Non-small Cell Type Research Articles

Expectations concerning cancer treatment: perspectives of medical oncologists and patients on advanced, unresectable lung carcinoma.

This study seeks to compare expectations regarding systemic cancer treatment for advanced lung cancer from the perspectives of both patient and medical oncologist. A cross-sectional study involving 17 medical oncologists from 13 Spanish hospitals between 2021 and 2022. Patients with advanced, unresectable lung cancer were recruited prior to initiating systemic cancer treatment. Both patients and oncologists completed the NEOetic-EIT and the STAR. Seventeen medical oncologists specializing in lung cancer participated, with a mean age of 36.2 years (range 28-56); 65% were female. The study included 298 patients with advanced, unresectable lung cancer, predominantly non-small cell type (72%), and most at stage IV (77%). Most patients were retired or unemployed (71%), and married or partnered (77%). Treatment approaches varied, with 44% based on biomarkers. Oncologists had greater expectations of positive outcomes for participants with better baseline prognosis, such as ECOG 0, newly diagnosed, locally advanced, unresectable non-small cell lung cancer, and those receiving biomarker-based treatments. In contrast, patients' treatment expectations did not vary based on sociodemographic or clinical factors. Generally, patients had high expectations of cure, in contrast to oncologists' lower expectations, though both anticipated similar quality-of-life improvements. Patients anticipated more side effects than oncologists. Among oncologists, expectations varied by gender and decreased with age and experience, with no differences detected among patients based on gender, age, or doctor-patient relationship. This study reveals the complex expectations of patients and oncologists in advanced lung cancer treatment. It underscores the need for effective communication in oncology to align patient expectations with clinical realities.

Imaging Recommendations for Diagnosis, Staging, and Management of Lung Cancer

AbstractGlobally and in India, lung cancer is one of the leading malignancies in terms of incidence and mortality. Smoking and environmental pollution are the common risk factors for developing lung cancer. Traditionally, lung cancer is divided into small cell and nonsmall cell types, with nonsmall cell carcinomas including squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.In this review article, we describe the imaging recommendations and findings in the diagnosis, staging, and management of lung cancer, including the imaging of treatment-related complications.

A 5 Year Tertiary Centre Experience of Frequency & Risk Factors Association with Primary and Secondary Lung Cancers

Introduction: Lung cancer is one of the commonest cancers worldwide having either small cell or non-small cell types and smoking is its major risk factor. We intend to study distribution of various lung malignancies and their association with various risk factors in a Pakistani population sample.
 Aims & Objectives: To evaluate the frequency of types of primary and secondary lung cancers in a sample of the Pakistani population and see their association with age, gender, and smoking.
 Place and duration of study: The department of Pulmonology, Shaikh Zayed Hospital, Federal Postgraduate Medical Institute, Lahore, Pakistan, from August 2017 to August 2022 (5 years).
 Material & Methods: Analysis of retrospective data of 156 consecutive patients age 40-70 years diagnosed with primary or secondary lung cancers. Data were stored and analyzed using IBM-SPSS version 23.0. Diagnosis was established through fibreoptic (FOB), or rigid bronchoscopies or CT and U/S guided percutaneous lung biopsies, P- value<0.05 was taken as significant
 Results: There were 156 samples, among them 37.8% were found with age group 41 – 60 years old, 31.4% with age group 61 – 70 years old, mean age of subjects was 58.3 (SD=±14.9) years. 82.1% were of male gender, 42.9% were non- smokers, 25% were found with less than or equal to 25 smoking pack years, median smoking pack years were 30 with range 5 – 100 smoking pack years. Distribution of primary lung malignancy revealed; 28.8% having Squamous cell carcinoma, 35.3% with Adenocarcinoma, 13.5% with small cell carcinoma, 2.6% with large cell carcinoma and 5.8% with primary lung carcinoid tumors. Secondary deposits of cancer in lungs were found in 22 (14.1%) subjects. Pearson Chi Square test showed significant association of primary type of cancer with age group, gender, and smoking pack years (p <0.01).
 Conclusion: Adenocarcinoma was most frequent lung malignancy followed by Squamous cell carcinoma and small cell carcinoma was less frequent. Advancing age, male gender and cigarette smoking are strongly associated with the diagnosis of lung cancer.

An analysis of studies on non-small cell lung cancer registered on clinical trials registry of India

Background: Lung cancer is the most common cancer in males, of which non-small cell type is more prevalent. It is an active area of research owing to the limited available treatment modalities with several studies registered on CTRI. Objectives of current study was to analyse randomized control trials for non-small cell lung cancer registered on clinical trial registry India.Methods: Studies registered on CTRI were reviewed in this registry-based audit using the keywords lung cancer and non-small cell lung cancer. Parameters such as type of study, nature of intervention, phase of study, primary and secondary endpoints used, etc, were analysed and summarised using descriptive statistics in Microsoft Excel 365.Results: Out of 230 trials for lung cancer, 121 studied non-small cell lung cancer, of which 103 studies (85.1%) were interventional studies. Most common intervention under study was drug 97 studies (94.2%) followed by radiation 4 studies (3.3%). Majority of trials were phase 3, 48 trials (39.7%) and only 4 (3.3%) studies were phase 1. Five most common primary and secondary endpoints observed were survival, response rate, safety, pharmacokinetic data & quality of life. Maximum patients were in the advanced stage of cancer(52.1%) and pemetrexed (9.9%) was the most common drug used.Conclusions: We observed an increasing trend in studies registered on CTRI, with maximum studies in phase 3 with patients in the advanced stage of cancer having overall survival as the endpoint.

Inhaled Atorvastatin Nanoparticles for Lung Cancer.

Lung cancer is one of the main causes of mortality globally. This research paper aims a the development of inhaled nanotechnology for lung cancer to deliver an atorvastatin calcium compound, for lung cancer, capable of reaching the tumor site directly via inhalation. Atorvastatin calcium micellar nanoparticles (ATO-NPs) encapsulated with Pluronic F-127 and polyvinyl alcohol (PVA) were manufactured utilizing the solvent and anti-solvent precipitation technique. The physicochemical features of the formulation were evaluated in terms of their physicochemical characteristics using Fourier transform infrared spectroscopy, differential scanning calorimetry, and dynamic light scattering. Additionally, the Andersen Cascade impactor was used at 15 L/minutes to assist in the aerosols performances of the formulation. The ATO-NPs formula's cell viability was tested in vitro using the A549 non-small cell lung cancer cell type. Transmission electron microscopy was utilized to determine the ATO-NPs particle morphology, demonstrating a spherical shape with a smooth surface. The fine particle fraction of the aerosol produced was 62.70 ± 1.18%. This finding suggests that atorvastatin micellar nanoparticles are suitable for medication administration by inhalation with a wide particle size dispersion. Moreover, it was found in vitro that concentrations of up to 21 μg/mL of the atorvastatin nanoparticles were safe and non-toxic in the cell model. This study found that atorvastatin micellar nanoparticles for inhalation could potentially be used for lung cancer treatment.

Effects of Hypofractionated Radiotherapy in Advanced Stage of Non-Small Cell Type Bronchogenic Carcinoma

Introduction: Bronchogenic carcinoma accounts for about one-third of all cancer deaths among males. The inclination is such among females as well. This disease is more communal in males than females. Decreasing the number of fractions required for palliative care should be of understandable advantage for both individual patients and the usage of radiotherapy resources. Methods: This prospective study was carried out in Sylhet MAG Osmani Medical College & Hospital from 1st July 2020 to 30th June 2021 to determine the effects of hypofractionated radiotherapy in an advanced stage of bronchogenic carcinoma. Completed data forms were reviewed, edited, and processed for computer data entry. The data analysis was performed using Statistical Package for the Social Sciences (SPSS) Version 25.0. Result: The age of the patients ranged from 41-70 years and the maximum prevalence of the disease was seen above the 50s. The male- to-female ratio was 6:1 in the intervention arm and 14:1 in the control arm. The male gender is predominant. All the male patients were tobacco smokers and the females were passive smokers. Lung cancer was found most in cultivators in this study. Cough, chest pain, dyspnoea and haemoptysis were considered as parameters of symptoms. Most of the patients presented with cough, chest pain, dyspnoea and some with haemoptysis. In Arm A, 67% of patients got relief from all the symptoms during treatment time. In the rest 33%, early side effects were developed and treated accordingly. Ultimately 87% of patients got relief from all the symptoms within 2 weeks of completion of treatment. In 13% of cases, there was no relief. In Arm B, 74% of cases got relief from all the symptoms during treatment time. In the rest 26% of cases, adverse reactions developed. These subsided automatically in some cases and others, supportive treatment was required. Finally, 83.33% of cases became free of symptoms and 16.67% of cases were having no symptomatic relief. ..........

Enrichment of cancer stem-like cells by controlling oxygen, glucose and fluid shear stress in a microfluidic spheroid culture device

Current chemotherapies can often kill fast-growing cancer cells but are ineffective in destroying cancer stem cells (CSCs). This study aimed to investigate the effect of in vitro cell culture conditions on the features of lung adenocarcinoma cells (represented by A549, non-small cell type (NSCLC), cell lines) and the induction of cancer stem-like cells. For this purpose, a microfluidic system containing U-shaped arrays was designed and numerically optimized. This system was used for the three-dimensional culture of cells under a continuous laminar flow of culture medium. Numerical simulations were also performed to estimate the quiescent and necrotic zones inside the spheroids and the fluid shear stress on the cultured spheroids. Moreover, the effects of culture medium flow rate, oxygen and glucose concentrations and anoikis phenomenon on the number of CD90+ cells and expression of stemness, epithelial-mesenchymal transition (EMT) and ATP-binding cassette (ABC)-transporters genes were investigated. The results showed that all these parameters substantially affected the enrichment of A549 cancer stem-like cells. We also investigated the effect of the CSC enrichment method, i.e., shear stress and oxygen and glucose concentrations, on resistance to cisplatin treatment. Increasing shear stress and glucose concentration and decreasing oxygen concentration led to a sharp increase in chemoresistance of cells. Interestingly, changing oxygen concentration was more significant than changing the other factors. The results of this paper can be helpful for the effective enrichment of CSCs by adjusting in vitro culture conditions.

Evaluation of antimicrobial and antiproliferative activities of Actinobacteria isolated from the saline lagoons of northwestern Peru.

Extreme environments Morrope and Bayovar Salt lagoons, several ecosystems and microhabitats remain unexplored, and little is known about the diversity of Actinobacteria. We suggest that the endemic bacteria present in this extreme environment is a source of active molecules with anticancer, antimicrobial, and antiparasitic properties. Using phenotypic and genotypic characterization techniques, including 16S rRNA sequencing, we identified these bacteria as members of the genera Streptomyces, Pseudonocardia, Staphylococcus, Bacillus, and Pseudomonas. Actinobacteria strains were found predominantly. Phylogenetic analysis revealed 13 Actinobacteria clusters of Streptomyces, the main genus. Three Streptomycetes, strains MW562814, MW562805, and MW562807 showed antiproliferative activities against three tumor cell lines: U251 glioma, MCF7 breast, and NCI-H460 lung (non-small cell type); and antibacterial activity against Staphylococcus aureus ATCC 6538, Escherichia coli ATCC 10536, and the multidrug resistant Acinetobacter baumannii AC-972. The antiproliferative activities (measured as total growth inhibition [TGI]) of Streptomyces sp. MW562807 were 0.57 μg/mL, for 0.61 μg/mL, and 0.80 μg/mL for glioma, lung non-small cell type, and breast cancer cell lines, respectively; the methanolic fraction of the crude extract showed a better antiproliferative activity and could inhibit the growth of (U251 (TGI = 38.3 μg/mL), OVCAR-03 (TGI = 62.1 μg/mL), and K562 (TGI = 81.5 μg/mL)) of nine tumor cells types and one nontumor cell type. Extreme enviroments, such as the Morrope and Bayovar Salt saloons are promising sources of new bacteria, whose compounds may be useful for treating various infectious diseases or even some types of cancer.

Preparation and Characterization of Palladium Derivate-Loaded Micelle Formulation in Vitro as an Innovative Therapy Option against Non-Small Cell Lung Cancer Cells.

Nanoparticles have been used in cancer treatments to target tumor and reduce side effects. In this study, we aimed to increase the effectiveness of palladium(II) complex [PdCl(terpy)](sac) ⋅ 2H2 O, which previously showed anticancer potential, by preparing the nanoparticle formulation. An inhalable micellar dispersion containing a palladium(II) complex (PdNP) was prepared and its physicochemical characteristics were evaluated using in vitro tests. Morphology, size and surface charges of particle and loading/encapsulation efficiency of PdNP were analyzed by scanning electron microscopy, zeta sizer and inductively coupled plasma mass spectrometry while aerosol properties of PdNP were measured by the next generation impactor. A549 and H1299 non-small lung cancer cell types were used for cytotoxicity using SRB and ATP assays. Fluorescent staining and M30 antigen assay were carried out for cell death evaluation. Apoptosis was confirmed by flow cytometry analyses. SEM, particle size, and zeta potential results showed the particles have inhalable properties. The amount of the palladium(II) complex loaded into the particles was quantified which indicated high encapsulation efficiencies (97 %). The micellar dispersion expected to reach the alveolar region and the brachial region was determined 35 % and 47 %, respectively. PdNP showed an anti-growth effect by increasing reactive oxygen species that is followed by the induction of mitochondria-dependent apoptosis that is evidenced by pyknotic nuclei and M30 antigen level increments and disruption of polarization of membrane in mitochondria (Δψm). The results show that PdNP might be a promising inhalable novel complex to be used in non-small cell lung cancer, which warrants animal studies in further.

Scoping the Problem

Scoping the Problem

Identification and Analysis of Dysfunctional Genes and Pathways in CD8+ T Cells of Non-Small Cell Lung Cancer Based on RNA Sequencing.

Lung cancer, the most common of malignant tumors, is typically of the non-small cell (NSCLC) type. T-cell-based immunotherapies are a promising and powerful approach to treating NSCLCs. To characterize the CD8+ T cells of non-small cell lung cancer, we re-analyzed the published RNA-Seq gene expression profiles of 36 CD8+ T cell isolated from tumor (TIL) samples and 32 adjacent uninvolved lung (NTIL) samples. With an advanced Monte Carlo method of feature selection, we identified the CD8+ TIL specific expression patterns. These patterns revealed the key dysfunctional genes and pathways in CD8+ TIL and shed light on the molecular mechanisms of immunity and use of immunotherapy.

Identification of suitable reference genes in blood samples of carcinoma lung patients using quantitative real-time polymerase chain reaction.

INTRODUCTION:Lung cancer (LC), among all other cancers, is the leading cause of death worldwide, while the third most common cancer-causing mortality in India. Several techniques of the assay for early detection of cancer that improve survival rates have been employed in tissues and cell lines. Reverse transcriptase quantitative polymerase chain reaction (RTqPCR) is one of the most common techniques employed for gene expression studies for the normalization of a target gene using a reference gene (RG). The present study used the three most common RGs: glyceraldehyde-3-phosphate dehydrogenase (GAPDH), β-Actin, and 18s ribosomal ribonucleic acid (18s rRNA), which were assessed by qPCR to validate, as of which is a more effective RG in blood samples of LC patients.MATERIALS AND METHODS:A total of thirty participants with LC of non-small cell and small cell type were included along with twenty healthy controls. Ribonucleic acid (RNA) isolated from peripheral blood mononuclear cells was quantified, prepared for complementary deoxyribose nucleic acid synthesis, and analyzed for expression of three RG on RTqPCR.RESULTS:Expression levels as Ct values of studied RG were reported as mean ± standard deviation for GAPDH (26.97 ± 5.107), β-actin (20.5 ± 2.3), and 18s rRNA (25.10 ± 4.075). GAPDH showed the lowest expression, whereas β-actin showed the highest expression among the studied RG in subjects of LC. The expression of GAPDH and 18s rRNA were statistically significantly lower than β-actin (p < 0.0001), whereas expression levels of GAPDH and 18s rRNA were comparable. However, the expression level of only β-actin in LC patients was comparable with healthy controls with P < 0.1611 at 95% confidence interval.CONCLUSION:It is concluded that β -actin may be considered the most suitable RG isolated and studied from peripheral blood mononuclear cells using RT qPCR in LC.

Non-Resolving Lung Infiltrate: A Rare Case of Papillary Adenocarcinoma of the Lung

Lung carcinoma is one of most common and leading cause of cancer related mortality in United States. The main sub-types of lung cancer are non-small cell lung carcinoma (NSCLC) and small cell carcinoma (SCLC). About 85% of lung cancers are of the non-small cell type, of which more than 50% are adenocarcinomas. Primary papillary adenocarcinoma (PA) is a subtype of adenocarcinoma with predominance of papillary structures that replace the underlying alveolar architecture supported by fibro-vascular cores with complicated secondary and tertiary branches. PA is a relatively rare type that can present a diagnostic challenge when it presents as a non-resolving infilitrate as seen in this case. It is more common in woman and non-smokers. The subtype of adenocarcinoma is key factor for therapeutic choice of chemotherapy. The case reviewed here is a rare presentation of a middle aged chronic smoker Man with past medical history of chronic obstructive pulmonary disease (COPD) who was treated several times for recurrent episodes of worsening dyspnea attributed to an infectious etiology, but without any significant improvement which led to further testing and trans-bronchial biopsy which reveled PA of the lung. Tissue diagnosis is therefore warranted in patients with a non-resolving lung infiltrate.

Immunohistochemistry of non-small cell type of lung cancer can be used as a separate prognostic factor?

Aim We aim to assess prognostic significance of immunohistochemistry represented in Napsin A and CK 5/6 in NSCLC, Moreover we aim to correlate histologic patterns of adenocarcinoma with Napsin A expression and identify its prognostic significance. Patients and methods The study was conducted on 130 cases diagnosed pathologically as NSCLC, and then we used Napsin A and CK 5/6 for subtyping them into actual histologic types (108 cases were diagnosed as adenocarcinoma and 22 cases as squamous cell carcinoma, we correlated expression levels of Napsin A and CK 5/6 to different clinicopathological variants. Results Napsin A score 2 was high in age more than or equal 60 years while Napsin A score 3 was high in age less than 50 years also Napsin A score 3 was high in cases with lymph node metastasis, while CK 5/6 was associated with cases without distant metastasis. Conclusion Both Napsin A and CK 5/6 could be used as prognostic and diagnostic markers in NSCLC.

Abstract 1820: Overcoming drug resistance in NSCLC with SRC inhibitor

Abstract Lung cancer accounts for about 27 percent of all cancer deaths in the United States. Approximately 85 percent of lung cancers are non-small cell type (NSCLC) and, when treated with both chemotherapy and targeted therapies, have a five-year overall survival rate of approximately 16 percent. These statistics clearly emphasize the need for developing treatment methodologies more effective than the current standard of care. Here, we evaluated the efficacy of combined inhibition of SRC and AXL in NSCLC.Dasatinib, a BCR/abl and src family tyrosine kinase inhibitor (TKI) is a drug that has a potential to be used against both EGFR and KRAS mutated lung cancer patients, alone (phase II clinical trial) and in combination with cetuximab (in phase III clinical trial), osimertinib and erlotinib (both in phase II clinical trials) by exploiting its SRC inhibition capabilities. However, NSCLC patients treated with dasatinib often develop resistance and is the major reason for the low median survival in stage IV patients. Recently, AXL pathway has been shown to be upregulated in Dasatinib resistant cells causing activation of EMT, AKT and survival pathways. It has been suggested that auto-phosphorylation of DDR2 and subsequent activation of SHP2/RAS/AKT pathway as a result of AXL upregulation is one of the major reasons for failure to induce apoptosis in cells during dasatinib resistance. Therefore, we examined whether inhibition of AXL resensitized TKI resistant NSCLC to dasatinib. Our results show that AXL knockdown can resensitize cells to dasatinib. IC50 values decreased significantly following AXL inhibition. We have also demonstrated that nanoparticle-mediated AXL knockdown also produces similar resensitization. The details of the study will be presented. Citation Format: Soumavo Mukherjee, Dhananjay Suresh, Ajit P. Zambre, Anandhi Upendran, Raghuraman Kannan. Overcoming drug resistance in NSCLC with SRC inhibitor [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1820.

Primary high-grade calcitonin-negative neuroendocrine carcinoma of the thyroid: a very rare cancer.

SummaryMost medullary thyroid carcinomas (MTCs) are low grade and produce calcitonin. There are some calcitonin-negative MTCs that produce only calcitonin gene-related peptide (CGRP). Rarely, MTCs are negative for calcitonin and CGRP peptides, but contain their corresponding mRNAs. Primary thyroid neuroendocrine neoplasms other than MTCs are extremely rare. We describe a primary high-grade neuroendocrine carcinoma that was negative for CGRP and calcitonin at both the protein and mRNA levels. A 42-year-old woman presented with a rapidly enlarging thyroid mass replacing most of the left lobe and isthmus. A computed tomography-guided core-needle biopsy was performed. The tumor was composed of sheets of small-to-medium sized epithelial cells. The cells were immunoreactive for pancytokeratin, synaptophysin, CD56 and thyroid transcription factor-1, but negative for CK7, CK20, CD45, CD99, ERG, chromogranin A, thyroglobulin, calcitonin, CGRP and carcinoembryonic antigen. The Ki-67 proliferation index was ~90%. In situ hybridization was negative for calcitonin mRNA. The patient was initially diagnosed as having a small cell carcinoma. She was treated with cisplatin and etoposide (VP16), followed by radiation therapy. Given the excellent clinical course, the tumor was reviewed and reclassified as a high-grade neuroendocrine carcinoma (non-small-cell type). Heretofore, only a few other similar high-grade neuroendocrine tumors with negative markers of C-cell derivation have been reported. In our case, the patient is cancer free five years after diagnosis, but in the other cases, the outcome was poor.Learning points:There are neuroendocrine carcinomas of the thyroid that do not produce calcitonin or calcitonin gene-related peptide.This category of calcitonin-negative neuroendocrine carcinomas is heterogeneous, consisting of low- and high-grade tumors.The high-grade neuroendocrine carcinomas of the thyroid are rare and generally have a poor prognosis. They are divided into small cell and non-small cell or large cell types.

Wnt3 knockdown sensitizes human non-small cell type lung cancer (NSCLC) cells to cisplatin via regulating the cell proliferation and apoptosis.

Aberrant activation of (Wingless and mouse homolog Int-1) Wnt/β-catenin signaling pathways closely involved in the occurrence and progression of several types of human malignancies. This research was undertaken to elucidate the important role of (Wingless and mouse homolog Int-1) in lung cancer. Wnt3 expression in lung cancers and their respective normal tissues were examined by immunoblotting and immunohistochemistry. Then, Wnt3 was regulated with RNA interference (RNAi) technology in human lung cancer A549 cells, and the cell proliferation, cell cycle, cell invasion/metastasis, and apoptosis were evaluated. In all cases, Wnt3 expression was significantly elevated in lung cancers compared with normal tissues. Knocking down Wnt3 in A549 lung cancer cells by small interfering RNAs transfection led to a distinct reduction of Wnt3 in both transcript and protein levels. Knockdown of Wnt3 expression in lung cancer cells inhibited the expression of β-catenin and cyclin D1 genes in Wnt/β-catenin pathway. It also significantly blocked cellular proliferation, delayed cell cycle and suppressed cell invasion/metastasis, accompanied by a higher apoptosis rate. We conclude that the upregulation of Wnt3 plays a crucial role in lung tumorigenesis by inducing proliferation, migration, and invasion and inhibiting apoptosis of cancer cells. Wnt3 might be a potential target for the treatment of lung cancer.

Tissue and Blood Biomarkers in Lung Cancer: A Review.

Lung cancer is the most common cause of cancer-related death, worldwide. Historically, lung cancer has been divided into two main histological types: small cell and nonsmall cell (NSC) type with the latter being subdivided into adenocarcinoma, squamous cell type, and large cell type. The treatment of the NSC lung cancer (NSCLC), especially the adenocarcinoma subtype, has been transformed in the last decade by the availability of predictive biomarkers for molecularly targeted therapies. Currently, for patients with advanced adenocarcinomas, testing for sensitizing mutations in epidermal growth factor receptor (EGFR) is mandatory prior to the administration of anti-EGFR inhibitors such as erlotinib, gefitinib, afatinib, or osimertinib. For patients unable to provide tumor tissue, EGFR mutational analysis may be performed on plasma. For predicting response to crizotinib, testing for ALK and ROS1 gene rearrangement is necessary. The presence of ALK rearrangements is also a prerequisite for treatment with ceritinib, alectinib, or brigatinib. For predicting response to single agent pembrolizumab in the first-line treatment of patients with advanced adenocarcinoma or squamous cell NSCLCs, PD-L1 should be measured by an approved assay (e.g., PD-L1 IHC 22C3 pharmDx method). Although not widely used, serum biomarkers such as neuron-specific enolase, progastrin-releasing peptide, carcinoembryonic antigen, CYFRA 21-1, and squamous cell carcinoma antigen may help in the differential diagnosis of lung cancer when a tissue diagnosis is not possible. Serum biomarkers may also be of use in determining prognosis and monitoring response to systemic therapies. With the increasing use of biomarkers, personalized treatment especially for patients with adenocarcinoma-type NSCLC is finally on the horizon.

MS 07.06 Which Chemotherapy or Targeted Therapy is Better for Treatment of LCNEC Patients: SCLC-based versus Non-SCLC-based Regimens?

Staging of large cell neuroendocrine carcinoma (LCNEC) was classified based on non-small cell type (TNM stage). The treatment of early stage (I, II) was mainly surgery; the use of neo-adjuvant and adjuvant chemotherapy are in consideration but there's not a standard approach; for stage III which limited to the thoracic area, the role of concurrent chemotherapy and radiotherapy is one of the options. Whether the regimen of chemotherapy should be similar to small cell lung cancer (SCLC) or the regimen of non-small cell lung cancer (NSCLC) is not clear. Most of the data are in favor of SCLC regimen which is Cisplatin plus etoposide; however the data came from retrospective and small numbers of patients, thus there's an unmet need to improve the treatment of LCNEC. Large Cell Neuroendocrine Carcinoma and Small Cell Lung Cancer are both consider high grade neuroendocrine carcinoma of the lung. Small cell is the most frequent type of lung neuroendocrine tumor, occurs around 15% of lung cancer while Large Cell neuroendocrine carcinoma was only about 3% of lung cancer. According to WHO classification in 2004 LCNEC was classified as a variant of large-cell carcinoma; however in 2015 WHO classification LCNEC was classified into a group of neuroendocrine tumor which includes SCLC, typical carcinoid, atypical carcinoid and LCNEC. According to genomic analysis, LCNEC was separated into two groups. Some have genomic characteristic of SCLC and some have genomic characteristic of NSCLC. The new modalities such as anti-angiogenesis and in the case of EGFR mutation the treatment with EGFR inhibitor should be considered. The role of met inhibitors in LCNEC should be explored. Thus there is a long way to go in order to improve the outcome of this rare lung cancer type. large cell neuroendocrine carcinoma, chemotherapy regimen

Fast diagnostic track for suspected lung cancer: A patient centered approach

The aim of this study is to describe the characteristics of patients who underwent a fast diagnostic track (FDT) due to suspected lung cancer at Landspitali University Hospital, Iceland. Hospital records were reviewed on background characteristics, diagnosis, staging, waiting times and survival of all 550 patients (mean age 68.1 years, 57% female) that participated in the FDT from February 1, 2008 to January 31, 2015. Adjusting for clinical characteristics in a multivariate analysis, overall survival was compared for patients diagnosed with lung cancer within or outside the FDT in Iceland in 2014 (n=167, mean age 69.3 years, 61.7% female). Of the 550 FDT patients, 426 were diagnosed with lung cancer (77.5%); 346 of the non-small cell type (NSCLC) (81.2%). The proportion of patients receiving lung cancer diagnosis through the FDT increased from 23.3% in 2008 to 47.9% in 2014 (p<0.001). The waiting time from referral to diagnosis was 10 days median and 19 days from diagnosis to initiation of treatment. More patients with advanced disease were diagnosed outside the FDT (70.1% vs. 37.5%, p<0.05). When ad-- justed for age, sex, histology, stage at diagnosis and therapy, patients diagnosed with lung cancer outside the FDT had higher risk of all-cause mortality (HR 1.60; 95% CI: 0.95 - 2.71) although the difference was not statistically significant. An increasing proportion of lung cancer diagnosis in Iceland is made through a fast diagnostic track with potential benefits for patients. The waiting time from referral to diagnosis and treatment is in line with international guidelines. Key words: lung cancer, non-small cell lung cancer, diagnostic track, waiting times, survival. Correspondence: Hronn Hardardottir, hronnh@landspitali.is.