Lung Cancer

Key clinical point: In patients with stage I lung cancer treated with stereotactic body radiation therapy (SBRT), a model incorporating noncancerous imaging features on chest computed tomography (CT) and clinical features vs clinical features alone performed better at predicting overall survival (OS).

Major finding: The model that incorporated both clinical and imaging features vs the model that incorporated only clinical features performed better at predicting 5-year OS (area under the curve 0.75 vs 0.61; P < .01). Independent risk factors for shorter OS were elevated coronary artery calcium score, increased pulmonary artery-to-aorta ratio, and decreased thoracic skeletal muscle index.

Study details: The data come from a retrospective study involving 282 patients with stage I lung cancer treated with SBRT. Several clinical markers were assessed from pretreatment chest CT images.

Disclosures: No funding information was available. The corresponding author FJ Fintelmann reported no relevant financial relationships.

Source: Tahir I et al. Utility of noncancerous chest CT features for predicting overall survival and noncancer death in patients with stage I lung cancer treated with stereotactic body radiotherapy. AJR Am J Roentgenol. 2022 (Apr 13). Doi: 10.2214/AJR.22.27484

Key clinical point: In patients with stage I lung cancer treated with stereotactic body radiation therapy (SBRT), a model incorporating noncancerous imaging features on chest computed tomography (CT) and clinical features vs clinical features alone performed better at predicting overall survival (OS).

Major finding: The model that incorporated both clinical and imaging features vs the model that incorporated only clinical features performed better at predicting 5-year OS (area under the curve 0.75 vs 0.61; P < .01). Independent risk factors for shorter OS were elevated coronary artery calcium score, increased pulmonary artery-to-aorta ratio, and decreased thoracic skeletal muscle index.

Study details: The data come from a retrospective study involving 282 patients with stage I lung cancer treated with SBRT. Several clinical markers were assessed from pretreatment chest CT images.

Disclosures: No funding information was available. The corresponding author FJ Fintelmann reported no relevant financial relationships.

Source: Tahir I et al. Utility of noncancerous chest CT features for predicting overall survival and noncancer death in patients with stage I lung cancer treated with stereotactic body radiotherapy. AJR Am J Roentgenol. 2022 (Apr 13). Doi: 10.2214/AJR.22.27484

Key clinical point: In patients with stage I lung cancer treated with stereotactic body radiation therapy (SBRT), a model incorporating noncancerous imaging features on chest computed tomography (CT) and clinical features vs clinical features alone performed better at predicting overall survival (OS).

Major finding: The model that incorporated both clinical and imaging features vs the model that incorporated only clinical features performed better at predicting 5-year OS (area under the curve 0.75 vs 0.61; P < .01). Independent risk factors for shorter OS were elevated coronary artery calcium score, increased pulmonary artery-to-aorta ratio, and decreased thoracic skeletal muscle index.

Study details: The data come from a retrospective study involving 282 patients with stage I lung cancer treated with SBRT. Several clinical markers were assessed from pretreatment chest CT images.

Disclosures: No funding information was available. The corresponding author FJ Fintelmann reported no relevant financial relationships.

Source: Tahir I et al. Utility of noncancerous chest CT features for predicting overall survival and noncancer death in patients with stage I lung cancer treated with stereotactic body radiotherapy. AJR Am J Roentgenol. 2022 (Apr 13). Doi: 10.2214/AJR.22.27484

Key clinical point: Frontline therapy with anlotinib plus platinum-etoposide chemotherapy shows favorable outcomes in patients with extensive-stage (ES) small-cell lung cancer (SCLC).

Major finding: The median progression-free survival was 8.02 (95% CI 6.90-9.66) months and the overall survival was 15.87 (95% CI 10.38-18.89) months. The objective response rate was 85.71% (95% CI 69.74%-95.19%) and the disease control rate was 94.29% (95% CI 80.84%-99.30%). The incidence of grade 3-4 adverse events was 40%.

Study details: The data come from a phase 2 single-arm trial of anlotinib plus platinum-etoposide in 35 patients with ES-SCLC at a single center in China.

Disclosures: The trial was funded by Chia Tai Tianqing Pharmaceutical Group Co., Ltd. The authors declared no competing interests.

Source: Deng P et al. Anlotinib plus platinum-etoposide as a first-line treatment for extensive-stage small cell lung cancer: A single-arm trial. Cancer Med. 2022 (May 8). Doi: 10.1002/cam4.4736

Key clinical point: Frontline therapy with anlotinib plus platinum-etoposide chemotherapy shows favorable outcomes in patients with extensive-stage (ES) small-cell lung cancer (SCLC).

Major finding: The median progression-free survival was 8.02 (95% CI 6.90-9.66) months and the overall survival was 15.87 (95% CI 10.38-18.89) months. The objective response rate was 85.71% (95% CI 69.74%-95.19%) and the disease control rate was 94.29% (95% CI 80.84%-99.30%). The incidence of grade 3-4 adverse events was 40%.

Study details: The data come from a phase 2 single-arm trial of anlotinib plus platinum-etoposide in 35 patients with ES-SCLC at a single center in China.

Disclosures: The trial was funded by Chia Tai Tianqing Pharmaceutical Group Co., Ltd. The authors declared no competing interests.

Source: Deng P et al. Anlotinib plus platinum-etoposide as a first-line treatment for extensive-stage small cell lung cancer: A single-arm trial. Cancer Med. 2022 (May 8). Doi: 10.1002/cam4.4736

Key clinical point: Frontline therapy with anlotinib plus platinum-etoposide chemotherapy shows favorable outcomes in patients with extensive-stage (ES) small-cell lung cancer (SCLC).

Major finding: The median progression-free survival was 8.02 (95% CI 6.90-9.66) months and the overall survival was 15.87 (95% CI 10.38-18.89) months. The objective response rate was 85.71% (95% CI 69.74%-95.19%) and the disease control rate was 94.29% (95% CI 80.84%-99.30%). The incidence of grade 3-4 adverse events was 40%.

Study details: The data come from a phase 2 single-arm trial of anlotinib plus platinum-etoposide in 35 patients with ES-SCLC at a single center in China.

Disclosures: The trial was funded by Chia Tai Tianqing Pharmaceutical Group Co., Ltd. The authors declared no competing interests.

Source: Deng P et al. Anlotinib plus platinum-etoposide as a first-line treatment for extensive-stage small cell lung cancer: A single-arm trial. Cancer Med. 2022 (May 8). Doi: 10.1002/cam4.4736

Key clinical point: Segmentectomy is noninferior to lobectomy for overall survival (OS) in patients with small-sized peripheral nonsmall cell lung cancer (NSCLC).

Major finding: Segmentectomy was noninferior to lobectomy for 5-year OS (94.3% vs 91.1%; hazard ratio 0.663; 95% CI 0.474-0.927; 1-sided P < .0001 for noninferiority). There were no differences between the groups in 5-year relapse-free survival.

Study details: The data come from a Japanese randomized controlled, noninferiority phase 3 trial (n = 1106) of segmentectomy vs lobectomy for stage IA NSCLC.

Disclosures: The trial was funded by the National Cancer Center Research and the Ministry of Health, Labor, and Welfare of Japan. R Nakajima, T Aoki, J Okami, H Ito, N Okumura, M Yamaguchi, K Nakamura, and S Nakamura reported no competing interests. The other authors reported ties with one or more pharmaceutical companies outside this work.

Source: Saji H et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399(10335):1607-1617 (Apr 23). Doi: 10.1016/S0140-6736(21)02333-3

Key clinical point: Segmentectomy is noninferior to lobectomy for overall survival (OS) in patients with small-sized peripheral nonsmall cell lung cancer (NSCLC).

Major finding: Segmentectomy was noninferior to lobectomy for 5-year OS (94.3% vs 91.1%; hazard ratio 0.663; 95% CI 0.474-0.927; 1-sided P < .0001 for noninferiority). There were no differences between the groups in 5-year relapse-free survival.

Study details: The data come from a Japanese randomized controlled, noninferiority phase 3 trial (n = 1106) of segmentectomy vs lobectomy for stage IA NSCLC.

Disclosures: The trial was funded by the National Cancer Center Research and the Ministry of Health, Labor, and Welfare of Japan. R Nakajima, T Aoki, J Okami, H Ito, N Okumura, M Yamaguchi, K Nakamura, and S Nakamura reported no competing interests. The other authors reported ties with one or more pharmaceutical companies outside this work.

Source: Saji H et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399(10335):1607-1617 (Apr 23). Doi: 10.1016/S0140-6736(21)02333-3

Key clinical point: Segmentectomy is noninferior to lobectomy for overall survival (OS) in patients with small-sized peripheral nonsmall cell lung cancer (NSCLC).

Major finding: Segmentectomy was noninferior to lobectomy for 5-year OS (94.3% vs 91.1%; hazard ratio 0.663; 95% CI 0.474-0.927; 1-sided P < .0001 for noninferiority). There were no differences between the groups in 5-year relapse-free survival.

Study details: The data come from a Japanese randomized controlled, noninferiority phase 3 trial (n = 1106) of segmentectomy vs lobectomy for stage IA NSCLC.

Disclosures: The trial was funded by the National Cancer Center Research and the Ministry of Health, Labor, and Welfare of Japan. R Nakajima, T Aoki, J Okami, H Ito, N Okumura, M Yamaguchi, K Nakamura, and S Nakamura reported no competing interests. The other authors reported ties with one or more pharmaceutical companies outside this work.

Source: Saji H et al. Segmentectomy versus lobectomy in small-sized peripheral non-small-cell lung cancer (JCOG0802/WJOG4607L): A multicentre, open-label, phase 3, randomised, controlled, non-inferiority trial. Lancet. 2022;399(10335):1607-1617 (Apr 23). Doi: 10.1016/S0140-6736(21)02333-3

Key clinical point: Immune checkpoint inhibitors (ICI) plus radiotherapy (RT) conferred an overall survival (OS) benefit over chemotherapy plus RT after resection of brain metastasis from non-small cell lung cancer (NSCLC).

Major finding: The chemotherapy plus RT group had a shorter median OS than the ICI plus RT group after neurosurgery (11.8 months; 95% CI 9.1-15.2 vs 23.0 months; 95% CI 20.3-53.8; P < .001).

Study details: The data come from a retrospective propensity score-matched cohort study involving 62 NSCLC patients treated with ICI plus RT and 62 treated with chemotherapy plus RT after neurosurgery for brain metastasis, from 2010 to 2021.

Disclosures: No funding information was available. N Frost reported receiving personal fees and nonfinancial support from pharmaceutical companies outside this work. The other authors declared no competing interests.

Source: Wasilewski D et al. Effectiveness of immune checkpoint inhibition vs chemotherapy in combination with radiation therapy among patients with non–small cell lung cancer and brain metastasis undergoing neurosurgical resection. JAMA Netw Open. 2022;5(4):e229553 (Apr 29). Doi: 10.1001/jamanetworkopen.2022.9553

Key clinical point: Immune checkpoint inhibitors (ICI) plus radiotherapy (RT) conferred an overall survival (OS) benefit over chemotherapy plus RT after resection of brain metastasis from non-small cell lung cancer (NSCLC).

Major finding: The chemotherapy plus RT group had a shorter median OS than the ICI plus RT group after neurosurgery (11.8 months; 95% CI 9.1-15.2 vs 23.0 months; 95% CI 20.3-53.8; P < .001).

Study details: The data come from a retrospective propensity score-matched cohort study involving 62 NSCLC patients treated with ICI plus RT and 62 treated with chemotherapy plus RT after neurosurgery for brain metastasis, from 2010 to 2021.

Disclosures: No funding information was available. N Frost reported receiving personal fees and nonfinancial support from pharmaceutical companies outside this work. The other authors declared no competing interests.

Source: Wasilewski D et al. Effectiveness of immune checkpoint inhibition vs chemotherapy in combination with radiation therapy among patients with non–small cell lung cancer and brain metastasis undergoing neurosurgical resection. JAMA Netw Open. 2022;5(4):e229553 (Apr 29). Doi: 10.1001/jamanetworkopen.2022.9553

Key clinical point: Immune checkpoint inhibitors (ICI) plus radiotherapy (RT) conferred an overall survival (OS) benefit over chemotherapy plus RT after resection of brain metastasis from non-small cell lung cancer (NSCLC).

Major finding: The chemotherapy plus RT group had a shorter median OS than the ICI plus RT group after neurosurgery (11.8 months; 95% CI 9.1-15.2 vs 23.0 months; 95% CI 20.3-53.8; P < .001).

Study details: The data come from a retrospective propensity score-matched cohort study involving 62 NSCLC patients treated with ICI plus RT and 62 treated with chemotherapy plus RT after neurosurgery for brain metastasis, from 2010 to 2021.

Disclosures: No funding information was available. N Frost reported receiving personal fees and nonfinancial support from pharmaceutical companies outside this work. The other authors declared no competing interests.

Source: Wasilewski D et al. Effectiveness of immune checkpoint inhibition vs chemotherapy in combination with radiation therapy among patients with non–small cell lung cancer and brain metastasis undergoing neurosurgical resection. JAMA Netw Open. 2022;5(4):e229553 (Apr 29). Doi: 10.1001/jamanetworkopen.2022.9553

Key clinical point: In a real-world cohort of patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitor (ICI) monotherapy, the 4-year overall survival (OS) was nearly 18%.

Major finding: The mean progression-free survival (PFS) was 3.4 months and OS was 13.0 months. The 4-year OS rate was 17.9%. The predictors of favorable OS and PFS included age >70 years, a good Eastern Cooperative Oncology Group Performance Status score, programmed cell death-ligand 1 tumor proportion score of ≥50%, absence of bone metastasis, and presence of immune-related skin toxicity.

Study details: The data come from a real-world retrospective cohort study of 435 patients diagnosed with advanced, metastatic, or recurrent NSCLC and treated with ICI monotherapy across seven Japanese centers (2015-2018).

Disclosures: No information on funding and disclosures was available.

Source: Yoneda T et al. Long-term survival of patients with non-small cell lung cancer treated with immune checkpoint inhibitor monotherapy in real-world settings. Clin Lung Cancer. 2022 (May 1). Doi: 10.1016/j.cllc.2022.03.008

Key clinical point: In a real-world cohort of patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitor (ICI) monotherapy, the 4-year overall survival (OS) was nearly 18%.

Major finding: The mean progression-free survival (PFS) was 3.4 months and OS was 13.0 months. The 4-year OS rate was 17.9%. The predictors of favorable OS and PFS included age >70 years, a good Eastern Cooperative Oncology Group Performance Status score, programmed cell death-ligand 1 tumor proportion score of ≥50%, absence of bone metastasis, and presence of immune-related skin toxicity.

Study details: The data come from a real-world retrospective cohort study of 435 patients diagnosed with advanced, metastatic, or recurrent NSCLC and treated with ICI monotherapy across seven Japanese centers (2015-2018).

Disclosures: No information on funding and disclosures was available.

Source: Yoneda T et al. Long-term survival of patients with non-small cell lung cancer treated with immune checkpoint inhibitor monotherapy in real-world settings. Clin Lung Cancer. 2022 (May 1). Doi: 10.1016/j.cllc.2022.03.008

Key clinical point: In a real-world cohort of patients with advanced non-small cell lung cancer (NSCLC) treated with immune checkpoint inhibitor (ICI) monotherapy, the 4-year overall survival (OS) was nearly 18%.

Major finding: The mean progression-free survival (PFS) was 3.4 months and OS was 13.0 months. The 4-year OS rate was 17.9%. The predictors of favorable OS and PFS included age >70 years, a good Eastern Cooperative Oncology Group Performance Status score, programmed cell death-ligand 1 tumor proportion score of ≥50%, absence of bone metastasis, and presence of immune-related skin toxicity.

Study details: The data come from a real-world retrospective cohort study of 435 patients diagnosed with advanced, metastatic, or recurrent NSCLC and treated with ICI monotherapy across seven Japanese centers (2015-2018).

Disclosures: No information on funding and disclosures was available.

Source: Yoneda T et al. Long-term survival of patients with non-small cell lung cancer treated with immune checkpoint inhibitor monotherapy in real-world settings. Clin Lung Cancer. 2022 (May 1). Doi: 10.1016/j.cllc.2022.03.008

Key clinical point: Anticoagulant use is linked to worse progression-free survival (PFS) and objective response rate (ORR) in patients with ALK- and ROS1-rearranged advanced nonsmall cell lung cancer (NSCLC) treated with crizotinib.

Major finding: In the ROS1-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (5.1 vs 29 months) and poorer ORR (41.7% vs 80.5%). Similarly, in the ALK-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (7.1 vs 12 months) and poorer ORR (41% vs 74.3%).

Study details: The data come from a retrospective analysis of patients with ROS1- and ALK-rearranged advanced NSCLC (n = 206) who received crizotinib in the phase 1 PROFILE 1001 trial.

Disclosures: The study was funded by Pfizer. The authors reported receiving grants or personal fees from one or more pharmaceutical companies, including Pfizer, outside this work.

Source: Ng TL, Tsui DCC, et al. Association of anticoagulant use with clinical outcomes from crizotinib in ALK- and ROS1-rearranged advanced non-small cell lung cancers: A retrospective analysis of PROFILE 1001. Cancer Med. 2022 (May 5). Doi: 10.1002/cam4.4789

Key clinical point: Anticoagulant use is linked to worse progression-free survival (PFS) and objective response rate (ORR) in patients with ALK- and ROS1-rearranged advanced nonsmall cell lung cancer (NSCLC) treated with crizotinib.

Major finding: In the ROS1-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (5.1 vs 29 months) and poorer ORR (41.7% vs 80.5%). Similarly, in the ALK-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (7.1 vs 12 months) and poorer ORR (41% vs 74.3%).

Study details: The data come from a retrospective analysis of patients with ROS1- and ALK-rearranged advanced NSCLC (n = 206) who received crizotinib in the phase 1 PROFILE 1001 trial.

Disclosures: The study was funded by Pfizer. The authors reported receiving grants or personal fees from one or more pharmaceutical companies, including Pfizer, outside this work.

Source: Ng TL, Tsui DCC, et al. Association of anticoagulant use with clinical outcomes from crizotinib in ALK- and ROS1-rearranged advanced non-small cell lung cancers: A retrospective analysis of PROFILE 1001. Cancer Med. 2022 (May 5). Doi: 10.1002/cam4.4789

Key clinical point: Anticoagulant use is linked to worse progression-free survival (PFS) and objective response rate (ORR) in patients with ALK- and ROS1-rearranged advanced nonsmall cell lung cancer (NSCLC) treated with crizotinib.

Major finding: In the ROS1-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (5.1 vs 29 months) and poorer ORR (41.7% vs 80.5%). Similarly, in the ALK-rearranged group, anticoagulant use vs no use was associated with a shorter median PFS (7.1 vs 12 months) and poorer ORR (41% vs 74.3%).

Study details: The data come from a retrospective analysis of patients with ROS1- and ALK-rearranged advanced NSCLC (n = 206) who received crizotinib in the phase 1 PROFILE 1001 trial.

Disclosures: The study was funded by Pfizer. The authors reported receiving grants or personal fees from one or more pharmaceutical companies, including Pfizer, outside this work.

Source: Ng TL, Tsui DCC, et al. Association of anticoagulant use with clinical outcomes from crizotinib in ALK- and ROS1-rearranged advanced non-small cell lung cancers: A retrospective analysis of PROFILE 1001. Cancer Med. 2022 (May 5). Doi: 10.1002/cam4.4789

Key clinical point: Noncachexic patients with advanced nonsmall cell lung cancer (NSCLC) and adipose tissue loss may respond more favorably to immunotherapy.

Major finding: Cachexic patients with loss and maintenance of adipose tissue showed no significant differences in the objective response rate (ORR) and progression-free survival (PFS). Noncachexic patients with loss vs maintenance of adipose tissue demonstrated a higher ORR (64.7% vs 23.5%; P < .05) and longer PFS (18.5 vs 2.86 months; P = .037) in response to immunotherapy.

Study details: The data come from a single-center retrospective cohort study involving patients with advanced NSCLC (40 with cachexia and 34 without cachexia) who received programmed cell death-1/programmed cell death-ligand 1 inhibitors (pembrolizumab, nivolumab, or atezolizumab).

Disclosures: The study was funded by the Japan Agency for Medical Research and Development. The authors reported ties with one or more pharmaceutical companies outside this work.

Source: Nishioka N et al. Impact of losing adipose tissue on outcomes from PD-1/PD-L1 inhibitor monotherapy in non-small cell lung cancer. Thorac Cancer. 2022;13(10):1496-1504 (Apr 14). Doi: 10.1111/1759-7714.14421

Key clinical point: Noncachexic patients with advanced nonsmall cell lung cancer (NSCLC) and adipose tissue loss may respond more favorably to immunotherapy.

Major finding: Cachexic patients with loss and maintenance of adipose tissue showed no significant differences in the objective response rate (ORR) and progression-free survival (PFS). Noncachexic patients with loss vs maintenance of adipose tissue demonstrated a higher ORR (64.7% vs 23.5%; P < .05) and longer PFS (18.5 vs 2.86 months; P = .037) in response to immunotherapy.

Study details: The data come from a single-center retrospective cohort study involving patients with advanced NSCLC (40 with cachexia and 34 without cachexia) who received programmed cell death-1/programmed cell death-ligand 1 inhibitors (pembrolizumab, nivolumab, or atezolizumab).

Disclosures: The study was funded by the Japan Agency for Medical Research and Development. The authors reported ties with one or more pharmaceutical companies outside this work.

Source: Nishioka N et al. Impact of losing adipose tissue on outcomes from PD-1/PD-L1 inhibitor monotherapy in non-small cell lung cancer. Thorac Cancer. 2022;13(10):1496-1504 (Apr 14). Doi: 10.1111/1759-7714.14421

Key clinical point: Noncachexic patients with advanced nonsmall cell lung cancer (NSCLC) and adipose tissue loss may respond more favorably to immunotherapy.

Major finding: Cachexic patients with loss and maintenance of adipose tissue showed no significant differences in the objective response rate (ORR) and progression-free survival (PFS). Noncachexic patients with loss vs maintenance of adipose tissue demonstrated a higher ORR (64.7% vs 23.5%; P < .05) and longer PFS (18.5 vs 2.86 months; P = .037) in response to immunotherapy.

Study details: The data come from a single-center retrospective cohort study involving patients with advanced NSCLC (40 with cachexia and 34 without cachexia) who received programmed cell death-1/programmed cell death-ligand 1 inhibitors (pembrolizumab, nivolumab, or atezolizumab).

Disclosures: The study was funded by the Japan Agency for Medical Research and Development. The authors reported ties with one or more pharmaceutical companies outside this work.

Source: Nishioka N et al. Impact of losing adipose tissue on outcomes from PD-1/PD-L1 inhibitor monotherapy in non-small cell lung cancer. Thorac Cancer. 2022;13(10):1496-1504 (Apr 14). Doi: 10.1111/1759-7714.14421

Key clinical point: The addition of nivolumab to neoadjuvant chemotherapy is more efficacious than and comparably safe compared to chemotherapy alone in patients with stage IB-IIIA resectable nonsmall cell lung cancer (NSCLC).

Major finding: The nivolumab plus chemotherapy vs chemotherapy-alone group demonstrated longer event-free survival (31.6 vs 20.8 months; hazard ratio 0.63; P = .005) and had a higher proportion of patients achieving pathological complete response (24.0% vs 2.2%; odds ratio 13.94; P < .001). The rates of grade 3/4 treatment-related adverse events were comparable between the groups (33.5% vs 36.9%).

Study details: The data come from an open-label phase 3 CheckMate 816 trial which included patients with resectable NSCLC who were randomly assigned to receive neoadjuvant nivolumab plus platinum-doublet chemotherapy (n = 179) or platinum-doublet chemotherapy alone (n = 179).

Disclosures: The trial was funded by Bristol Myers Squibb. The authors reported ties with one or more pharmaceutical companies outside this work, including Bristol Myers Squibb.

Source: Forde PM et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N Engl J Med. 2022 (Apr 11). Doi: 10.1056/NEJMoa2202170

Key clinical point: The addition of nivolumab to neoadjuvant chemotherapy is more efficacious than and comparably safe compared to chemotherapy alone in patients with stage IB-IIIA resectable nonsmall cell lung cancer (NSCLC).

Major finding: The nivolumab plus chemotherapy vs chemotherapy-alone group demonstrated longer event-free survival (31.6 vs 20.8 months; hazard ratio 0.63; P = .005) and had a higher proportion of patients achieving pathological complete response (24.0% vs 2.2%; odds ratio 13.94; P < .001). The rates of grade 3/4 treatment-related adverse events were comparable between the groups (33.5% vs 36.9%).

Study details: The data come from an open-label phase 3 CheckMate 816 trial which included patients with resectable NSCLC who were randomly assigned to receive neoadjuvant nivolumab plus platinum-doublet chemotherapy (n = 179) or platinum-doublet chemotherapy alone (n = 179).

Disclosures: The trial was funded by Bristol Myers Squibb. The authors reported ties with one or more pharmaceutical companies outside this work, including Bristol Myers Squibb.

Source: Forde PM et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N Engl J Med. 2022 (Apr 11). Doi: 10.1056/NEJMoa2202170

Key clinical point: The addition of nivolumab to neoadjuvant chemotherapy is more efficacious than and comparably safe compared to chemotherapy alone in patients with stage IB-IIIA resectable nonsmall cell lung cancer (NSCLC).

Major finding: The nivolumab plus chemotherapy vs chemotherapy-alone group demonstrated longer event-free survival (31.6 vs 20.8 months; hazard ratio 0.63; P = .005) and had a higher proportion of patients achieving pathological complete response (24.0% vs 2.2%; odds ratio 13.94; P < .001). The rates of grade 3/4 treatment-related adverse events were comparable between the groups (33.5% vs 36.9%).

Study details: The data come from an open-label phase 3 CheckMate 816 trial which included patients with resectable NSCLC who were randomly assigned to receive neoadjuvant nivolumab plus platinum-doublet chemotherapy (n = 179) or platinum-doublet chemotherapy alone (n = 179).

Disclosures: The trial was funded by Bristol Myers Squibb. The authors reported ties with one or more pharmaceutical companies outside this work, including Bristol Myers Squibb.

Source: Forde PM et al. Neoadjuvant nivolumab plus chemotherapy in resectable lung cancer. N Engl J Med. 2022 (Apr 11). Doi: 10.1056/NEJMoa2202170

Some smokers might not get lung cancer because of their DNA, researchers report in a new study.

These people have genes that help limit mutations to DNA that would turn cells malignant and make them grow into tumors, the researchers say.

Scientists have long suspected that smoking leads to lung cancer by triggering DNA mutations in healthy cells. But it was hard for them to identify the mutations in healthy cells that might help predict future cancer risk, Jan Vijg, PhD, a senior author of the study and researcher at the University School of Medicine, Shanghai, China, said in a statement.

His team used a process called single-cell whole genome sequencing to examine cells lining the lungs of 19 smokers and 14 nonsmokers ranging in age from their pre-teens to their mid-80s. The cells came from patients who had tissue samples collected from their lungs during diagnostic testing unrelated to cancer. The scientists reported their findings in Nature Genetics.

The researchers specifically looked at cells lining the lungs because these cells can survive for years and build up mutations over time that are linked to aging and smoking.

“Of all the lung’s cell types, these are among the most likely to become cancerous,” says Simon Spivack, MD, a senior author of the study and professor at the Albert Einstein College of Medicine, New York.

Smokers had far more gene mutations that can cause lung cancer than nonsmokers, the analysis found.

“This experimentally confirms that smoking increases lung cancer risk by increasing the frequency of mutations, as previously hypothesized,” says Dr. Spivack. “This is likely one reason why so few nonsmokers get lung cancer, while 10 to 20 percent of lifelong smokers do.”

Among the smokers, people had smoked a maximum of 116 pack-years. A pack-year is the equivalent of smoking one pack a day for a year. The number of mutations detected in smokers’ lung cells increased in direct proportion to the number of pack-years they smoked.

But after 23 pack-years, the lung cells in smokers didn’t appear to add more mutations, the researchers report, suggesting that some people’s genes might make them more likely to fight mutations.

“The heaviest smokers did not have the highest mutation burden,” says Dr. Spivack. “Our data suggest that these individuals may have survived for so long in spite of their heavy smoking because they managed to suppress further mutation accumulation.”

While it’s possible these findings could one day help doctors come up with better ways to screen for lung cancer and treat the disease, that’s still a long way off. Many more lab tests and larger studies will be needed to better pinpoint which smokers might be more prone to lung cancer and why.

A version of this article first appeared on WebMD.com.

Some smokers might not get lung cancer because of their DNA, researchers report in a new study.

These people have genes that help limit mutations to DNA that would turn cells malignant and make them grow into tumors, the researchers say.

Scientists have long suspected that smoking leads to lung cancer by triggering DNA mutations in healthy cells. But it was hard for them to identify the mutations in healthy cells that might help predict future cancer risk, Jan Vijg, PhD, a senior author of the study and researcher at the University School of Medicine, Shanghai, China, said in a statement.

His team used a process called single-cell whole genome sequencing to examine cells lining the lungs of 19 smokers and 14 nonsmokers ranging in age from their pre-teens to their mid-80s. The cells came from patients who had tissue samples collected from their lungs during diagnostic testing unrelated to cancer. The scientists reported their findings in Nature Genetics.

The researchers specifically looked at cells lining the lungs because these cells can survive for years and build up mutations over time that are linked to aging and smoking.

“Of all the lung’s cell types, these are among the most likely to become cancerous,” says Simon Spivack, MD, a senior author of the study and professor at the Albert Einstein College of Medicine, New York.

Smokers had far more gene mutations that can cause lung cancer than nonsmokers, the analysis found.

“This experimentally confirms that smoking increases lung cancer risk by increasing the frequency of mutations, as previously hypothesized,” says Dr. Spivack. “This is likely one reason why so few nonsmokers get lung cancer, while 10 to 20 percent of lifelong smokers do.”

Among the smokers, people had smoked a maximum of 116 pack-years. A pack-year is the equivalent of smoking one pack a day for a year. The number of mutations detected in smokers’ lung cells increased in direct proportion to the number of pack-years they smoked.

But after 23 pack-years, the lung cells in smokers didn’t appear to add more mutations, the researchers report, suggesting that some people’s genes might make them more likely to fight mutations.

“The heaviest smokers did not have the highest mutation burden,” says Dr. Spivack. “Our data suggest that these individuals may have survived for so long in spite of their heavy smoking because they managed to suppress further mutation accumulation.”

While it’s possible these findings could one day help doctors come up with better ways to screen for lung cancer and treat the disease, that’s still a long way off. Many more lab tests and larger studies will be needed to better pinpoint which smokers might be more prone to lung cancer and why.

A version of this article first appeared on WebMD.com.

Some smokers might not get lung cancer because of their DNA, researchers report in a new study.

These people have genes that help limit mutations to DNA that would turn cells malignant and make them grow into tumors, the researchers say.

Scientists have long suspected that smoking leads to lung cancer by triggering DNA mutations in healthy cells. But it was hard for them to identify the mutations in healthy cells that might help predict future cancer risk, Jan Vijg, PhD, a senior author of the study and researcher at the University School of Medicine, Shanghai, China, said in a statement.

His team used a process called single-cell whole genome sequencing to examine cells lining the lungs of 19 smokers and 14 nonsmokers ranging in age from their pre-teens to their mid-80s. The cells came from patients who had tissue samples collected from their lungs during diagnostic testing unrelated to cancer. The scientists reported their findings in Nature Genetics.

The researchers specifically looked at cells lining the lungs because these cells can survive for years and build up mutations over time that are linked to aging and smoking.

“Of all the lung’s cell types, these are among the most likely to become cancerous,” says Simon Spivack, MD, a senior author of the study and professor at the Albert Einstein College of Medicine, New York.

Smokers had far more gene mutations that can cause lung cancer than nonsmokers, the analysis found.

“This experimentally confirms that smoking increases lung cancer risk by increasing the frequency of mutations, as previously hypothesized,” says Dr. Spivack. “This is likely one reason why so few nonsmokers get lung cancer, while 10 to 20 percent of lifelong smokers do.”

Among the smokers, people had smoked a maximum of 116 pack-years. A pack-year is the equivalent of smoking one pack a day for a year. The number of mutations detected in smokers’ lung cells increased in direct proportion to the number of pack-years they smoked.

But after 23 pack-years, the lung cells in smokers didn’t appear to add more mutations, the researchers report, suggesting that some people’s genes might make them more likely to fight mutations.

“The heaviest smokers did not have the highest mutation burden,” says Dr. Spivack. “Our data suggest that these individuals may have survived for so long in spite of their heavy smoking because they managed to suppress further mutation accumulation.”

While it’s possible these findings could one day help doctors come up with better ways to screen for lung cancer and treat the disease, that’s still a long way off. Many more lab tests and larger studies will be needed to better pinpoint which smokers might be more prone to lung cancer and why.

A version of this article first appeared on WebMD.com.

In states that adopted Medicaid expansion following the implementation of the Affordable Care Act (ACA), patients with cancer have improved 2-year overall survival rates, compared with patients in states that did not adopt the expansion.

The finding comes from an American Cancer Society study of more than 2 million patients with newly diagnosed cancer, published online in the Journal of the National Cancer Institute.

The analysis also showed that the evidence was strongest for malignancies with poor prognosis such as lung, pancreatic, and liver cancer, and also for colorectal cancer.

Importantly, improvements in survival were larger in non-Hispanic Black patients and individuals residing in rural areas, suggesting there was a narrowing of disparities in cancer survival by race and rurality.

“Our findings provide further evidence of the importance of expanding Medicaid eligibility in all states, particularly considering the economic crisis and health care disruptions caused by the COVID-19 pandemic,” said lead author Xuesong Han, PhD, scientific director of health services research at the American Cancer Society, in a statement. “What’s encouraging is the American Rescue Plan Act of 2021 provides new incentives for Medicaid expansion in states that have yet to increase eligibility.”

The ACA provided states with incentives to expand Medicaid eligibility to all low-income adults under 138% federal poverty level, regardless of parental status.

As of last month, just 12 states have not yet opted for Medicaid expansion, even though the American Rescue Plan Act of 2021 provides new incentives for those remaining jurisdictions. But to date, none of the remaining states have taken advantage of these new incentives.

An interactive map showing the status of Medicare expansion by state is available here. The 12 states that have not adopted Medicare expansion (as of April) are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.  

The benefit of Medicaid expansion on cancer outcomes has already been observed in other studies. The first study to show a survival benefit was presented at the 2020 American Society of Clinical Oncology annual meeting. That analysis showed that cancer mortality declined by 29% in states that expanded Medicaid and by 25% in those that did not. The authors also noted that the greatest mortality benefit was observed in Hispanic patients.
 

Improved survival with expansion

In the current paper, Dr. Han and colleagues used population-based cancer registries from 42 states and compared data on patients aged 18-62 years who were diagnosed with cancer in a period of 2 years before (2010-2012) and after (2014-2016) ACA Medicaid expansion. They were followed through Sept. 30, 2013, and Dec. 31, 2017, respectively.

The analysis involved a total of 2.5 million patients, of whom 1.52 million lived in states that adopted Medicaid expansion and compared with 1 million patients were in states that did not.

Patients with grouped by sex, race and ethnicity, census tract-level poverty, and rurality. The authors note that non-Hispanic Black patients and those from high poverty areas and nonmetropolitan areas were disproportionately represented in nonexpansion states. 

During the 2-year follow-up period, a total of 453,487 deaths occurred (257,950 in expansion states and 195,537 in nonexpansion states).

Overall, patients in expansion states generally had better survival versus those in nonexpansion states, the authors comment. However, for most cancer types, overall survival improved after the ACA for both groups of states.

The 2-year overall survival increased from 80.6% before the ACA to 82.2% post ACA in expansion states and from 78.7% to 80% in nonexpansion states.

This extrapolated to net increase of 0.44 percentage points in expansion states after adjusting for sociodemographic factors. By cancer site, the net increase was greater for colorectal cancer, lung cancer, non-Hodgkin’s lymphoma, pancreatic cancer, and liver cancer.

For Hispanic patients, 2-year survival also increased but was similar in expansion and nonexpansion states, and little net change was associated with Medicaid expansion.

“Our study shows that the increase was largely driven by improvements in survival for cancer types with poor prognosis, suggesting improved access to timely and effective treatments,” said Dr. Han. “It adds to accumulating evidence of the multiple benefits of Medicaid expansion.”

A version of this article first appeared on Medscape.com.

In states that adopted Medicaid expansion following the implementation of the Affordable Care Act (ACA), patients with cancer have improved 2-year overall survival rates, compared with patients in states that did not adopt the expansion.

The finding comes from an American Cancer Society study of more than 2 million patients with newly diagnosed cancer, published online in the Journal of the National Cancer Institute.

The analysis also showed that the evidence was strongest for malignancies with poor prognosis such as lung, pancreatic, and liver cancer, and also for colorectal cancer.

Importantly, improvements in survival were larger in non-Hispanic Black patients and individuals residing in rural areas, suggesting there was a narrowing of disparities in cancer survival by race and rurality.

“Our findings provide further evidence of the importance of expanding Medicaid eligibility in all states, particularly considering the economic crisis and health care disruptions caused by the COVID-19 pandemic,” said lead author Xuesong Han, PhD, scientific director of health services research at the American Cancer Society, in a statement. “What’s encouraging is the American Rescue Plan Act of 2021 provides new incentives for Medicaid expansion in states that have yet to increase eligibility.”

The ACA provided states with incentives to expand Medicaid eligibility to all low-income adults under 138% federal poverty level, regardless of parental status.

As of last month, just 12 states have not yet opted for Medicaid expansion, even though the American Rescue Plan Act of 2021 provides new incentives for those remaining jurisdictions. But to date, none of the remaining states have taken advantage of these new incentives.

An interactive map showing the status of Medicare expansion by state is available here. The 12 states that have not adopted Medicare expansion (as of April) are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.  

The benefit of Medicaid expansion on cancer outcomes has already been observed in other studies. The first study to show a survival benefit was presented at the 2020 American Society of Clinical Oncology annual meeting. That analysis showed that cancer mortality declined by 29% in states that expanded Medicaid and by 25% in those that did not. The authors also noted that the greatest mortality benefit was observed in Hispanic patients.
 

Improved survival with expansion

In the current paper, Dr. Han and colleagues used population-based cancer registries from 42 states and compared data on patients aged 18-62 years who were diagnosed with cancer in a period of 2 years before (2010-2012) and after (2014-2016) ACA Medicaid expansion. They were followed through Sept. 30, 2013, and Dec. 31, 2017, respectively.

The analysis involved a total of 2.5 million patients, of whom 1.52 million lived in states that adopted Medicaid expansion and compared with 1 million patients were in states that did not.

Patients with grouped by sex, race and ethnicity, census tract-level poverty, and rurality. The authors note that non-Hispanic Black patients and those from high poverty areas and nonmetropolitan areas were disproportionately represented in nonexpansion states. 

During the 2-year follow-up period, a total of 453,487 deaths occurred (257,950 in expansion states and 195,537 in nonexpansion states).

Overall, patients in expansion states generally had better survival versus those in nonexpansion states, the authors comment. However, for most cancer types, overall survival improved after the ACA for both groups of states.

The 2-year overall survival increased from 80.6% before the ACA to 82.2% post ACA in expansion states and from 78.7% to 80% in nonexpansion states.

This extrapolated to net increase of 0.44 percentage points in expansion states after adjusting for sociodemographic factors. By cancer site, the net increase was greater for colorectal cancer, lung cancer, non-Hodgkin’s lymphoma, pancreatic cancer, and liver cancer.

For Hispanic patients, 2-year survival also increased but was similar in expansion and nonexpansion states, and little net change was associated with Medicaid expansion.

“Our study shows that the increase was largely driven by improvements in survival for cancer types with poor prognosis, suggesting improved access to timely and effective treatments,” said Dr. Han. “It adds to accumulating evidence of the multiple benefits of Medicaid expansion.”

A version of this article first appeared on Medscape.com.

In states that adopted Medicaid expansion following the implementation of the Affordable Care Act (ACA), patients with cancer have improved 2-year overall survival rates, compared with patients in states that did not adopt the expansion.

The finding comes from an American Cancer Society study of more than 2 million patients with newly diagnosed cancer, published online in the Journal of the National Cancer Institute.

The analysis also showed that the evidence was strongest for malignancies with poor prognosis such as lung, pancreatic, and liver cancer, and also for colorectal cancer.

Importantly, improvements in survival were larger in non-Hispanic Black patients and individuals residing in rural areas, suggesting there was a narrowing of disparities in cancer survival by race and rurality.

“Our findings provide further evidence of the importance of expanding Medicaid eligibility in all states, particularly considering the economic crisis and health care disruptions caused by the COVID-19 pandemic,” said lead author Xuesong Han, PhD, scientific director of health services research at the American Cancer Society, in a statement. “What’s encouraging is the American Rescue Plan Act of 2021 provides new incentives for Medicaid expansion in states that have yet to increase eligibility.”

The ACA provided states with incentives to expand Medicaid eligibility to all low-income adults under 138% federal poverty level, regardless of parental status.

As of last month, just 12 states have not yet opted for Medicaid expansion, even though the American Rescue Plan Act of 2021 provides new incentives for those remaining jurisdictions. But to date, none of the remaining states have taken advantage of these new incentives.

An interactive map showing the status of Medicare expansion by state is available here. The 12 states that have not adopted Medicare expansion (as of April) are Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming.  

The benefit of Medicaid expansion on cancer outcomes has already been observed in other studies. The first study to show a survival benefit was presented at the 2020 American Society of Clinical Oncology annual meeting. That analysis showed that cancer mortality declined by 29% in states that expanded Medicaid and by 25% in those that did not. The authors also noted that the greatest mortality benefit was observed in Hispanic patients.
 

Improved survival with expansion

In the current paper, Dr. Han and colleagues used population-based cancer registries from 42 states and compared data on patients aged 18-62 years who were diagnosed with cancer in a period of 2 years before (2010-2012) and after (2014-2016) ACA Medicaid expansion. They were followed through Sept. 30, 2013, and Dec. 31, 2017, respectively.

The analysis involved a total of 2.5 million patients, of whom 1.52 million lived in states that adopted Medicaid expansion and compared with 1 million patients were in states that did not.

Patients with grouped by sex, race and ethnicity, census tract-level poverty, and rurality. The authors note that non-Hispanic Black patients and those from high poverty areas and nonmetropolitan areas were disproportionately represented in nonexpansion states. 

During the 2-year follow-up period, a total of 453,487 deaths occurred (257,950 in expansion states and 195,537 in nonexpansion states).

Overall, patients in expansion states generally had better survival versus those in nonexpansion states, the authors comment. However, for most cancer types, overall survival improved after the ACA for both groups of states.

The 2-year overall survival increased from 80.6% before the ACA to 82.2% post ACA in expansion states and from 78.7% to 80% in nonexpansion states.

This extrapolated to net increase of 0.44 percentage points in expansion states after adjusting for sociodemographic factors. By cancer site, the net increase was greater for colorectal cancer, lung cancer, non-Hodgkin’s lymphoma, pancreatic cancer, and liver cancer.

For Hispanic patients, 2-year survival also increased but was similar in expansion and nonexpansion states, and little net change was associated with Medicaid expansion.

“Our study shows that the increase was largely driven by improvements in survival for cancer types with poor prognosis, suggesting improved access to timely and effective treatments,” said Dr. Han. “It adds to accumulating evidence of the multiple benefits of Medicaid expansion.”

A version of this article first appeared on Medscape.com.