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RESPIRATORY DISEASES (102 journals)                     

Showing 1 - 102 of 102 Journals sorted alphabetically
Advances in Respiratory Medicine     Open Access   (Followers: 7)
American Journal of Respiratory and Critical Care Medicine     Full-text available via subscription   (Followers: 257)
American Journal of Respiratory Cell and Molecular Biology     Full-text available via subscription   (Followers: 20)
American Review of Respiratory Disease     Full-text available via subscription   (Followers: 4)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1)
Annals of the American Thoracic Society     Full-text available via subscription   (Followers: 17)
Annals of Thoracic Medicine     Open Access   (Followers: 6)
Archivos de Bronconeumología     Full-text available via subscription  
Archivos de Bronconeumología (English Edition)     Full-text available via subscription   (Followers: 1)
Asthma Research and Practice     Open Access   (Followers: 1)
BMC Pulmonary Medicine     Open Access   (Followers: 5)
BMJ Open Respiratory Research     Open Access   (Followers: 6)
Breathe     Open Access   (Followers: 4)
Canadian Journal of Respiratory, Critical Care, and Sleep Medicine     Hybrid Journal   (Followers: 1)
Canadian Respiratory Journal     Open Access   (Followers: 3)
Case Reports in Pulmonology     Open Access   (Followers: 3)
Chest     Full-text available via subscription   (Followers: 101)
Chest Disease Reports     Open Access   (Followers: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9)
Clinical Lung Cancer     Hybrid Journal   (Followers: 6)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3)
Clinical Pulmonary Medicine     Hybrid Journal   (Followers: 2)
COPD Research and Practice     Open Access   (Followers: 1)
COPD: Journal of Chronic Obstructive Pulmonary Disease     Hybrid Journal   (Followers: 15)
Current Opinion in Pulmonary Medicine     Hybrid Journal   (Followers: 10)
Current Pulmonology Reports     Hybrid Journal  
Current Research in Tuberculosis     Open Access   (Followers: 3)
Current Respiratory Care Reports     Hybrid Journal   (Followers: 1)
Current Respiratory Medicine Reviews     Hybrid Journal   (Followers: 5)
Der Pneumologe     Hybrid Journal   (Followers: 1)
Egyptian Journal of Chest Diseases and Tuberculosis     Open Access   (Followers: 3)
ERJ Open Research     Open Access   (Followers: 3)
Eurasian Journal of Pulmonology     Open Access  
European Clinical Respiratory Journal     Open Access   (Followers: 3)
European Respiratory Journal     Full-text available via subscription   (Followers: 39)
European Respiratory Review     Open Access   (Followers: 7)
Experimental Lung Research     Hybrid Journal  
Expert Review of Respiratory Medicine     Hybrid Journal   (Followers: 5)
Heart & Lung: The Journal of Acute and Critical Care     Hybrid Journal   (Followers: 13)
Heart, Lung and Circulation     Full-text available via subscription   (Followers: 9)
Indian Journal of Respiratory Care     Open Access   (Followers: 3)
Indian Journal of Tuberculosis     Full-text available via subscription  
Influenza and Other Respiratory Viruses     Open Access   (Followers: 3)
International Journal of Chronic Obstructive Pulmonary Disease     Open Access   (Followers: 3)
Journal of Association of Chest Physicians     Open Access   (Followers: 2)
Journal of Asthma     Hybrid Journal   (Followers: 4)
Journal of Asthma Allergy Educators     Hybrid Journal   (Followers: 4)
Journal of Bronchology & Interventional Pulmonology     Hybrid Journal   (Followers: 4)
Journal of Clinical Tuberculosis and Other Mycobacterial Diseases     Open Access  
Journal of Heart and Lung Transplantation     Hybrid Journal   (Followers: 12)
Journal of Respiratory Medicine     Open Access   (Followers: 4)
Journal of Respiratory Research     Open Access   (Followers: 1)
Journal of Tuberculosis Research     Open Access   (Followers: 1)
Jurnal Respirasi     Open Access  
Karger Kompass Pneumologie     Full-text available via subscription   (Followers: 1)
Kindheit und Entwicklung     Hybrid Journal  
Lung     Hybrid Journal   (Followers: 2)
Lung Cancer     Hybrid Journal   (Followers: 16)
Lung Cancer International     Open Access   (Followers: 2)
Lung Cancer: Targets and Therapy     Open Access   (Followers: 3)
Lung India     Open Access   (Followers: 1)
Multidisciplinary Respiratory Medicine     Open Access   (Followers: 4)
npj Primary Care Respiratory Medicine     Open Access   (Followers: 2)
Open Journal of Respiratory Diseases     Open Access   (Followers: 1)
Open Respiratory Medicine Journal     Open Access   (Followers: 1)
Paediatric Respiratory Reviews     Hybrid Journal   (Followers: 11)
Pediatric Quality & Safety     Open Access  
Pediatric Respirology and Critical Care Medicine     Open Access   (Followers: 1)
Pulmonary Circulation     Open Access   (Followers: 4)
Pulmonary Medicine     Open Access   (Followers: 2)
Pulmonary Pharmacology & Therapeutics     Hybrid Journal   (Followers: 2)
Pulmonary Therapy     Open Access   (Followers: 1)
Pulmonology and Respiratory Research     Open Access   (Followers: 1)
Respiratory Care     Full-text available via subscription   (Followers: 10)
Respiratory Investigation     Full-text available via subscription  
Respiratory Medicine     Hybrid Journal   (Followers: 18)
Respiratory Medicine : X     Open Access  
Respiratory Medicine Case Reports     Open Access  
Respiratory Medicine CME     Hybrid Journal  
Respiratory Medicine Extra     Full-text available via subscription   (Followers: 1)
Respiratory Physiology & Neurobiology     Hybrid Journal   (Followers: 4)
Respiratory Research     Open Access   (Followers: 1)
Respirology     Hybrid Journal   (Followers: 5)
Respirology Case Reports     Open Access  
Revista Americana de Medicina Respiratoria     Open Access  
Revista Chilena de Enfermedades Respiratorias     Open Access  
Revista Inspirar     Open Access  
Revista ORL     Open Access  
Revista Portuguesa de Pneumologia     Open Access  
Sarcoidosis Vasculitis and Diffuse Lung Disese     Full-text available via subscription   (Followers: 3)
Seminars in Respiratory and Critical Care Medicine     Hybrid Journal   (Followers: 14)
Sleep Medicine Reviews     Hybrid Journal   (Followers: 18)
The Clinical Respiratory Journal     Hybrid Journal   (Followers: 3)
The International Journal of Tuberculosis and Lung Disease     Full-text available via subscription   (Followers: 8)
The Lancet Respiratory Medicine     Full-text available via subscription   (Followers: 33)
Therapeutic Advances in Chronic Disease     Open Access   (Followers: 7)
Therapeutic Advances in Respiratory Disease     Open Access   (Followers: 1)
Thorax     Hybrid Journal   (Followers: 38)
Translational Respiratory Medicine     Open Access   (Followers: 1)
Tuberculosis     Hybrid Journal   (Followers: 12)
Tuberculosis Research and Treatment     Open Access   (Followers: 3)
Пульмонология     Full-text available via subscription  

           

Similar Journals
Journal Cover
Lung Cancer
Journal Prestige (SJR): 1.75
Citation Impact (citeScore): 4
Number of Followers: 16  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0169-5002 - ISSN (Online) 1872-8332
Published by Elsevier Homepage  [3206 journals]
  • Impressive clinical response to anti-PD-1 therapy in epithelioid
           
    • Abstract: Publication date: Available online 14 February 2020Source: Lung CancerAuthor(s): Giuseppe Bronte, Angelo Delmonte, Marco Angelo Burgio, Alberto Verlicchi, Maurizio Puccetti, Sara Bravaccini, Paola Cravero, Maria Maddalena Tumedei, Danila Diano, Giulio Rossi, Paola Ulivi, Giovanni Martinelli, Lucio CrinòAbstractObjectivesTreatment options for malignant pleural mesothelioma (MPM) are limited but some studies on immune checkpoint inhibitors (ICIs) in MPM have reported antitumor activity. Very little is known about immune-related predictive factors.Materials and MethodsHere we report the case of a 45-year-old woman presenting with dyspnea and evidence of pleural effusion. She was diagnosed with malignant epithelioid pleural mesothelioma with brain metastasis and peritoneal carcinosis, refractory to initial standard chemotherapy treatment. Because of high PDL1 expression (100%), she was treated with the anti-PD1 agent, pembrolizumab.ResultsChemotherapy with cisplatin and pemetrexed was started, imaging studies showing stable disease after 3 treatment cycles. The patient underwent pleural decortication but rapidly progressed and thus started chemotherapy with carboplatin and gemcitabine. After 2 cycles she experienced seizures caused by a brain metastasis. This secondary lesion was surgically removed and confirmed as a metastasis from mesothelioma. Samples from both the primary tumor and the metastasis were molecularly characterized, the pleural sample proving ALK-positive and the brain sample, ALK-negative. PD-L1 was positive in 10% of tumor cells in the pleural biopsy and 100% in the brain lesion. Next generation sequencing analysis was negative for both samples. It was decided to start alectinib. Disease progression (peritoneal carcinosis and liver metastases) was documented after one month followed by complete bowel obstruction and recurrence in the site of the brain surgery. Alectinib was stopped and supportive care begun with parenteral nutrition via nasogastric tube. Pembrolizumab was started and after 15 days the patient’s condition had significantly improved, enabling recanalization and restoration of enteral nutrition. Imaging displayed complete response of the brain metastasis, peritoneal carcinosis, bone lesions and mediastinal nodal metastases. A partial response was documented in the pleural and pulmonary nodules, with stable liver metastases. The patient is still undergoing immunotherapy and has no cancer-related symptoms.ConclusionsOur findings indicate that the use of immunotherapy in MPM warrants further investigation. Furthermore, the impressive clinical response obtained by our patient suggests that immune checkpoint inhibitors could help in the management of the disease after the failure of other treatments.
       
  • A phase II study of the combination of gemcitabine and imatinib mesylate
           in pemetrexed-pretreated patients with malignant pleural mesothelioma
    • Abstract: Publication date: Available online 12 February 2020Source: Lung CancerAuthor(s): Paolo Andrea Zucali, Matteo Perrino, Fabio De Vincenzo, Laura Giordano, Nadia Cordua, Federica D’Antonio, Armando SantoroAbstractObjectivesSecond-line chemotherapy is not a standard of care in patients with malignant pleural mesothelioma (MPM) that progresses after first-line treatment with cisplatin and pemetrexed. In pre-clinical models, the combination of gemcitabine (GEM) and imatinib mesylate (IM), compared with GEM alone, led to a further tumor growth inhibition and improved survival. This phase II study evaluates the antitumor activity of a combination of IM and GEM in platinum-pemetrexed-pretreated MPM patients expressing PDGFR-β and/or cKIT by immunohistochemistry (IHC).Patients and methodsGEM (1000 mg/m2) was given on days 3 and 10; IM (400 mg) was taken orally on days 1–5 and 8–12 of a 21-day cycle. The primary endpoint was the 3-month progression-free survival (PFS) rate. The study follows the optimal two-stage design of Simon. A 3-month PFS target of 75% was required. With a probability error α = 10% and a power of 80%, the calculated sample size was 22 patients. In particular, in the first step, six out of nine patients and globally 14/22 patients free from progressive disease at 3 months were required. Secondary endpoints included response rate, duration of response, toxicity and overall survival (OS).ResultsIn total, 23 patients were enrolled (ECOG PS 0–1/2: 9/13; one previous line/≥two previous lines: 10/13). Partial response was achieved in four patients (17.4%) and stable disease in 11 (47.8%) with a disease control rate of 65.3%. After a median follow-up of 34.5 months, median PFS and OS were 2.8 and 5.7 months, respectively. The 3-month PFS rate was 39.1% (9/23 patients). All-grade drug-related adverse events occurred in 17 (73.9%) patients. Grade 3 treatment-related adverse events were observed in four (17%) patients.ConclusionsThe combination of IM and GEM is well tolerated in platinum-pemetrexed-pretreated MPM patients expressing PDGFR-β and/or cKIT by IHC, but it does not show a significant PFS benefit.
       
  • ATOM: A Phase II Study to Assess Efficacy of Preemptive Local Ablative
           Therapy to Residual Oligometastases of NSCLC After EGFR TKI
    • Abstract: Publication date: Available online 11 February 2020Source: Lung CancerAuthor(s): Oscar S.H. Chan, Kwok Chi Lam, Jacky Y.C. Li, Frankie P.T. Choi, Catherine Y.H. Wong, Amy T.Y. Chang, Frankie Mo, Ki Wang, Rebecca M.W. Yeung, Tony S.K. MokAbstractObjectivesNSCLC patients harboring EGFR mutation invariably developed resistance to EGFR TKI. We postulated that oligoresidual disease (ORD) after initial TKI might harbor resistant clones. This study aimed to test if preemptive local ablative therapy (LAT) can improve progression free survival (PFS) or not compared to historic data.Materials and MethodsPatients indicated for EGFR TKI who possessed ORD (≤ 4 PET-avid lesions) after an initial 3-month TKI therapy were enrolled. After screening PET-CT, eligible patients with PET-avid ORDs were treated by LAT, either by stereotactic ablative radiotherapy (SABR) or surgery per clinicians’ discretion. TKI was continued after LAT until it was considered ineffective. PET-CT was repeated on the 3rd and 12th month post-LAT (or at progression) apart from regular imaging. Further LAT was allowed in oligoprogressive disease. Primary endpoint was PFS rate at one-year from enrollment. Overall survival (OS), PFS and treatment safety were secondary endpoints. A post hoc comparison with screen failure cohort was performed.ResultsEighteen patients were enrolled from 2014-17. Recruitment was stopped before the planned number (34) due to slow accrual. Two were excluded due to consent withdrawal and significant protocol violation. Median follow up was 39.1 months. Among the 16 analyzed patients, the one-year PFS rate (i.e. 15 month post TKI) was 68.8%. Median OS was 43.3 months. All LAT were done by SABR, and none experienced ≥ grade 3 SABR related toxicities. Compared with screen failure cohort (n = 48), pre-emptive LAT effectively reduced risk of progression (HR 0.41, p = 0.0097).ConclusionPreemptive LAT in ORD appeared to be safe and feasible. The 1-year PFS rate was encouraging. However, potential biases and the limitations of the study should not be overlooked. Further randomized studies are warranted.
       
  • sSurvival Comparison of Three Histological Subtypes of Lung Squamous Cell
           Carcinoma: A Population-based Propensity Score Matching Analysis
    • Abstract: Publication date: Available online 3 February 2020Source: Lung CancerAuthor(s): Na An, Xuejiao Leng, Xue Wang, Yile Sun, Zhiwei ChenAbstractObjectivesThis study is aimed to analyze the survival differences among patients with lung basaloid squamous cell carcinoma (BSCC), keratinizing squamous cell carcinoma (KSCC), and nonkeratinizing squamous cell carcinoma (NKSCC), and explore the prognostic factors of patients with lung BSCC.Materials and MethodsWe searched the information of 4743 patients with lung SCC between 2005 and 2014 from the SEER database. Propensity score matching (PSM) was used to adjust confounding factors. The overall survival (OS), cancer-specific survival (CSS), and cumulative incidence of cancer-specific mortality (CSM) were estimated with a comparative analysis. A competing risks regression model was conducted to identify the prognostic factors of lung BSCC.ResultsAfter PSM, patients with lung BSCC had a higher CSS rate than those with lung KSCC or NKSCC (5-year CSS rate: 50.4% vs. 37.7% vs. 38.5%, p = 0.033 and p = 0.033). The cumulative incidence of CSM was lower for patients with lung BSCC than those with lung KSCC or NKSCC (5-year CSM rate: 46.4% vs. 56.9% vs. 56.4%, p =  0.046 and p =  0.042), which were similar to the results before PSM. As for patients with lung KSCC and NKSCC, there was no survival differences between them (5-year CSS rate: 37.7% vs. 38.5%, p = 0.997). The competing risks regression analysis showed that T stage, N stage, M stage and surgery were independent prognostic factors for patients with lung BSCC (all p 
       
  • Quantifying potential confounders of panel-based tumor mutational burden
           (TMB) measurement
    • Abstract: Publication date: Available online 1 February 2020Source: Lung CancerAuthor(s): Jan Budczies, Daniel Kazdal, Michael Allgäuer, Petros Christopoulos, Eugen Rempel, Nicole Pfarr, Wilko Weichert, Stefan Fröhling, Michael Thomas, Solange Peters, Volker Endris, Peter Schirmacher, Albrecht StenzingerABSTRACTObjectivesRetrospective data including subgroup analyses in clinical studies have sparked strong interest in developing tumor mutational burden (TMB) as a predictive biomarker for immune checkpoint blockade. While individual factors influencing panel sequencing based measurement of TMB (psTMB) have been discussed in recent studies, an integrative study quantifying, comparing and combining all potential confounders is still missing.Material and methodsWe separated different potential confounders of psTMB measurement including “panel size”, “germline mutation filtering”, “biological variance” and “technical variance” and developed a specific error model for each of these factors. Published experimental psTMB data were fitted to the error models to quantify the contribution of each of the confounders. The total psTMB variance was obtained as sum over the different variance contributions.ResultsUsing a typical large panel (size 1 to 1.5 Mbp) total errors of 57%, 42%, 34% and 28% were observed for tumors with psTMB of 5, 10, 20 and 40 muts/Mbp. Even for large panels, the stochastic error connected to the panel size represented the largest of all contributions to the total psTMB variance, especially for tumors with TMB up to 20 muts/Mbp. Other sources of psTMB variability could be kept under control, but rigorous quality control, best practice laboratory workflows and optimized bioinformatics pipelines are essential.ConclusionA statistical framework for the analysis of complex, quantitative biomarkers was developed and applied to the analysis of psTMB variability. The methods developed here can support the analysis of other quantitative biomarkers and their implementation in clinical practice.
       
  • Positive EGFR mutation status is a risk of recurrence in pN0–1 lung
           adenocarcinoma when combined with pathological stage and histological
           subtype: a retrospective multi-center analysis
    • Abstract: Publication date: Available online 30 January 2020Source: Lung CancerAuthor(s): Masaoki Ito, Yoshihiro Miyata, Yasuhiro Tsutani, Hiroyuki Ito, Haruhiko Nakayama, Kentaro Imai, Norihiko Ikeda, Morihito OkadaAbstractObjectives: Recurrence risk of resected lung adenocarcinoma is represented by pathological stage (pStage), histological subtype, and potentially by EGFR mutation. However, the relationship among these factors and their combined impact on prognosis are unclear.Materials and MethodsUsing a multicenter database, we retrospectively investigated the prognostic impact of EGFR mutation status in relation to pStage and histological subtype in resected pN0–1M0 lung adenocarcinoma.ResultsAmong 1155 pN0–1M0 adenocarcinoma cases, pStage 0 and IA1–IB were confirmed predominantly in EGFR-positive cases. AIS, MIA, and lepidic predominant adenocarcinoma were also more frequently found in EGFR-positive cases and showed no/little recurrence regardless of EGFR mutation status. The 5-year recurrence-free survival (RFS) of papillary, acinar, solid, and micropapillary predominant adenocarcinoma was stratified by pStage (IA1–IB, IIA–IIIA) or histological malignant subtype (intermediate or high malignant subtype), and more finely subdivided by EGFR mutation status. Positive EGFR mutation cases showed worse RFS in both classifications. Low malignant subtype and pStage IA1–IB intermediate malignant subtype showed low frequency of recurrence. Whereas, in pStage IA1–IB high malignant subtype and pStage IIA–IIIA cases, EGFR-positive cases showed poorer 5-year RFS than EGFR-negative (49.6% and 75.6%, respectively, hazard ratio [HR] = 1.84, 95% CI = 1.38–7.42, p 
       
  • A multicenter study of thromboembolic events among patients diagnosed with
           ROS1-rearranged non-small cell lung cancer
    • Abstract: Publication date: Available online 22 January 2020Source: Lung CancerAuthor(s): Marliese Alexander, B. Pharm, Nick Pavlakis, Thomas John, Rachel O'Connell, Steven Kao, Brett Hughes, Adrian Lee, Sarah A Hayes, Viive M Howell, Stephen J Clarke, Michael Millward, Kate Burbury, Benjamin Solomon, Malinda ItchinsAbstractObjectives: This study aimed to describe the longitudinal thromboembolism (TE) risk relative to the natural history of disease and clinical course of ROS-1 rearranged non-small cell lung cancer (NSCLC).Materials and MethodsCases of ROS1-rearranged NSCLC from six Australian hospitals were pooled and evaluated for incidence, timing, predictors and outcomes of venous or arterial TE, as well as objective response rate (ORR) to active therapy and overall survival (OS).ResultsOf 42 patients recruited, 20 (48%) experienced TE; one (2%) arterial, 13 (31%) a pulmonary emboli (PE), and 12 (29%) a deep vein thrombosis. Among those with TE, six (30%) experienced multiple events, three as concurrent and three as recurrent diagnoses. The cumulative incidence of TE over time, adjusted for death as a competing risk factor, approached 50%. TE occurred prior to, during and post the peri-diagnostic period and occurred irrespective of treatment strategy. A thrombophilia was identified in n = 3/10 (30%) cases screened: in two factor V Leiden and inone anti-thrombin III (ATIII) deficiency. Median OS was 21.3 in those with TE vs 28.8 months in those without; hazard ratio 1.16 (95%CI 0.43-3.15). Respective ORR to first-line therapy with TE was 50% vs 44% without in the chemotherapy arm and 67% vs 50% in the targeted therapy arm.ConclusionIn the rare cancer subtype,ROS1, these real-world data demonstrate sustained TE risk beyond the diagnostic period irrespective of therapeutic strategy. High incidence of PE, concurrent TE, and recurrent TE warrant validation in larger cohorts. Consideration of primary thromboprophylaxis in ROS1 populations is recommended.
       
  • Neighborhood Context and Non-Small Cell Lung Cancer Outcomes in Florida
           non-Elderly Patients by Race/Ethnicity
    • Abstract: Publication date: Available online 16 January 2020Source: Lung CancerAuthor(s): Asal Johnson, Allen Johnson, Robert Hines, Raheleh MohammadiAbstractObjectiveThe purpose of this study was to investigate the relationship between neighborhood environment and lung cancer outcomes among Florida residents younger than 65 years of age.Methods and materialsThis was a retrospective cohort study that included patients diagnosed with non-small cell lung cancer (NSCLC) in Florida from January 2005 to December 2014 (n = 22,750). Multi-level, mixed-effect logistic regression models were used for two outcomes: receipt of treatment and receipt of surgery. Survival analyses, using proportional subdistribution hazard models, were conducted to examine the impact of neighborhood characteristics on risk of death due to lung cancer with adjustment for individual-level variables. Neighborhood exposures of interest were census tract level black and Hispanic segregation combined with economic deprivation.ResultsWhite patients who lived in low black segregation/high deprivation areas had 15% lower odds of receiving surgery (95% CI: 0.76-0.93). However, the likelihood of receiving surgery for black patients who lived in high black segregation/low deprivation and high black segregation/high deprivation was lower than for black patients who lived in low black segregation/low deprivation neighborhoods (level 3 AOR = 0.56 [0.38-0.85]; level 4 AOR = 0.69 [0.54-0.88]). Living in suburban and rural areas increased the risk of lung cancer death for white patients by 14% (95% CI: 1.05-1.24) and 26% (95% CI: 1.08-1.46), respectively. Living in rural areas increased the risk of death for black patients by 54% r (SHR = 1.54 [1.19-2.0]). Black patients who live in high Hispanic segregation/high deprivation had 36 % increased risk of death compared to black patients who lived in low Hispanic segregation/low deprivation areas.ConclusionThis study suggests that when investigating cancer disparities, merely adjusting for race/ethnicity does not provide sufficient explanation to understand survival and treatment variations. Lung cancer outcomes are impacted by neighborhood environments that are formed based on the distribution of race, ethnicity and class.
       
  • Corrigendum to “Down-regulation of HSP27 sensitizes TRAIL-resistant
           tumor cell to TRAIL-induced apoptosis” [Lung Cancer 68 (1) (2010)
           27–38]
    • Abstract: Publication date: Available online 16 January 2020Source: Lung CancerAuthor(s): Hongqin Zhuang, Weiwei Jiang, Wei Cheng, Kui Qian, Wei Dong, Lin Cao, Qilai Huang, Shufeng Li, Fei Dou, Jen-Fu Chiu, Xue-Xun Fang, Min Lu, Zi-Chun Hua
       
  • Is it necessary to sample the contralateral nodal stations by EBUS-TBNA in
           patients with lung cancer and clinical N0 / N1 on PET-CT'
    • Abstract: Publication date: Available online 13 January 2020Source: Lung CancerAuthor(s): Pere Serra, Carmen Centeno, José Sanz-Santos, Mohamed Torky, Sonia Baeza, Leire Mendiluce, Carlos Martínez-Barenys, Pedro López de Castro, Jorge Abad, Antoni Rosell, Felipe AndreoAbstractObjectivesSystematic mediastinal staging (sampling all visible nodes measuring ≥ 5 mm from N3 station to N1, regardless of PET/CT (positron emission tomography/computed tomography) by endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a decisive step in patients with non-small cell lung cancer (NSCLC). We analyzed the prevalence of N3 disease and the utility of systematic staging in the subgroup of patients who underwent EBUS-TBNA staging without showing mediastinal lesions on the PET/CT (N0/N1)Material and methodsWe conducted a retrospective analysis of a prospectively collected database that included 174 patients with a final diagnosis of NSCLC, with N0/N1 disease on PET/CT who underwent a systematic EBUS-TBNA staging.Results174 consecutive patients were included. Systematic EBUS-TBNA detected N2 mediastinal involvement in 21 (12%) cases, and no cases of N3 disease were detected (neither hilar nor mediastinal). Of the remaining 153 patients N0/N1 EBUS-TBNA, 122 underwent lung resection that revealed 4 cases of N2 disease while 117 were confirmed to be N0/N1. Thirty-three patients with N0/1 disease after EBUS-TBNA did not undergo surgery and were excluded for the NPV calculation. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV) and overall accuracy of systematic EBUS was 84%, 100%, 96.7%, 100% and 97% respectively.ConclusionSystematic EBUS-TBNA is a very accurate method for lymph node staging in patients with NSCLC without mediastinal involvement on PET/CT. Pending more studies, the absence of contralateral hilar nodal involvement in our series, questions the need for a contralateral hilar sampling in this subgroup of patients.
       
  • Cytology for PD-L1 testing: a systematic review
    • Abstract: Publication date: Available online 13 January 2020Source: Lung CancerAuthor(s): John R. Gosney, Anne-Marie Boothman, Marianne Ratcliffe, Keith M. KerrAbstractEvaluation of tumoral programmed cell death ligand-1 (PD-L1) expression is standard practice for patients with advanced non-small-cell lung cancer (NSCLC) who may be candidates for treatment targeting the programmed cell death-1 (PD-1)/PD-L1 pathway. Currently, all of the commercially available immunohistochemistry (IHC) assays have been validated for use with histology specimens although, in routine clinical practice, approximately 30–40% of patients with advanced NSCLC have only cytology specimens available for diagnosis, staging, and biomarker analysis. This systematic review evaluated the success rate, concordance, and clinical utility of using cytology specimens to assess tumor PD-L1 expression levels compared with histology specimens from patients with advanced NSCLC. EMBASE and PubMed database searches identified 142 unique, relevant publications, of which 15 met the inclusion criteria for at least one analysis. In 709 specimens, across seven publications, the proportion of cytology specimens evaluable for PD-L1 testing was 92.0%. Among nine studies eligible for concordance analysis between cytology and histology specimens at a PD-L1 tumor cell expression cutoff of ≥50%, overall percentage agreement was 89.7% (n = 428), 72.0% for positive percentage agreement (n = 218), and 95.0% for negative percentage agreement (n = 258); results using a tumor PD-L1 expression cutoff of ≥1% were similar. Our analyses suggest that using cytology specimens to assess PD-L1 expression is feasible, with good levels of concordance between cytology and histology specimens using PD-L1 tumor cell expression cutoffs of ≥1% and ≥50%. In conclusion, there is no convincing evidence that cytology specimens are inadequate or inferior to histology specimens for assessing PD-L1 expression in patients with NSCLC.
       
  • Mutations in genes connected with the TCF7L2 transcription factor are
           associated with a poor prognosis in Non-Small Cell Lung Cancer
    • Abstract: Publication date: Available online 13 January 2020Source: Lung CancerAuthor(s): Shawn J. Rice, Xin Liu, Victoria Hyland, Zhenqiu Liu, Chandra P. BelaniAbstractObjectivesPrecision medicine with molecular profiling has revolutionized the management of lung cancer leading to improved outcomes. Patients with actionable mutations receive targeted therapy. As next-generation sequencing (NGS) becomes standard in lung cancer clinics, we sought to use molecular information to identify novel pathways to target in order to improve survival for non-small cell lung cancer (NSCLC) patients.Materials and MethodsThis retrospective analysis included 183 lung cancer patients who received commercial NGS sequencing as part of their clinical care, as well as the lung adenocarcinoma (LUAD) and squamous cell carcinoma (LUSC) dataset from the Cancer Genome Atlas (TCGA). We grouped mutations using a transcription factor enrichment analysis (TFEA), and the resulting TFEA groups were used to sort patients for survival analyses.ResultsMutations connected to transcription factor 7 like 2/ Transcription Factor 4 (TCF7L2/TCF4) were associated with poor survival in NSCLC patients. Furthermore, Mutations in CCND1, IDH1, SMARC4, and TP53 are the primary contributors to a poor prognosis in these patients. This four gene panel was also found to be associated with a poor prognosis in the LUAD data of TCGA dataset.ConclusionsWe determined that the TCF7L2 pathway is associated with a poor prognosis in patients with lung adenocarcinoma. Therefore, targeting the TCF7L2 pathway may improve outcomes for this group of patients.
       
  • A systematic review of survival following anti-cancer treatment for small
           cell lung cancer
    • Abstract: Publication date: Available online 11 January 2020Source: Lung CancerAuthor(s): Gavin S Jones, Kelly Elimian, David R Baldwin, Richard Hubbard, Tricia M McKeeverAbstractObjectivesWe conducted a systematic review and meta-analysis of survival following treatment recommended by the European Society of Medical Oncology for SCLC in order to determine a benchmark for novel therapies to be compared with.Materials and MethodsRandomized controlled trials and observational studies reporting overall survival following chemotherapy for SCLC were included. We calculated survival at 30 and 90-days along with 1-year, 2-year and median.ResultsWe identified 160 for inclusion. There were minimal 30-day deaths. Survival was 99% (95%CI 98.0-99.0%, I233.9%, n = 77) and 90% (95%CI 89.0-92.0%, I279.5%, n = 73) at 90 days for limited (LD-SCLC) and extensive stage (ED-SCLC) respectively. The median survival for LD-SCLC was 18.1 months (95%CI 17.0-19.1%, I277.3%, n = 110) and early thoracic radiotherapy (thoracic radiotherapy 18.4 months (95%CI 17.3-19.5, I278.4%, n = 100)) vs no radiotherapy 11.7 months (95%CI 9.1-14.3, n = 10), prophylactic cranial irradiation (PCI 19.7 months vs No PCI 13.0 months (95%CI 18.5-21.0, I275.7%, n = 78 and 95%CI 10.5-16.6, I281.1%, n = 15 respectively)) and better performance status (PS0-1 22.5 months vs PS0-4 15.3 months (95%CI 18.7-26.1, I272.4%, n = 11 and 95%CI 11.5-19.1 I277.9%, n = 13)) augmented this. For ED-SCLC the median survival was 9.6 months (95%CI 8.9-10.3%, I295.2%, n = 103) and this improved when irinotecan + cisplatin was used, however studies that used this combination were mostly conducted in Asian populations where survival was better. Survival was not improved with the addition of thoracic radiotherapy or PCI. Survival for both stages of cancer was better in modern studies and Asian cohorts. It was poorer for studies administering carboplatin + etoposide but this regimen was used in studies that had fewer patient selection criteria.ConclusionEarly thoracic radiotherapy and PCI should be offered to people with LD-SCLC in accordance with guideline recommendations. The benefit of the aforementioned therapies to treat ED-SCLC and the use of chemotherapy in people with poor PS is less clear.
       
  • Micropapillary pattern is associated with the development of brain
           metastases and the reduction of survival time in EGFR-mutation lung
           adenocarcinoma patients with surgery
    • Abstract: Publication date: Available online 10 January 2020Source: Lung CancerAuthor(s): Changhui Li, Yinchen Shen, Fang Hu, Tianqing Chu, Xiaohua Yang, Jinchen Shao, Xiaoxuan Zheng, Jianlin Xu, Hai Zhang, Baohui Han, Hua Zhong, Xueyan ZhangAbstractObjectiveThe role of micropapillary pattern (MIP) in EGFR-mutated NSCLC patients with brain metastases (BM) after complete surgical resection still remains unclear. Therefore, a retrospective study was conducted to evaluate the role of MIP in those patients.MethodsThis study included 332 stage I-III patients with EGFR-mutant lung adenocarcinoma and complete resection. Patients were classified in four groups: the MIP-positive patients without BM development, the MIP-negative patients without BM development, the MIP-positive patients with BM development and the MIP-negative patients with BM development. Intracranial disease-free survival (iDFS), systemic disease-free survival (DFS) and overall survival (OS) were evaluated.ResultsThe median OS in the whole group was 70 months. The patients with MIP show inferior DFS (13 months vs. 22 months; P 
       
  • Cryobiopsy increases the EGFR detection rate in non-small cell lung cancer
    • Abstract: Publication date: Available online 7 January 2020Source: Lung CancerAuthor(s): Maik Haentschel, Michael Boeckeler, Ahmed Ehab, Robert Wagner, Werner Spengler, Volker Steger, Hans Boesmueller, Marius Horger, Richard A. Lewis, Falko Fend, Lothar Kanz, Irina Bonzheim, Juergen HetzelAbstractObjectivesDetection of activating epidermal growth factor receptor (EGFR) mutation is crucial for individualized treatment of advanced non-small-cell lung cancer (NSCLC). However little is known about how biopsy technique affects the detection rate of EGFR mutations. This retrospective, single center study evaluated the detection rate of EGFR mutations in tissue obtained by bronchoscopic cryobiopsy and compared this to other standard tissue sampling techniques.Materials and MethodsWe retrospectively analyzed 414 patients with histologically confirmed NSCLC and known EGFR mutation status between 3/2008-7/2014. Tumor specimens obtained by tissue preserving bronchoscopic cryobiopsy were compared to those obtained by other techniques.Results and ConclusionAnalysis of bronchoscopic cryobiopsy tissue detected 29 activating EGFR mutations in 27 (21.6%) out of 125 patients, while analysis of tissue obtained by non-cryobiopsy techniques (bronchoscopic forceps biopsies, fine needle aspiration, imaging guided transthoracical and surgical procedures) detected 42 EGFR mutations in 40 (13.8%) out of 298 patients (p 
       
  • Elucidation of the relationships of MET protein expression and gene copy
           number status with PD-L1 expression and the immune microenvironment in
           non-small cell lung cancer
    • Abstract: Publication date: Available online 7 January 2020Source: Lung CancerAuthor(s): Katsuhiro Yoshimura, Yusuke Inoue, Kazuo Tsuchiya, Masato Karayama, Hidetaka Yamada, Yuji Iwashita, Akikazu Kawase, Masayuki Tanahashi, Hiroshi Ogawa, Naoki Inui, Kazuhito Funai, Kazuya Shinmura, Hiroshi Niwa, Takafumi Suda, Haruhiko SugimuraAbstractObjectivesAlterations in the MET gene, such as mutations and high-level amplification, are important drivers of non-small cell lung cancer (NSCLC). The efficacy of immune checkpoint inhibitors (ICIs) in lung cancer with MET abnormalities is unclear. We evaluate the potential relationship between MET alterations and the tumor immune microenvironment and PD-1/PD-L1 axis.Material and MethodsMET and phospho-MET protein expression were assessed in 622 resected NSCLC specimens. MET amplification was assessed by fluorescence in-situ hybridization in 272 tumors. PD-L1 expression was evaluated by immunohistochemistry. CD8+, Foxp3+, CD45RO, and PD-1+ tumor-infiltrating lymphocytes (TILs) in the tumor nest and surrounding stroma were profiled. Associations with MET alterations were explored.ResultsThe cohort comprised 425 male patients (68.3%), 184 never-smokers (29.6%), and 408 adenocarcinoma (ADC) patients (65.6%). Median age was 68 years. MET alteration was observed mainly in ADCs (18.9% MET-positive, 3.9% phospho-MET-positive, and 15.1% with MET amplification). PD-L1 expression was significantly increased in MET-altered ADCs (P < 0.001 for MET; P = 0.002 for phospho-MET; P = 0.019 for MET amplification). Most TIL subset numbers in the tumor nest were significantly increased in MET-altered tumors. Only MET amplification was independently associated with tumoral CD8 + TILs. Three of the six patients responded to ICI treatment; two of them showed MET overexpression and an increase in MET copy number.ConclusionMET-altered tumors showed significantly stronger PD-L1 expression and more abundant tumoral TILs than non-MET-altered tumors. Among the MET alterations assessed, MET amplification was particularly implicated in the inflamed microenvironment, suggesting that MET-amplified tumors might respond to ICIs.
       
  • COPD and lung cancer incidence in the Women’s Health Initiative
           Observational Study: A brief report
    • Abstract: Publication date: Available online 7 January 2020Source: Lung CancerAuthor(s): Misako Nagasaka, Amy Lehman, Rowan Chlebowski, Brittany M. Haynes, Gloria Ho, Manali Patel, Lori C. Sakoda, Ann G. Schwartz, Michael S. Simon, Michele L. CoteAbstractObjectivesLung cancer is the leading cause of cancer mortality in both men and women in the United States. COPD is associated with lung cancer independently of cigarette smoking, but remains understudied in women. Utilizing data from the Women’s Health Initiative Observational Study (WHI-OS), this report investigates the association between COPD and development of lung cancer, with a focus on ethnicity and cancer subtype.Materials and methodsThe WHI-OS, part of the larger Women’s Health Initiative (WHI), is comprised of postmenopausal women between ages 50 and 79 years old at enrollment. Self-administered questionnaires were utilized to gather baseline demographic, socioeconomic, and behavioral information from participants. For this analysis, COPD status was determined at study entry (baseline) and on annual survey (incident). Information on the primary outcome of interest, diagnosis of lung cancer, was also collected annually.Results and conclusionOf the 92,789 women examined, 1,536 developed lung cancer. Overall, women with COPD were 1.64 times more likely to develop lung cancer than those without COPD, after adjusting for smoking status and intensity, ethnicity, education, body mass index, and income (HR = 1.64, 95% CI: 1.43, 1.89). The relationship between COPD and lung cancer was not found to be significantly different between ethnic groups (p-value = 0.697). The associations between COPD and lung cancer was similar across subtypes (HR range 1.31-2.16), after adjusting for smoking status and intensity.COPD increases risk of lung cancer in women, thus they may benefit from more intensive surveillance compared to similar women without COPD.
       
  • Hospital volume and the case for centralisation of surgical services
    • Abstract: Publication date: Available online 3 January 2020Source: Lung CancerAuthor(s): Rob Stirling, Michael Stenger, John Zalcberg
       
  • Predicting Risk of Chemotherapy-induced Severe Neutropenia: A Pooled
           Analysis in Individual Patients Data with Advanced Lung Cancer
    • Abstract: Publication date: Available online 3 January 2020Source: Lung CancerAuthor(s): Xiaowen Cao, Apar Kishor Ganti, Thomas Stinchcombe, Melisa L. Wong, James C. Ho, Chen Shen, Yingzhou Liu, Jeffery Crawford, Herbert Pang, Xiaofei WangAbstractObjectivesNeutropenia is associated with the risk of life-threatening infections, chemotherapy dose reductions and delays that may compromise outcomes. This analysis was conducted to develop a prediction model for chemotherapy-induced severe neutropenia in lung cancer.Materials and MethodsIndividual patient data from existing cooperative group phase II/III trials of stages III/IV non-small cell lung cancer or extensive small-cell lung cancer were included. The data were split into training and testing sets. In order to enhance the prediction accuracy and the reliability of the prediction model, lasso method was used for both variable selection and regularization on the training set. The selected variables was fit to a logistic model to obtain regression coefficients. The performance of the final prediction model was evaluated by the area under the ROC curve in both training and testing sets.ResultsThe dataset was randomly separated into training [7606 (67%) patients] and testing [3746 (33%) patients] sets. The final model included: age (>65 years), gender (male), weight (kg), BMI, insurance status (yes/unknown), stage (IIIB/IV/ESSCLC), number of metastatic sites (1, 2 or ≥3), individual drugs (gemcitabine, taxanes), number of chemotherapy agents (2 or ≥3), planned use of growth factors, associated radiation therapy, previous therapy (chemotherapy, radiation, surgery), duration of planned treatment, pleural effusion (yes/unknown), performance status (1, ≥2) and presence of symptoms (yes/unknown).ConclusionsWe have developed a relatively simple model with routinely available pre-treatment variables, to predict for neutropenia. This model should be independently validated prospectively.
       
  • Clearing of circulating tumour DNA predicts clinical response to first
           line tyrosine kinase inhibitors in advanced epidermal growth factor
           receptor mutated non-small cell lung cancer
    • Abstract: Publication date: Available online 30 December 2019Source: Lung CancerAuthor(s): Eva Boysen Fynboe Ebert, Tine McCulloch, Karin Holmskov Hansen, Hanne Linnet, Boe Sorensen, Peter MeldgaardObjectivesEpidermal growth factor receptor (EGFR) mutations confer sensitivity to tyrosine kinase inhibitors (TKIs) in non-small cell lung cancer (NSCLC). However, a subset of patients has limited or no response. We investigated the initial dynamics of EGFR mutations detected in circulating tumour DNA (ctDNA) during treatment as a predictive marker of outcome.MethodsA total of 225 patients with advanced EGFR mutated NSCLC were included for consecutive blood sampling in this prospective multicentre study. Out of these, 146 patients received first line TKI and had a baseline blood sample available for EGFR mutation testing with the Cobas® EGFR mutation test V2. For examinations on clearing and clinical outcome, 98 patients who had detectable ctDNA at baseline and at least one follow-up blood sample were included.ResultsFor patients with EGFR mutations present in plasma at baseline, clearing of mutations from the blood during first line TKI served as a positive predictor for objective response rate (p = 0.0008), progression-free survival (PFS) (p 
       
  • Upstaging, centrality and survival in early stage non-small cell lung
           cancer video-assisted surgery: Lymph nodal upstaging in lung cancer
           surgery: is it really a surgical technique problem'
    • Abstract: Publication date: Available online 18 December 2019Source: Lung CancerAuthor(s): Dania Nachira, Elisa Meacci, Maria Teresa Congedo, Marco Chiappetta, Leonardo Petracca-Ciavarella, Maria Letizia Vita, Stefano Margaritora
       
  • Randomized Phase II Trial of Adjuvant Chemotherapy with Docetaxel plus
           Cisplatin versus Paclitaxel plus Carboplatin in Patients with Completely
           Resected Non-Small Cell Lung Cancer: TORG 0503
    • Abstract: Publication date: Available online 29 November 2019Source: Lung CancerAuthor(s): Kaoru Kubota, Hideo Kunitoh, Takashi Seto, Naoki Shimada, Masahiro Tsuboi, Tatsuo Ohhira, Hiroaki Okamoto, Noriyuki Masuda, Riichiroh Maruyama, Masahiko Shibuya, Koshiro WatanabeAbstractObjectiveAdjuvant chemotherapy is standard of care for patients with completely resected stage IB, II and IIIA NSCLC. However, optimum chemotherapy regimen has not been determined. TORG0503 was undertaken to select a preferred platinum-based 3rd generation regimen in this clinical setting.Materials and MethodsPatients with completely resected stage IB, IIA, IIB or stage IIIA NSCLC were stratified by stage (IB/IIA vs. IIB/IIIA) and institutions, and randomized to receive 3 cycles of docetaxel (60 mg/m2) plus cisplatin (80 mg/m2) (arm A) or paclitaxel (200 mg/m2) plus carboplatin (AUC 6) (arm B) on day 1, every 3 weeks. The primary endpoint of the study was 2-year relapse free survival, and the key secondary endpoints included overall survival, feasibility and toxicity.Results111 patients were randomized, 58 patients to arm A and 53 to arm B. Patient demographics were balanced between the two arms. 93% (54/58) of patients on the arm A and 92% (49/53) patients on the arm B completed the planned 3 cycles of chemotherapy. There was no treatment-related death in both arms. The 2 and 5 year relapse free survival was 74.5% (95%CI: 68.6-80.4) and 61.6% in the arm A, and 72.0% (95%CI: 65.7-78.3) and 46.0% in the arm B. The overall 2, 5-year survival was 89.7%, 73.9% in the arm A and 86.9%, 67.5% in the arm B.ConclusionBoth docetaxel plus cisplatin and paclitaxel plus carboplatin are safe and feasible regimens as adjuvant chemotherapy. We choose docetaxel plus cisplatin as the control regimen for the next clinical trial.
       
  • Next-generation sequencing based mutation profiling reveals heterogeneity
           of clinical response and resistance to osimertinib
    • Abstract: Publication date: Available online 25 November 2019Source: Lung CancerAuthor(s): Jun Zhao, Gen Lin, Minglei Zhuo, Zaiwen Fan, Liyun Miao, Likun Chen, Aiping Zeng, Rong Yin, Yangming Ou, Zhihui Shi, Jie Yin, Wen Gao, Jianhua Chen, Xiangdong Zhou, Yong Zeng, Xiang Liu, Huamin Xu, Rongrong Chen, Xuefeng Xia, David P. CarboneAbstractObjectivesThe 3rd generation epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR TKI) osimertinib has shown promising efficacy both in EGFR-mutant, T790 M positive non-small cell lung cancer (NSCLC) patients who have become resistant to 1st or 2nd generation EGFR TKIs and patients with sensitizing EGFR mutations as the first line therapy. However, the degree and duration of response to osimertinib are heterogeneous. We hypothesized that the concurrent genomic landscape of these tumors could play a role in clinical outcomes and/or mechanisms of resistance.Materials and MethodsWe conducted a retrospective multicenter study of lung cancer patients who had developed resistance to osimertinib. Genomic profiling was done for all the patients by using targeted next-generation sequencing encompassing 59-1021 cancer-related genes.Results and ConclusionKnown EGFR-dependent resistant mutations and activation of alternative pathways were identified in 44% of all the patients with great heterogeneity. Gain-of-function mutations of CTNNB1 were highly enriched in our cohort. Some other putative resistance mechanisms to osimertinib, such as the recurrent EGFR V834 L mutation, were also identified. Moreover, pathogenic mutations of TP53 were negatively related to the efficacy of osimertinib. To sum up, heterogeneity of resistance to osimertinib was not only manifested by inter-individual differences, but also embodied in its intra-individual diversity.
       
  • Newly diagnosed patients with advanced non-small cell lung cancer: A
           
    • Abstract: Publication date: Available online 21 November 2019Source: Lung CancerAuthor(s): B.L. Andersen, T.R. Valentine, S.B. Lo, D.P. Carbone, C.J. Presley, P.G. ShieldsAbstractObjectivesThe aims of this observational study were to 1) accrue newly diagnosed patients with advanced-stage non-small cell lung cancer (NSCLC) awaiting the start of first-line treatment and identify those with moderate to severe depressive symptoms and, 2) provide a clinical description of the multiple, co-occurring psychological and behavioral difficulties and physical symptoms that potentially exacerbate and maintain depressive symptoms.Materials and methodsPatients with stage IV NSCLC (N = 186) were enrolled in an observational study (ClinicalTrials.gov Identifier: NCT03199651) and completed the American Society of Clinical Oncology-recommended screening measure for depression (Patient Health Questionnaire-9 [PHQ-9]). Individuals with none/mild (n = 119; 64%), moderate (n = 52; 28%), and severe (n = 15; 8%) depressive symptoms were identified. Patients also completed measures of hopelessness, generalized anxiety disorder (GAD) symptoms, stress, illness perceptions, functional status, and symptoms.ResultsPatients with severe depressive symptoms reported concomitant feelings of hopelessness (elevating risk for suicidal behavior), anxiety symptoms suggestive of GAD, and traumatic, cancer-specific stress. They perceived lung cancer as consequential for their lives and not controllable with treatment. Pain and multiple severe symptoms were present along with substantial functional impairment. Patients with moderate depressive symptoms had generally lower levels of disturbance, though still substantial. The most salient differences were low GAD symptom severity and fewer functional impairments for those with moderate symptoms.ConclusionsDepressive symptoms of moderate to severe levels co-occur in a matrix of clinical levels of anxiety symptoms, traumatic stress, impaired functional status, and pain and other physical symptoms. All of the latter factors have been shown, individually and collectively, to contribute to the maintenance or exacerbation of depressive symptoms. As life-extending targeted and immunotherapy use expands, prompt identification of patients with moderate to severe depressive symptoms, referral for evaluation, and psychological/behavioral treatment are key to maximizing treatment outcomes and quality of life for individuals with advanced NSCLC.
       
 
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