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Lung cancer is the leading cause of cancer mortality worldwide, and non-small cell lung cancer (NSCLC) accounts for about 85% of all cases of lung cancer. Most patients present with advanced disease and five-year survival is low at about 15%. Surgery is the main treatment for early stage disease. If patients are deemed inoperable, systemic chemotherapy is considered. For patients with locally advanced disease, multimodality therapy is administered where chemotherapy is given in combination with definitive radiation therapy or surgery in selected cases. Cytotoxic chemotherapy regimens mainly consist of a platinum doublet. Biologic agents are increasingly being incorporated into treatment regimens. This pocketbook summarises the latest evidence-based and practical information on the use of systemic therapies in the management of non-small cell lung cancer (NSCLC), for early stage, locally advanced, and metastatic disease. Including contributions from leading thoracic oncologists from North America and Europe, the book covers the range of therapies currently available to clinicians including cytotoxic chemotherapy, biologic therapies, and other novel agents. This book will serve as an invaluable reference for all health care professionals involved in the management of patients with NSCLC.
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!
Despite an overall decrease in tobacco use, lung cancer (80–85% of which is non-small-cell lung cancer [NSCLC]) is still the leading cause of cancer death in both men and women worldwide. Annual low-dose CT screening of high-risk individuals has the potential to detect early-stage tumors, which can usually be successfully treated with a combination of surgery, radiotherapy and chemotherapy and, in some cases, targeted therapy. However, most patients with NSCLC still present with advanced or metastatic disease. For these patients, initial therapy is guided by the tumor’s molecular characteristics and patient’s performance status. Targeted therapies have significantly improved clinical outcomes and, for some patients with no targetable genetic alterations, immunotherapy has demonstrated significant overall survival benefit. This insightful guide is designed to bring you up to speed with the latest developments and is important reading for all health professionals and medical trainees working in this fast-moving field. Table of Contents: • Prevention and screening • Diagnosis and staging • Surgery • Radiotherapy • Systemic therapy in non-metastatic NSCLC • Systemic therapy in advanced-stage/metastatic disease without a molecular driver • Personalized treatment in advanced NSCLC • Oligometastatic disease and brain metastases
Lung cancer is the second most common cancer and the leading cancer-related cause of death in both men and women. Non-small cell lung cancer (NSCLC) is the most common type of lung cancer, comprising approximately 84% of all lung cancer. Approximately half of patients with NSCLC are diagnosed at an advanced stage when survival rates are very poor (5 year survival of 4.5% for distant disease). Systemic therapies are the primary treatment for patients with advanced-stage disease. In the past two decades, many new systemic therapies have been developed. These treatments have been shown to increase survival in clinical trials, but their use and effectiveness at the population-level is unknown. The present study was based on data collected by the California Cancer Registry (CCR), California’s statewide cancer surveillance system. The CCR collects types of systemic treatment in an unstructured free-text format. In Chapter 1, we manually reviewed treatment text fields in the CCR to determine first-line systemic therapies used in patients with stage IV NSCLC and associations with survival. Chapter 2 explored the relationship between systemic therapy use and source of health insurance. Finally, in Chapter 3, we developed a SAS-based text mining algorithm to extract treatment information from unstructured free-text fields and compared the results to manual review. Our findings indicate that the treatments associated with a significant survival advantage (tyrosine kinase inhibitors and bevacizumab combinations versus platinum doublets) for advanced-stage nonsquamous NSCLC were underutilized among the over 14,000 patients included in our study. Substantial disparities in the use of systemic therapies exist by health insurance type in California. Patients with Medicaid, military, or no insurance have significantly decreased odds of receiving tyrosine kinase inhibitors, bevacizumab combinations, or any systemic treatment at all. Our SAS-based text mining algorithm accurately detected systemic treatments administered to stage IV NSCLC patients, with Kappa ranging from 0.71 to 0.92, and may become a viable alternative to the considerable time involved in manual review of patient records. Our algorithm can be applied to other cancer types, potentially maximizing the utility of extant information in cancer registries for comparative effectiveness research.
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!
This book is intended as a comprehensive resource for clinicians and researchers seeking in-depth information on geriatric oncology. The coverage encompasses epidemiology, the biology and (patho)physiology of aging and cancer, geriatric assessment and management, hematologic malignancies, solid tumors, issues in patient care, and research methods. Since cancer is a disease of aging and people are living longer, most cancer patients are now aged 70 and older. Yet the more we age, the more diverse we become in terms of our health, biologic fitness, and cancer behavior. Typically, however, general oncology clinical trials address only a selected healthier and younger population of patients. Geriatric oncology is the area of oncology that addresses these issues but while a wealth of knowledge has been accumulated, information is often difficult to retrieve or insufficiently detailed. The SpringerReference program, in which this book is published, offers an ideal format for overcoming these limitations since it combines thorough coverage with access to living editions constantly updated chapter by chapter via a dynamic peer-review process, ensuring that information remains current and pertinent.
Defining the Lung Cancer Problem 1 Lung cancer is the leading cause of cancer death in the world. It kills almost as many Americans as cancers of the breast, prostate, colon, rectum, pancreas, and 2 kidney combined, and accounts for 28.6% of all US cancer deaths. With an increase in the 5-year relative survival rate from 13% to only 16% in the more than 2 30 years from 1974 to the present, it will take us another 840 years to eradicate lung cancer deaths if we do not improve the current rate of progress. As discussed in this text, lung cancer prevention has received substantial att- tion. The decrease in smoking in recent decades has helped, but smoking is not the only problem. Lung cancer in people who have never smoked is currently the 5th 3 leading cause of cancer death in the United States. Several factors contribute to the lethality of lung cancer, including the rapidity of tumor growth, advanced stage at diagnosis (due to nonspecificity of early sy- toms and the uncertain efficacy of screening), early development of metastases, and resistance to therapy. Several chapters in this book discuss new molecular targets that may be potentially exploitable in the future, as well as discussing our track record to date in exploiting them.
Providing a historical perspective on the etiology of lung cancer, this comprehensive reference presents an in-depth analysis of the epidemiology of cancer of the lung-describing the current understanding of risk factors and the use of epidemiological data to design programs for the control of this leading cause of death worldwide.