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Lung cancer is the second most common type of cancer and is the leading cause of cancer death globally. In 2018, almost 2.1 million new cases were diagnosed, accounting for ~12% of the cancer burden worldwide. The malignant stage of lung tumor is known as lung adenocarcinoma, which is most common and is diagnosed in both smokers and non-smokers.There are two main types of lung cancer, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Genomic studies have indicated that more than 80% of lung malignancies are classified as NSCLC, of which adenocarcinoma is a predominant subtype. Although significant progress has been made in treating tumor with targetable driver mutations, like EGFR mutations, most tumor do not have such mutations and the prognosis remains poor for metastasis stage patients. Platinum doublet chemotherapy has been the mainstay first-line treatment of patients who are diagnosed with metastatic lung adenocarcinoma without a targetable mutation.In recent years, immunotherapy has emerged as a treatment option that has shown strong response in a subset of patients. The immune agents block crucial checkpoints and regulate the immune response, but the tumor cells evade the patient’s immune systems. By blocking these receptor–ligand interactions, a particular subset of T cells is activated to recognize and respond to tumor cells. While such responses to immunotherapy are promising, they have only been effective in ~20% of patients.
Lung cancer has seen a paradigm shift in disease treatment over the past few years, with major changes in the therapeutic drugs now available as well as in the overall management approach. For targeted and immunotherapeutic approaches, understanding the biology of acquired resistance is a key strategy that has yielded productive advances in the subsequent treatment. Future advances also include incorporating biomarker data obtained from solid and liquid biopsies, as well as combination of immunotherapy with radiotherapy and in special populations such patients with CNS involvement.
This book describes the molecular mechanisms of lung cancer development and progression that determine therapeutic interventions in the era of genomics, when the rapid evolution in lung cancer diagnosis and treatment necessitates critical review of new results to integrate advances into practice. The text opens with background and emerging information regarding the molecular biology of lung cancer pathogenesis. Updated results regarding lung cancer prevention and screening are discussed, followed by chapters on diagnostic techniques and pathological evaluation. This leads on to a detailed presentation of treatment modalities, from surgery and radiation therapy to standard chemotherapy and targeted agents. The coverage includes resistance to therapy and the emergence of immunotherapy for lung cancer; in addition, the current evidence in respect of small cell lung cancer is summarized. The book presents insights from experts across disciplines to emphasize the importance of collaborative care. Advances in our understanding of issues in geriatric oncology and palliative care complete the comprehensive discussion of lung cancer.
This issue of Hematology/Oncology Clinics will focus on lung cancer; specifically, Genomics in lung cancer; Neoadjuvant and adjuvant therapy for NSCLC; Treatment of locally advanced NSCLC; First line systemic therapy for NSCLC; Second line chemotherapy and beyond for NSCLC; Treatment of EGFR mutant tumors; Treatment of ALK positive tumors; New targets in NSCLC; Immunotherapy; Advances in Small cell lung cancer; and many more!
Lung cancer remains the leading cause of cancer-related death worldwide. Although surgical resections of these tumors are considered as one of the most effective treatments, most lung cancer patients present at an advanced stage of the disease at the time of diagnosis and are not candidates for surgical resection. Overall, the prognosis of lung cancer is very poor and the 5-year survival rate is only about 16 %, which has not significantly changed in the past several decades. Therefore, seeking new directions of treatment for this most deadly disease becomes crucial. Recent development in the understanding of the molecular pathogenesis of lung cancer has led to new strategies of treatment. Development of lung cancers is thought to be driven by gene mutations in most, if not all, cases. Detailed analysis at the molecular level to identify these gene mutations or alterations in lung cancer provides the insight for understanding the disease and is fundamental for establishment of personalized targeted therapy. Personalized targeted therapy based on particular gene mutations has shown to be effective and is believed to be one of the new directions of the treatment in dealing with this disease. In modern oncology, there is an increasing need to facilitate the development and implementation of biomarkers based on known gene mutations/alterations in clinical practice and identification of new gene mutations/alterations through high-throughput DNA sequencing technology to enter a new era of personalized targeted therapy for lung cancer patients.
Lung Carcinoma is the 2nd most common cancer worldwide, with more than 2.2 million cases recorded globally in the year 2020, as well as 1.8 million deaths. It is the most common cancer in men and the 2nd most common cancer in women, with an estimated lifetime risk of developing the disease of 1 in 15 for men and 1 in 17 for women. Whilst being the most prevalent cancer, it is important to note that smoking is the single biggest risk factor for developing Lung Cancer, with over 70% of cases being estimated to have been caused by tobacco smoke, and excessive smoking potentially leading to as much as a 25x increase in the likelihood of the disease developing. Mortality rates have been steadily dropping globally due to declining smoking rates, especially in younger generations who are now more aware of the potential dangers, but also because of the increasing advancements being made in our understanding of the disease. Improved screening methods mean many more cases are now caught earlier than they would otherwise have been, and our ever-advancing ranges of treatments can begin earlier than they could have previously. Recent advances in sequencing technology, computational approaches, and our biological understanding of lung cancer have revolutionized how we diagnose, prognosticate, and treat lung carcinoma. Genetic studies into this disease have revealed a plethora of information which can be used to combat the Cancer, such as novel biomarkers and gene signatures, as well as opening the door to more of a ‘personalized medicine’ approach.
This issue of Thoracic Surgery Clinics, guest edited by Drs. Jyoti Patel and Jessica Donington, is devoted to Advances in Systemic Therapy for Non-Small Cell Lung Cancer. Drs. Patel and Donington have assembled expert authors to review the following topics: Adjuvant and Neoadjuvant Immunotherapy; Combining Immunotherapy with Radiation in Lung Cancer; Adjuvant Chemotherapy; ALK Mutations; Molecular Targets Beyond the Big 3; Advances in Systemic Therapy; Liquid Biopsies in NSCLC; Combining Immunotherapy and Chemotherapy for NSCLC; ROS-1 Mutations; EGFR Mutations; and more!
This book discusses the latest molecular targeted therapy of lung cancer including its evaluation and future directions. It clearly illustrates the initial dramatic effectiveness of molecular targeted therapy, recurrence of the disease, overcoming the wide variety of resistance mechanisms using new-generation molecular targeted agents and potential novel approaches. It also outlines the increasing necessity for new diagnostic technology and strategies for managing different adverse effects and novel methods for evaluating effectiveness and safety. Edited and authored by opinion leaders, Molecular Targeted Therapy of Lung Cancer provides a comprehensive overview of the disease and its treatments. It is a valuable resource for graduate students, post-doctoral fellows and faculty staff, as well as researchers involved in clinical and translational research on lung cancer, helping promote new ideas for further advances.
This book contextualizes translational research and provides an up to date progress report on therapies that are currently being targeted in lung cancer. It is now well established that there is tremendous heterogeneity among cancer cells both at the inter- and intra-tumoral level. Further, a growing body of work highlights the importance of targeted therapies and personalized medicine in treating cancer patients. In contrast to conventional therapies that are typically administered to the average patient regardless of the patient’s genotype, targeted therapies are tailored to patients with specific traits. Nonetheless, such genetic changes can be disease-specific and/or target specific; thus, the book addresses these issues manifested in the somatically acquired genetic changes of the targeted gene. Each chapter is written by a leading medical oncologist who specializes in thoracic oncology and is devoted to a particular target in a specific indication. Contributors provide an in-depth review of the literature covering the mechanisms underlying signaling, potential cross talk between the target and downstream signaling, and potential emergence of drug resistance.
This, the second of two volumes on personalized medicine in lung cancer, touches upon the recent progress in targeted drug development based on genomics; emerging biomarkers and therapeutic targets such as EMT, cancer stem cells, and the tumor microenvironment; current personalized clinical management and radiation therapy for lung cancers; and the promise of epigenetics and next-generation sequencing for the advancements towards personalized therapy of lung cancer patients. With chapters on state-of-the-art therapies and technologies written by leading experts working to develop novel companion diagnosis tools for the personalized treatment of lung cancer patients, this volume brings readers up-to-date by presenting the current knowledge on the efforts to make personalized management of lung cancer patients a reality.