Lung Cancer Outcomes Research Articles

Assessing the impact of socioeconomic status on incidental lung nodules at an urban safety net hospital

IntroductionLower socioeconomic status has been identified as an emerging risk factor for health disparities, including lung cancer outcomes. Most research investigating these outcomes includes patients from formal lung cancer screening programs. There is a paucity of studies assessing the relationship between socioeconomic status and incidental lung nodules. This study aimed to investigate the association between socioeconomic status and the size of incidental lung nodules on initial presentation at an urban safety net hospital, which did not have a formal lung cancer screening program or incidental lung nodule program.MethodsA retrospective chart review was conducted on patients with incidental lung nodules on CT chest imaging who were referred from primary care to a pulmonology clinic at a safety net hospital. Patients with incomplete nodule characteristics information were excluded. Data on demographics, comorbidities, smoking history, insurance type, immigration status, and geographical factors were collected. Less commonly studied determinants such as crime index, cost of living, and air quality index were also assessed. Logistic regression analysis was performed to assess relationships between nodule size and socioeconomic determinants.ResultsOut of 3,490 patients with chest CT scans, 268 patients with ILNs were included in the study. 84.7% of patients represented racial or ethnic minorities, and most patients (67.8%) had federal insurance. Patients with non-commercial insurance were more likely to have larger, inherently higher-risk nodules (> 8 mm) compared to those with commercial insurance (OR 2.18, p 0.01). Patients from areas with higher unemployment rates were also less likely (OR 0.75, p 0.04) to have smaller nodules (< 6 mm). Patients representing racial or ethnic minorities were also more likely to have nodules > 8 mm (OR 1.6, p 0.24), and less likely to have nodules < 6 mm (OR 0.6, p 0.32), however, these relationships were not statistically significant.ConclusionThis study found that lower socioeconomic status, indicated by having non-commercial insurance, was associated with larger incidental lung nodule size on initial presentation. While it is established that socioeconomic status is associated with disparities in lung cancer screening, these findings suggest that inequalities may also be present in those with incidental lung nodules. Further research is needed to understand the underlying mechanisms and develop interventions to address these disparities in incidental lung nodule evaluation and improve outcomes.

The use of non-steroid anti-inflammatory drugs during radical resection correlated with the outcome in non-small cell lung cancer

AimsThe use of non-steroid anti-inflammatory drugs (NSAIDs) is conventional in management of postoperative pain in cancer patients, and further investigations have reported that some of these drugs correlated with the outcome in cancers. However, the prognostic value of the use of NSAIDs during surgery in non-small cell lung cancer (NSCLC) patients has been less addressed.MethodsNSCLC patients staged I–III are retrospectively enrolled, and the data of the use of NSAIDs during surgery are collected. Patients are divided into two subgroups according to the use intensity (UI) (low or high) of the NSAIDs, which was calculated by the accumulate dosage of all the NSAIDs divided by the length of hospitalization. The differences of the clinical features among these groups were checked. And the disease-free survival (DFS) and overall survival (OS) differences in these groups were compared by Kaplan–Meier analysis; risk factors for survival were validated by using a Cox proportional hazards model.ResultsThe UI was significant in predicting the DFS (AUC = 0.65, 95% CI: 0.57–0.73, P = 0.001) and OS (AUC = 0.70, 95% CI: 0.59–0.81, P = 0.001). Clinical features including type of resection (P = 0.001), N stages (P < 0.001), and TNM stages (P = 0.004) were significantly different in UI low (< 74.55 mg/day) or high (≥ 74.55 mg/day) subgroups. Patients in UI-high subgroups displayed significant superior DFS (log rank = 11.46, P = 0.001) and OS (log rank = 7.63, P = 0.006) than the UI-low ones. At last, the UI was found to be an independent risk factor for DFS (HR: 0.52, 95% CI: 0.28–0.95, P = 0.034).ConclusionsThe use of NSAIDs during radical resection in NSCLC patients correlated with the outcome and patients with a relative high UI has better outcome.

Real-World Data on Treatment Outcome of ALK-Positive Non-Small Cell Lung Cancer from an Indian Multicentric Cancer Registry.

Lalatendu Moharana The Anaplastic lymphoma kinase inhibitors (ALKi) represent the standard of care for metastatic non-small cell lung cancer (NSCLC) patients with EML4-ALK rearrangements. Various ALKi agents are available; however, not all eligible patients receive treatment with them due to various reasons. Given the limited real-world data available in our country, we aimed to assess treatment outcomes through a multicenter collaboration. This retrospective, multi-institutional study was conducted under the Network of Oncology Clinical Trials India and included a total of 67 ALK-positive metastatic lung cancer patients from 10 institutes across India, with a median follow-up of 23 months. In the first line setting, the objective response rate (ORR) with ALKi was 63.6% (crizotinib: 60.7%, ceritinib: 70%, alectinib: 66.6%, p = 0.508), while with chemotherapy, it was 26.1%. The median progression-free survival (mPFS) for the first line ALKi group was significantly higher than that for chemotherapy (19 vs. 9 months, p = 0.00, hazard ratio [HR] = 0.30, 95% confidence interval [CI]: 0.17-0.54). The mPFS for crizotinib, alectinib, and ceritinib was 17, 22, and 19 months, respectively ( p = 0.48). Patients who received ALKi upfront or after 1 to 3 cycles of chemotherapy or after 4 or more cycles of chemotherapy had mPFS of 16, 22, and 23 months, respectively ( p = 0.47). ALKi showed superior mPFS compared to chemotherapy in the second line (14 vs. 5 months; p = 0.002) and the third line (20 vs. 4 months; p = 0.009). The median overall survival (OS) was significantly better in patients who received ALKi in any line of therapy (44 vs. 14 months, p < 0.001, HR = 0.10, 95% CI: 0.04-0.23). Brain progression was higher among those who did not receive ALKi (69.2 vs. 31.5%). In conclusion, the use of ALKi as first line treatment for ALK-positive metastatic NSCLC patients resulted in improved PFS. PFS and ORR did not significantly differ between patients who received ALKi upfront or after initiating chemotherapy. Notably, patients who received ALKi in second or later lines demonstrated significantly better outcomes compared to those receiving chemotherapy. The use of ALKi in any line of therapy was associated with significantly prolonged OS.

Elucidating diagnostic efficacy and safety of the procedure: cryobiopsy of endobronchial lesions with a flexible bronchoscope

When compared to conventional forceps biopsy, the use of a flexible cryoprobe allows for the sampling of endobronchial lesions, yielding well-preserved, circumferential, and substantial specimens, resulting in a higher diagnostic yield, as demonstrated in multiple studies. We evaluated the utility of cryobiopsy in the diagnosis of endobronchial lesions as well as its safety profile in this study. This retrospective study included 200 patients who underwent cryobiopsy for bronchoscopically visible endobronchial lesions between March 2016 and July 2022. Cryobiopsy was performed under conscious sedation using a flexible cryoprobe. Data on baseline patient characteristics, post-biopsy bleeding, and final histopathological diagnosis were collected. We evaluated the procedure's diagnostic yield and safety. The majority of the patients were male (84.5%) and the mean age of the patients was 56.96±13.64 years. In our study, the average size of cryobiopsy specimen was 6.8±1.2 mm. In 93% of cases, a definitive diagnosis was established; the most common diagnosis was squamous cell carcinoma of the lung (42.5%), followed by adenocarcinoma (18.5%) and small cell carcinoma (13.5%). Tuberculosis and sarcoidosis were reported in 2.5% and 1% of cases, respectively. In this study, 1% of patients had severe bleeding that required intubation and ICU admission, while 26% had moderate bleeding that was treated with cold saline and local epinephrine instillation. No mortality was reported in the study. Endobronchial cryobiopsy with a flexible bronchoscope is a safe procedure with a high diagnostic yield. This approach, which has a favorable safety profile, holds the promise of improving diagnostic and treatment outcomes in lung cancer and other benign lung diseases.

A phase I study of the combination of atezolizumab, tiragolumab, and stereotactic body radiation therapy in patients with metastatic multiorgan cancer

BackgroundImmunotherapy targeting the PD-1/PD-L1 pathway is a standard of care in a number of metastatic malignancies, but less than a fifth of patients are expected to respond to ICIs (Immune Checkpoint Inhibitors). In a clinical trial, combining the anti-TIGIT (T cell immunoreceptor with Ig and ITIM domains) Mab (monoclonal antibody) tiragolumab with atezolizumab improved outcomes in non-small cell lung cancer. In preclinical models, SBRT (Stereotactic Body Radiation Therapy) could increase expression levels of the inhibitory co-receptors TIGIT and PD-L1. We aim to assess the combination of tiragolumab with atezolizumab and SBRT in metastatic, previously treated by ICIs, non-small cell lung cancer, head and neck cancer, bladder cancer, and renal cell cancer.MethodsThis phase I study (ClinicalTrials.gov NCT05259319) will assess the efficacy and safety of the combination of atezolizumab with tiragolumab and stereotactic body radiation therapy in patients with histologically proven metastatic non-small cell lung cancer, renal cell cancer, bladder cancer, and head and neck cancer previously treated. First part: 2 different schedules of SBRT in association with a fixed dose of atezolizumab and tiragolumab will be investigated only with metastatic non-small cell lung cancer patients (cohort 1). The expansion cohorts phase will be a multicentric, open-label study at the recommended scheme of administration and enroll additional patients with metastatic bladder cancer, renal cell cancer, and head and neck cancer (cohort 2, 3 and 4). Patients will be treated until disease progression, unacceptable toxicity, intercurrent conditions that preclude continuation of treatment, or patient refusal in the absence of progression or intolerance. The primary endpoint of the first phase is the safety of the combination in a sequential or concomitant scheme and to determine the expansion cohorts phase recommended scheme of administration. The primary endpoint of phase II is to evaluate the efficacy of tiragolumab + atezolizumab + SBRT in terms of 6-month PFS (Progression-Free Survival). Ancillary analyses will be performed with peripheral and intratumoral immune biomarker assessments.Trial registrationThis study is registered on ClinicalTrials.gov: NCT05259319, since February 28th, 2022.

Implementation of a methodology to assess patient reported outcomes in lung cancer patients: The PeOpLe (Patient-reported Outcomes in Lung cancer) study protocol

ObjectiveThe purpose of this article is to describe the PeOpLe study protocol, developed to assess patient-reported health outcomes in advanced or metastatic non-small-cell lung cancer in routine clinical practice using the methodology provided by the International Consortium for Health Outcomes Measurement tool. MethodThe study envisaged will be multicenter, longitudinal, ambispective and observational. Two groups will be compared: a control group (followed up according to standard clinical practice) and an experimental group (followed up using the International Consortium for Health Outcomes Measurement methodology adapted to the Spanish setting for 6 months). The variables collected will be related to demography (age, sex, degree of family support), clinical factors (smoking, comorbidities, lung capacity), the neoplasm (histology, staging, mutations), pharmacotherapy (treatment schedule, modifications, and complications), health status (functional status, quality of life, satisfaction and overall survival) and resource consumption (emergency visits, hospital admissions and time spent by health providers). The PeOpLe study protocol has been approved by the Ethics Committee for Research into Medicinal Products of the Gregorio Marañón General University Hospital and will be conducted in compliance with prevailing ethical principles and standards. ConclusionsThe PeOpLe study will explore how patient-reported outcomes collection can be developed and integrated with the clinical processes used in the management of patients with locally advanced or metastatic non-small cell lung cancer what patient-reported outcomes can be measured with systems that can conveniently be used both by patients and by healthcare providers. Systematic evaluation of patient-reported outcomes will help determine their impact in terms of effectiveness (survival), safety (complications of systemic therapy), and quality of life and patient satisfaction. The multidisciplinary and multicenter nature of the study will facilitate a comprehensive view of the subject analyzed and allow external reproducibility.

Clinical Features and Management of Lung Cancer During Pregnancy: A Narrative Review Based on Reported Cases.

This review aims to provide a summary of the clinical characteristics and outcomes of lung cancer during pregnancy. A comprehensive literature search yielded 93 cases of lung cancer during pregnancy from 1953 to 2022, with an average maternal age of ∼34 years old. The initial symptoms reported were often nonspecific, such as cough, dyspnea, and chest pain. Cancer-related treatments, including surgery, radiotherapy, chemotherapy, and tyrosine kinase inhibitors, have shown beneficial effects on maternal outcomes. A majority of the newborns were born without malformation or diseases, but extended follow-up remains necessary. Early diagnosis of lung cancer is imperative for reducing the risks of placental and fetal metastasis and enhancing overall survival.

Association between the modified lung immune predictive index and clinical outcomes of advanced non-small cell lung cancer treated with first-line immune checkpoint inhibitors combined with chemotherapy

Association between the modified lung immune predictive index and clinical outcomes of advanced non-small cell lung cancer treated with first-line immune checkpoint inhibitors combined with chemotherapy

EP03.06-06 KRAS-B: Molecular Epidemiology and Clinical Outcomes of KRAS-Mutant Non-small Cell Lung Cancer (NSCLC) in Brazil

EP03.06-06 KRAS-B: Molecular Epidemiology and Clinical Outcomes of KRAS-Mutant Non-small Cell Lung Cancer (NSCLC) in Brazil

EP12.01-17 Association of CYP450 and Drug Efflux Transporters Polymorphism Influence Outcomes of Thai Non-small Cell Lung Cancer Treated with Osimertinib

EP12.01-17 Association of CYP450 and Drug Efflux Transporters Polymorphism Influence Outcomes of Thai Non-small Cell Lung Cancer Treated with Osimertinib

P1.25-05 Real-World Outcomes in Non-metastatic Non-small Cell Lung Cancer (NSCLC): An I-O Optimise Multi-Country Analysis

P1.25-05 Real-World Outcomes in Non-metastatic Non-small Cell Lung Cancer (NSCLC): An I-O Optimise Multi-Country Analysis

P2.10-04 Real-World Outcome of Metastatic ALK-Positive Non-Small Cell Lung Cancer Treated with Tyrosine Kinase Inhibitors

P2.10-04 Real-World Outcome of Metastatic ALK-Positive Non-Small Cell Lung Cancer Treated with Tyrosine Kinase Inhibitors

EP07.05-12 The Impact of COVID-19 on Both the Diagnosis and Surgical Outcomes of Lung Cancer in Korea

EP07.05-12 The Impact of COVID-19 on Both the Diagnosis and Surgical Outcomes of Lung Cancer in Korea

WS08.08 Impact of KRASG12D Subtype and Concurrent Pathogenic Mutations on Advanced Non-small Cell Lung Cancer Outcomes

WS08.08 Impact of KRASG12D Subtype and Concurrent Pathogenic Mutations on Advanced Non-small Cell Lung Cancer Outcomes

P1.08-06 Impact of KRASG12D Subtype and Concurrent Pathogenic Mutations on Advanced Non-small Cell Lung Cancer Outcomes

P1.08-06 Impact of KRASG12D Subtype and Concurrent Pathogenic Mutations on Advanced Non-small Cell Lung Cancer Outcomes

Prognostic factors and survival prediction of resected non-small cell lung cancer with ipsilateral pulmonary metastases: a study based on the Surveillance, Epidemiology, and End Results (SEER) database

BackgroundPrognostic factors and survival outcomes of non-small cell lung cancer (NSCLC) with Ipsilateral pulmonary metastasis (IPM) are not well-defined. Thus, this study intended to identify the prognostic factors for these patients and construct a predictive nomogram model.MethodsOne thousand, seven hundred thirty-two patients with IPM identified between 2000 to 2019 were from the Surveillance, Epidemiology, and End Results (SEER) database. Independent prognostic factors were identified using multivariate Cox regression analyses. Nomograms were constructed to predict the overall survival (OS), C-index, the area under the curve (AUC), and the calibration curve to determine the predictive accuracy and discrimination; the decision curve analysis was used to confirm the clinical utility.ResultsPatients were randomly divided into training (n = 1213) and validation (n = 519) cohorts. In the training cohort, the multivariable analysis demonstrated that age, sex, primary tumor size, N status, number of regional lymph nodes removed, tumor grade, and chemotherapy were independent prognostic factors for IPM. We constructed a 1-year, 3-year, and 5-year OS prediction nomogram model using independent prognostic factors. The C-index of this model for OS prediction was 0.714 (95% confidence interval [CI], 0.692 to 0.773) in the training cohort and 0.695 (95% CI, 0.660 to 0.730) in the validation cohort. Based on the AUC of the receiver operating characteristic analysis, calibration plots, and decision curve analysis, we concluded that the prognosis model of IPM exhibited excellent performance. Patients with total nomogram points greater than 96 were considered high-risk.ConclusionWe constructed and internally validated a nomogram to predict 1-year, 3-year, and 5-year OS for NSCLC patients with IPM according to independent prognostic factors. This nomogram demonstrated good calibration, discrimination, clinical utility, and practical decision-making effects for the prognosis of NSCLC patients with IPM.

Routine perioperative blood tests predict survival of resectable lung cancer

There is growing evidence that inflammatory, immunologic, and metabolic status is associated with cancer patients survival. Here, we built a simple algorithm to predict lung cancer outcome. Perioperative routine blood tests (RBT) of a cohort of patients with resectable primary lung cancer (LC) were analysed. Inflammatory, immunologic, and metabolic profiles were used to create a single algorithm (RBT index) predicting LC survival. A concurrent cohort of patients with resectable lung metastases (LM) was used to validate the RBT index. Charts of 2088 consecutive LC and 1129 LM patients undergoing lung resection were evaluated. Among RBT parameters, C-reactive protein (CRP), lymphocytes, neutrophils, hemoglobin, albumin and glycemia independently correlated with survival, and were used to build the RBT index. Patients with a high RBT index had a higher 5-year mortality than low RBT patients (adjusted HR 1.93, 95% CI 1.62–2.31). High RBT patients also showed a fourfold higher risk of 30-day postoperative mortality (2.3% vs. 0.5%, p 0.0019). The LM analysis validated the results of the LC cohort. We developed a simple and easily available multifunctional tool predicting short-term and long-term survival of curatively resected LC and LM. Prospective external validation of RBT index is warranted.

Persistent racial disparities in refusal of resection in non-small cell lung cancer patients at high-volume and Black-serving institutions

BackgroundSurgical resection is the standard of care for early-stage non-small cell lung cancer. Black patients have higher surgical refusal rates than White patients. We evaluated factors associated with the refusal of resection and subsequent non-small cell lung cancer outcomes. MethodsWe identified patients with non-small cell lung cancer stages IA to IIIA eligible for surgical resection (lobectomy or pneumonectomy) listed between 2004 and 2017 in the National Cancer Database. We stratified hospitals by the proportion of Black patients served and lung cancer resection volume. We used multivariable regression models to identify factors associated with refusal of resection and assessed 5-year mortality using Kaplan–Meier analysis and Cox proportional hazard modeling. ResultsOf 221,396 patients identified, 7,753 (3.5%) refused surgery. Black race was associated with increased refusal (adjusted odds ratio 2.06, 95% confidence interval 1.90–2.22). Compared to White race, Black race was associated with increased refusal across the highest (adjusted odds ratio 2.29, 95% confidence interval 1.94–2.54), intermediate (adjusted odds ratio 2.05, 95% confidence interval 1.78–2.37), and lowest (adjusted odds ratio 1.77, 95% confidence interval 1.58–1.99) volume tertiles. Similarly, Black race was associated with increased refusal across the highest (adjusted odds ratio 1.97, 95% confidence interval 1.78–2.17), intermediate (adjusted odds ratio 2.08, 95% confidence interval 1.80–2.40), and lowest (adjusted odds ratio 1.53, 95% confidence interval 1.13–2.06) Black-serving tertiles. However, surgical resection yielded similar 5-year survival for Black and White patients. ConclusionRacial disparities in non-small cell lung cancer surgery refusal persist regardless of hospital volume or proportion of Black patients served. These findings suggest that a better understanding of patient and patient–provider level interventions could facilitate a better understanding of treatment decision-making.

Pan-immune-inflammation and its dynamics: predictors of survival and immune-related adverse events in patients with advanced NSCLC receiving immunotherapy

ObjectivesPan-immune-inflammation value (PIV) is defined by the neutrophil, platelet, monocyte, and lymphocyte counts and is associated with immune-checkpoint inhibitor (ICI) therapy outcomes in advanced non-small cell lung cancer (aNSCLC). However, PIV is dynamic under therapy and its longitudinal assessment may help predict efficacy. This study investigated the impact of baseline PIV and its dynamics on ICI efficacy and its immune-related adverse events (irAEs). The study additionally attempted to understand the biological significance of PIV.Patients and methodsThis retrospective study analyzed the clinical data of 269 consecutive patients with aNSCLC. PIV was calculated at baseline and at weeks 3–4 to determine its association with overall survival (OS), progression-free survival (PFS), and irAEs.ResultsResults revealed that low baseline PIV was positively correlated with the incidence of irAEs. Moreover, a low PIV at baseline was significantly associated with a prolonged PFS (median PFS: 10 vs. 7 months, p = 0.0005) and OS (median OS: 29 vs. 21 months, p < 0.0001). When the PIV at baseline and weeks 3–4 was considered together, its low dynamics correlated with a higher incidence of irAEs (p = 0.001), a longer PFS (median PFS, 9 vs. 6 months, p = 0.012), and a longer OS (median OS; 28 vs. 21 months, p = 0.002).ConclusionThus, PIV at baseline and its dynamics are novel and potent predictors of irAEs, PFS, and OS in patients with aNSCLC receiving immunotherapy. Moreover, the PIV dynamics may be an effective, novel surrogate marker to dynamically observe the efficacy of immunotherapy.

57P Clinical characteristics and outcomes in non-small cell lung cancer (NSCLC) with tumour and germline BRCA1/2 mutations

57P Clinical characteristics and outcomes in non-small cell lung cancer (NSCLC) with tumour and germline BRCA1/2 mutations