT features for predicting overall survival and noncancer death in patients with stage I lung cancer treated with stereotactic body radiotherapy. AJR Am J Roentgenol. 2022 (Apr 13). Doi: 10.2214/AJR.22.27484

Key clinical point: In patients with stage I lung cancer treated with stereotactic body radiation therapy (SBRT), a model incorporating noncancerous imaging features on chest computed tomography (CT) and clinical features vs clinical features alone performed better at predicting overall survival (OS).

Major finding: The model that incorporated both clinical and imaging features vs the model that incorporated only clinical features performed better at predicting 5-year OS (area under the curve 0.75 vs 0.61; P < .01). Independent risk factors for shorter OS were elevated coronary artery calcium score, increased pulmonary artery-to-aorta ratio, and decreased thoracic skeletal muscle index.

Study details: The data come from a retrospective study involving 282 patients with stage I lung cancer treated with SBRT. Several clinical markers were assessed from pretreatment chest CT images.

Disclosures: No funding information was available. The corresponding author FJ Fintelmann reported no relevant financial relationships.

Source: Tahir I et al. Utility of noncancerous chest CT features for predicting overall survival and noncancer death in patients with stage I lung cancer treated with stereotactic body radiotherapy. AJR Am J Roentgenol. 2022 (Apr 13). Doi: 10.2214/AJR.22.27484

Key clinical point: In patients with stage I lung cancer treated with stereotactic body radiation therapy (SBRT), a model incorporating noncancerous imaging features on chest computed tomography (CT) and clinical features vs clinical features alone performed better at predicting overall survival (OS).

Major finding: The model that incorporated both clinical and imaging features vs the model that incorporated only clinical features performed better at predicting 5-year OS (area under the curve 0.75 vs 0.61; P < .01). Independent risk factors for shorter OS were elevated coronary artery calcium score, increased pulmonary artery-to-aorta ratio, and decreased thoracic skeletal muscle index.

Study details: The data come from a retrospective study involving 282 patients with stage I lung cancer treated with SBRT. Several clinical markers were assessed from pretreatment chest CT images.

Disclosures: No funding information was available. The corresponding author FJ Fintelmann reported no relevant financial relationships.

Source: Tahir I et al. Utility of noncancerous chest CT features for predicting overall survival and noncancer death in patients with stage I lung cancer treated with stereotactic body radiotherapy. AJR Am J Roentgenol. 2022 (Apr 13). Doi: 10.2214/AJR.22.27484

Key clinical point: Frontline therapy with anlotinib plus platinum-etoposide chemotherapy shows favorable outcomes in patients with extensive-stage (ES) small-cell lung cancer (SCLC).

Major finding: The median progression-free survival was 8.02 (95% CI 6.90-9.66) months and the overall survival was 15.87 (95% CI 10.38-18.89) months. The objective response rate was 85.71% (95% CI 69.74%-95.19%) and the disease control rate was 94.29% (95% CI 80.84%-99.30%). The incidence of grade 3-4 adverse events was 40%.

Study details: The data come from a phase 2 single-arm trial of anlotinib plus platinum-etoposide in 35 patients with ES-SCLC at a single center in China.

Disclosures: The trial was funded by Chia Tai Tianqing Pharmaceutical Group Co., Ltd. The authors declared no competing interests.

Source: Deng P et al. Anlotinib plus platinum-etoposide as a first-line treatment for extensive-stage small cell lung cancer: A single-arm trial. Cancer Med. 2022 (May 8). Doi: 10.1002/cam4.4736

Key clinical point: Frontline therapy with anlotinib plus platinum-etoposide chemotherapy shows favorable outcomes in patients with extensive-stage (ES) small-cell lung cancer (SCLC).

Major finding: The median progression-free survival was 8.02 (95% CI 6.90-9.66) months and the overall survival was 15.87 (95% CI 10.38-18.89) months. The objective response rate was 85.71% (95% CI 69.74%-95.19%) and the disease control rate was 94.29% (95% CI 80.84%-99.30%). The incidence of grade 3-4 adverse events was 40%.

Study details: The data come from a phase 2 single-arm trial of anlotinib plus platinum-etoposide in 35 patients with ES-SCLC at a single center in China.

Disclosures: The trial was funded by Chia Tai Tianqing Pharmaceutical Group Co., Ltd. The authors declared no competing interests.

Source: Deng P et al. Anlotinib plus platinum-etoposide as a first-line treatment for extensive-stage small cell lung cancer: A single-arm trial. Cancer Med. 2022 (May 8). Doi: 10.1002/cam4.4736

Key clinical point: Frontline therapy with anlotinib plus platinum-etoposide chemotherapy shows favorable outcomes in patients with extensive-stage (ES) small-cell lung cancer (SCLC).

Major finding: The median progression-free survival was 8.02 (95% CI 6.90-9.66) months and the overall survival was 15.87 (95% CI 10.38-18.89) months. The objective response rate was 85.71% (95% CI 69.74%-95.19%) and the disease control rate was 94.29% (95% CI 80.84%-99.30%). The incidence of grade 3-4 adverse events was 40%.

Study details: The data come from a phase 2 single-arm trial of anlotinib plus platinum-etoposide in 35 patients with ES-SCLC at a single center in China.

Disclosures: The trial was funded by Chia Tai Tianqing Pharmaceutical Group Co., Ltd. The authors declared no competing interests.

Source: Deng P et al. Anlotinib plus platinum-etoposide as a first-line treatment for extensive-stage small cell lung cancer: A single-arm trial. Cancer Med. 2022 (May 8). Doi: 10.1002/cam4.4736

Key clinical point: Segmentectomy is noninferior to lobectomy for overall survival (OS) in patients with small-sized peripheral nonsmall cell lung cancer (NSCLC).

Major finding: Segmentectomy was noninferior to lobectomy for 5-year OS (94.3% vs 91.1%; hazard ratio 0.663; 95% CI 0.474-0.927; 1-sided P < .0001 for noninferiority). There were no differences between the groups in 5-year relapse-free survival.

Study details: The data come from a Japanese randomized controlled, noninferiority phase 3 trial (n = 1106) of segmentectomy vs lobectomy for stage IA NSCLC.

Disclosures: The trial was funded by the National Cancer Center Research and the Ministry of Health, Labor, and Welfare of Japan. R Nakajima, T Aoki, J Okami, H Ito, N Okumura, M Yamaguchi, K Nakamura, and S Nakamura reported no competing interests. The other authors reported ties with one or more pharmaceutical companies outside this work.

Source: Saji H et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399(10335):1607-1617 (Apr 23). Doi: 10.1016/S0140-6736(21)02333-3

Key clinical point: Segmentectomy is noninferior to lobectomy for overall survival (OS) in patients with small-sized peripheral nonsmall cell lung cancer (NSCLC).

Major finding: Segmentectomy was noninferior to lobectomy for 5-year OS (94.3% vs 91.1%; hazard ratio 0.663; 95% CI 0.474-0.927; 1-sided P < .0001 for noninferiority). There were no differences between the groups in 5-year relapse-free survival.

Study details: The data come from a Japanese randomized controlled, noninferiority phase 3 trial (n = 1106) of segmentectomy vs lobectomy for stage IA NSCLC.

Disclosures: The trial was funded by the National Cancer Center Research and the Ministry of Health, Labor, and Welfare of Japan. R Nakajima, T Aoki, J Okami, H Ito, N Okumura, M Yamaguchi, K Nakamura, and S Nakamura reported no competing interests. The other authors reported ties with one or more pharmaceutical companies outside this work.

Source: Saji H et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399(10335):1607-1617 (Apr 23). Doi: 10.1016/S0140-6736(21)02333-3

Key clinical point: Segmentectomy is noninferior to lobectomy for overall survival (OS) in patients with small-sized peripheral nonsmall cell lung cancer (NSCLC).

Major finding: Segmentectomy was noninferior to lobectomy for 5-year OS (94.3% vs 91.1%; hazard ratio 0.663; 95% CI 0.474-0.927; 1-sided P < .0001 for noninferiority). There were no differences between the groups in 5-year relapse-free survival.

Study details: The data come from a Japanese randomized controlled, noninferiority phase 3 trial (n = 1106) of segmentectomy vs lobectomy for stage IA NSCLC.

Disclosures: The trial was funded by the National Cancer Center Research and the Ministry of Health, Labor, and Welfare of Japan. R Nakajima, T Aoki, J Okami, H Ito, N Okumura, M Yamaguchi, K Nakamura, and S Nakamura reported no competing interests. The other authors reported ties with one or more pharmaceutical companies outside this work.

Source: Saji H et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399(10335):1607-1617 (Apr 23). Doi: 10.1016/S0140-6736(21)02333-3

Key clinical point: Immune checkpoint inhibitors (ICI) plus radiotherapy (RT) conferred an overall survival (OS) benefit over chemotherapy plus RT after resection of brain metastasis from non-small cell lung cancer (NSCLC).

Major finding: The chemotherapy plus RT group had a shorter median OS than the ICI plus RT group after neurosurgery (11.8 months; 95% CI 9.1-15.2 vs 23.0 months; 95% CI 20.3-53.8; P < .001).

Study details: The data come from a retrospective propensity score-matched cohort study involving 62 NSCLC patients treated with ICI plus RT and 62 treated with chemotherapy plus RT after neurosurgery for brain metastasis, from 2010 to 2021.

Disclosures: No funding information was available. N Frost reported receiving personal fees and nonfinancial support from pharmaceutical companies outside this work. The other authors declared no competing interests.

Source: Wasilewski D et al. Effectiveness of immune checkpoint inhibition vs chemotherapy in combination with radiation therapy among patients with non–small cell lung cancer and brain metastasis undergoing neurosurgical resection. JAMA Netw Open. 2022;5(4):e229553 (Apr 29). Doi: 10.1001/jamanetworkopen.2022.9553

Key clinical point: Immune checkpoint inhibitors (ICI) plus radiotherapy (RT) conferred an overall survival (OS) benefit over chemotherapy plus RT after resection of brain metastasis from non-small cell lung cancer (NSCLC).

Major finding: The chemotherapy plus RT group had a shorter median OS than the ICI plus RT group after neurosurgery (11.8 months; 95% CI 9.1-15.2 vs 23.0 months; 95% CI 20.3-53.8; P < .001).

Study details: The data come from a retrospective propensity score-matched cohort study involving 62 NSCLC patients treated with ICI plus RT and 62 treated with chemotherapy plus RT after neurosurgery for brain metastasis, from 2010 to 2021.

Disclosures: No funding information was available. N Frost reported receiving personal fees and nonfinancial support from pharmaceutical companies outside this work. The other authors declared no competing interests.

Source: Wasilewski D et al. Effectiveness of immune checkpoint inhibition vs chemotherapy in combination with radiation therapy among patients with non–small cell lung cancer and brain metastasis undergoing neurosurgical resection. JAMA Netw Open. 2022;5(4):e229553 (Apr 29). Doi: 10.1001/jamanetworkopen.2022.9553

Key clinical point: Immune checkpoint inhibitors (ICI) plus radiotherapy (RT) conferred an overall survival (OS) benefit over chemotherapy plus RT after resection of brain metastasis from non-small cell lung cancer (NSCLC).

Major finding: The chemotherapy plus RT group had a shorter median OS than the ICI plus RT group after neurosurgery (11.8 months; 95% CI 9.1-15.2 vs 23.0 months; 95% CI 20.3-53.8; P < .001).

Study details: The data come from a retrospective propensity score-matched cohort study involving 62 NSCLC patients treated with ICI plus RT and 62 treated with chemotherapy plus RT after neurosurgery for brain metastasis, from 2010 to 2021.

Disclosures: No funding information was available. N Frost reported receiving personal fees and nonfinancial support from pharmaceutical companies outside this work. The other authors declared no competing interests.

Source: Wasilewski D et al. Effectiveness of immune checkpoint inhibition vs chemotherapy in combination with radiation therapy among patients with non–small cell lung cancer and brain metastasis undergoing neurosurgical resection. JAMA Netw Open. 2022;5(4):e229553 (Apr 29). Doi: 10.1001/jamanetworkopen.2022.9553

Key clinical point: In a real-world cohort of patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitor (ICI) monotherapy, the 4-year overall survival (OS) was nearly 18%.

Major finding: The mean progression-free survival (PFS) was 3.4 months and OS was 13.0 months. The 4-year OS rate was 17.9%. The predictors of favorable OS and PFS included age >70 years, a good Eastern Cooperative Oncology Group Performance Status score, programmed cell death-ligand 1 tumor proportion score of ≥50%, absence of bone metastasis, and presence of immune-related skin toxicity.

Study details: The data come from a real-world retrospective cohort study of 435 patients diagnosed with advanced, metastatic, or recurrent NSCLC and treated with ICI monotherapy across seven Japanese centers (2015-2018).

Disclosures: No information on funding and disclosures was available.

Source: Yoneda T et al. Long-term survival of patients with non-small cell lung cancer treated with immune checkpoint inhibitor monotherapy in real-world settings. Clin Lung Cancer. 2022 (May 1). Doi: 10.1016/j.cllc.2022.03.008

Key clinical point: In a real-world cohort of patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitor (ICI) monotherapy, the 4-year overall survival (OS) was nearly 18%.

Major finding: The mean progression-free survival (PFS) was 3.4 months and OS was 13.0 months. The 4-year OS rate was 17.9%. The predictors of favorable OS and PFS included age >70 years, a good Eastern Cooperative Oncology Group Performance Status score, programmed cell death-ligand 1 tumor proportion score of ≥50%, absence of bone metastasis, and presence of immune-related skin toxicity.

Study details: The data come from a real-world retrospective cohort study of 435 patients diagnosed with advanced, metastatic, or recurrent NSCLC and treated with ICI monotherapy across seven Japanese centers (2015-2018).

Disclosures: No information on funding and disclosures was available.

Source: Yoneda T et al. Long-term survival of patients with non-small cell lung cancer treated with immune checkpoint inhibitor monotherapy in real-world settings. Clin Lung Cancer. 2022 (May 1). Doi: 10.1016/j.cllc.2022.03.008

Key clinical point: In a real-world cohort of patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitor (ICI) monotherapy, the 4-year overall survival (OS) was nearly 18%.

Major finding: The mean progression-free survival (PFS) was 3.4 months and OS was 13.0 months. The 4-year OS rate was 17.9%. The predictors of favorable OS and PFS included age >70 years, a good Eastern Cooperative Oncology Group Performance Status score, programmed cell death-ligand 1 tumor proportion score of ≥50%, absence of bone metastasis, and presence of immune-related skin toxicity.

Study details: The data come from a real-world retrospective cohort study of 435 patients diagnosed with advanced, metastatic, or recurrent NSCLC and treated with ICI monotherapy across seven Japanese centers (2015-2018).

Disclosures: No information on funding and disclosures was available.

Source: Yoneda T et al. Long-term survival of patients with non-small cell lung cancer treated with immune checkpoint inhibitor monotherapy in real-world settings. Clin Lung Cancer. 2022 (May 1). Doi: 10.1016/j.cllc.2022.03.008

Key clinical point: Anticoagulant use is linked to worse progression-free survival (PFS) and objective response rate (ORR) in patients with ALK- and ROS1-rearranged advanced nonsmall cell lung cancer (NSCLC) treated with crizotinib.

Major finding: In the ROS1-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (5.1 vs 29 months) and poorer ORR (41.7% vs 80.5%). Similarly, in the ALK-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (7.1 vs 12 months) and poorer ORR (41% vs 74.3%).

Study details: The data come from a retrospective analysis of patients with ROS1- and ALK-rearranged advanced NSCLC (n = 206) who received crizotinib in the phase 1 PROFILE 1001 trial.

Disclosures: The study was funded by Pfizer. The authors reported receiving grants or personal fees from one or more pharmaceutical companies, including Pfizer, outside this work.

Source: Ng TL, Tsui DCC, et al. Association of anticoagulant use with clinical outcomes from crizotinib in ALK- and ROS1-rearranged advanced non-small cell lung cancers: A retrospective analysis of PROFILE 1001. Cancer Med. 2022 (May 5). Doi: 10.1002/cam4.4789

Key clinical point: Anticoagulant use is linked to worse progression-free survival (PFS) and objective response rate (ORR) in patients with ALK- and ROS1-rearranged advanced nonsmall cell lung cancer (NSCLC) treated with crizotinib.

Major finding: In the ROS1-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (5.1 vs 29 months) and poorer ORR (41.7% vs 80.5%). Similarly, in the ALK-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (7.1 vs 12 months) and poorer ORR (41% vs 74.3%).

Study details: The data come from a retrospective analysis of patients with ROS1- and ALK-rearranged advanced NSCLC (n = 206) who received crizotinib in the phase 1 PROFILE 1001 trial.

Disclosures: The study was funded by Pfizer. The authors reported receiving grants or personal fees from one or more pharmaceutical companies, including Pfizer, outside this work.

Source: Ng TL, Tsui DCC, et al. Association of anticoagulant use with clinical outcomes from crizotinib in ALK- and ROS1-rearranged advanced non-small cell lung cancers: A retrospective analysis of PROFILE 1001. Cancer Med. 2022 (May 5). Doi: 10.1002/cam4.4789

Key clinical point: Anticoagulant use is linked to worse progression-free survival (PFS) and objective response rate (ORR) in patients with ALK- and ROS1-rearranged advanced nonsmall cell lung cancer (NSCLC) treated with crizotinib.

Major finding: In the ROS1-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (5.1 vs 29 months) and poorer ORR (41.7% vs 80.5%). Similarly, in the ALK-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (7.1 vs 12 months) and poorer ORR (41% vs 74.3%).

Study details: The data come from a retrospective analysis of patients with ROS1- and ALK-rearranged advanced NSCLC (n = 206) who received crizotinib in the phase 1 PROFILE 1001 trial.

Disclosures: The study was funded by Pfizer. The authors reported receiving grants or personal fees from one or more pharmaceutical companies, including Pfizer, outside this work.

Source: Ng TL, Tsui DCC, et al. Association of anticoagulant use with clinical outcomes from crizotinib in ALK- and ROS1-rearranged advanced non-small cell lung cancers: A retrospective analysis of PROFILE 1001. Cancer Med. 2022 (May 5). Doi: 10.1002/cam4.4789

Key clinical point: Noncachexic patients with advanced nonsmall cell lung cancer (NSCLC) and adipose tissue loss may respond more favorably to immunotherapy.

Major finding: Cachexic patients with loss and maintenance of adipose tissue showed no significant differences in the objective response rate (ORR) and progression-free survival (PFS). Noncachexic patients with loss vs maintenance of adipose tissue demonstrated a higher ORR (64.7% vs 23.5%; P < .05) and longer PFS (18.5 vs 2.86 months; P = .037) in response to immunotherapy.

Study details: The data come from a single-center retrospective cohort study involving patients with advanced NSCLC (40 with cachexia and 34 without cachexia) who received programmed cell death-1/programmed cell death-ligand 1 inhibitors (pembrolizumab, nivolumab, or atezolizumab).

Disclosures: The study was funded by the Japan Agency for Medical Research and Development. The authors reported ties with one or more pharmaceutical companies outside this work.

Source: Nishioka N et al. Impact of losing adipose tissue on outcomes from PD-1/PD-L1 inhibitor monotherapy in non-small cell lung cancer. Thorac Cancer. 2022;13(10):1496-1504 (Apr 14). Doi: 10.1111/1759-7714.14421

Key clinical point: Noncachexic patients with advanced nonsmall cell lung cancer (NSCLC) and adipose tissue loss may respond more favorably to immunotherapy.

Major finding: Cachexic patients with loss and maintenance of adipose tissue showed no significant differences in the objective response rate (ORR) and progression-free survival (PFS). Noncachexic patients with loss vs maintenance of adipose tissue demonstrated a higher ORR (64.7% vs 23.5%; P < .05) and longer PFS (18.5 vs 2.86 months; P = .037) in response to immunotherapy.

Study details: The data come from a single-center retrospective cohort study involving patients with advanced NSCLC (40 with cachexia and 34 without cachexia) who received programmed cell death-1/programmed cell death-ligand 1 inhibitors (pembrolizumab, nivolumab, or atezolizumab).

Disclosures: The study was funded by the Japan Agency for Medical Research and Development. The authors reported ties with one or more pharmaceutical companies outside this work.

Source: Nishioka N et al. Impact of losing adipose tissue on outcomes from PD-1/PD-L1 inhibitor monotherapy in non-small cell lung cancer. Thorac Cancer. 2022;13(10):1496-1504 (Apr 14). Doi: 10.1111/1759-7714.14421

Key clinical point: Noncachexic patients with advanced nonsmall cell lung cancer (NSCLC) and adipose tissue loss may respond more favorably to immunotherapy.

Major finding: Cachexic patients with loss and maintenance of adipose tissue showed no significant differences in the objective response rate (ORR) and progression-free survival (PFS). Noncachexic patients with loss vs maintenance of adipose tissue demonstrated a higher ORR (64.7% vs 23.5%; P < .05) and longer PFS (18.5 vs 2.86 months; P = .037) in response to immunotherapy.

Study details: The data come from a single-center retrospective cohort study involving patients with advanced NSCLC (40 with cachexia and 34 without cachexia) who received programmed cell death-1/programmed cell death-ligand 1 inhibitors (pembrolizumab, nivolumab, or atezolizumab).

Disclosures: The study was funded by the Japan Agency for Medical Research and Development. The authors reported ties with one or more pharmaceutical companies outside this work.

Source: Nishioka N et al. Impact of losing adipose tissue on outcomes from PD-1/PD-L1 inhibitor monotherapy in non-small cell lung cancer. Thorac Cancer. 2022;13(10):1496-1504 (Apr 14). Doi: 10.1111/1759-7714.14421