NCCN Guidelines Insights: Non–Small Cell Lung Cancer, Version 1.2020

Ettinger, David S.; Wood, Douglas E.; Aggarwal, Charu; Aisner, Dara L.; Akerley, Wallace; Bauman, Jessica R.; Bharat, Ankit; Bruno, Débora S.; Chang, Joe Y.; Chirieac, Lucian R.; D’Amico, Thomas A.; Dilling, Thomas J.; Dobelbower, M.C.; Gettinger, Scott; Govindan, Ramaswamy; Gubens, Matthew A.; Hennon, Mark; Horn, Leora; Lackner, Rudy P.; Lanuti, Michael; Leal, Ticiana; Lin, Jules; Loo, Billy W.; Martins, Renato; Otterson, Gregory A.; Patel, Sandip Pravin; Reckamp, Karen L.; Riely, Gregory J.; Schild, Steven E.; Shapiro, Theresa A.; Stevenson, James P.; Swanson, Scott J.; Tauer, Kurt W.; Yang, Stephen C.; Gregory, Kristina M.; Hughes, Miranda

doi:10.6004/jnccn.2019.0059

Cited by 810 publications

(811 citation statements)

References 33 publications

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“…The osimertinib treatment line was as follows: second-line (n = 19, 33.9%), third-line (n = 15, 26.8%), and fourth−/later-line (n = 22, 39.3%). The median number of previous regimens was two (range, [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Osimertinib (80 mg/day) was orally administered to all patients.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…The 2018 National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines for Non-Small Cell Lung Cancer (NSCLC) recommend epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors (TKIs) as first-line treatment for unresectable, EGFR mutation-positive, advanced NSCLC. 1 It is known that lung cancer patients with activated EGFR mutations respond to firstor second-generation EGFR-TKIs, such as gefitinib, erlotinib, and afatinib. [2][3][4][5][6][7] However, in many cases, the effects are transient, cause drug resistance, and lead to deterioration in clinical conditions in approximately one year.…”

Section: Introductionmentioning

confidence: 99%

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Osimertinib, a third‐generation EGFR tyrosine kinase inhibitor: A retrospective multicenter study of its real‐world efficacy and safety in advanced/recurrent non‐small cell lung carcinoma

et al. 2020

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Background Osimertinib is recommended for T790M mutation‐positive advanced non‐small cell lung cancer (NSCLC) resistant to first‐ and second‐generation epidermal growth factor receptor (EGFR)‐tyrosine kinase inhibitors (TKIs). Recently, some reports exist on the real‐world use of osimertinib; however, reports involving third/later‐line use are few. Hence, this study was conducted to evaluate the efficacy and safety of osimertinib used in various treatment lines for T790M‐positive NSCLC patients. Methods This retrospective, observational, multicenter study included T790M‐positive advanced/recurrent NSCLC patients treated with osimertinib from May 2016 to March 2018. The clinical characteristics, efficacy, and adverse events were retrospectively investigated. The Kaplan‐Meier method was used to analyze progression‐free survival (PFS) and overall survival (OS). PFS‐associated clinical characteristics were evaluated using the Cox proportional hazards model. Results The objective response rate (ORR) and disease control rate (DCR) were 60.7% and 91.1%, respectively; the median PFS was 11.0 months. There were no significant differences in the median PFS for patients treated with osimertinib as second‐line and third−/later‐line (14.5 vs. 11.0 months respectively, P = 0.327). Analysis using the Cox proportional hazards model for clinical features affecting PFS also revealed no significant factors. Adverse events of grade ≥ 3 were reported in 15 patients (26.8%); the most common were anemia (n = 3) and cutaneous toxicity (n = 3). Grade 4 neutropenia was observed in one patient; any‐grade pneumonitis was observed in six patients (10.7%), including one with grade 3 pneumonitis. Conclusions Osimertinib demonstrated efficacy even when administered as third−/later‐line treatment to NSCLC patients. Osimertinib‐related pneumonitis was observed more frequently than previously reported. Key points Significant findings of the studyOsimertinib shows efficacy even as later‐line treatment in T790M mutation‐positive NSCLC patients previously treated with EGFR‐TKIs. However, the incidence of ≥ grade 3 adverse events, especially pneumonitis, was higher than that previously reported by other studies. What this study addsOsimertinib was approved for previously EGFR‐TKI‐treated EGFR T790M‐positive NSCLC. With the increasing frequency of its use as first‐line treatment, this study provides valuable evidence for the efficacy and safety of osimertinib for previously EGFR‐TKI‐treated NSCLC.

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Section: Patient Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Osimertinib, a third‐generation EGFR tyrosine kinase inhibitor: A retrospective multicenter study of its real‐world efficacy and safety in advanced/recurrent non‐small cell lung carcinoma

et al. 2020

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“…The latest report according to world health organization (WHO) showed that lung cancer is the leading cause of morbidity and mortality worldwide malignant tumor. [1][2][3] Unfortunately, despite advances in treatment, the prognosis remains poor. Taking into account all stages at diagnosis, the 5-year survival rate for lung cancer is only 18.1%, while, it is much lower (approximately 4.5%) for those with metastatic disease at diagnosis.…”

Section: Introductionmentioning

confidence: 99%

The role of high‐mobility group protein box 1 in lung cancer

Wu¹,

Chen²,

Gong

et al. 2018

J of Cellular Biochemistry

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High-mobility group protein box 1(HMGB1)is a ubiquitous highly conserved nuclear protein. Acting as a chromatin-binding factor, HMGB1 binds to DNA and plays an important role in stabilizing nucleosome formation, facilitating gene transcription, DNA repairing, inflammation, cell differentiation, and regulating the activity of steroid hormone receptors. Currently, HMGB1 is discovered to be related to development, progression, and targeted therapy of lung cancer, which makes it an attractive biomarker, and therapeutic target. This review aims to encapsulate the relationship between HMGB1 and lung cancer, suggesting that HMGB1 plays a pivotal role in initiation, development, invasion, metastasis, and prognosis of lung cancer.

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“…procedures do not benefit N3 and M1 patients; chemotherapy or radiochemotherapy are the optimal treatments. 2 When a patient is suspected or confirmed with NSCLC, clinical TNM staging mainly based on imaging studies should be conducted to determine if surgery should be considered and what type of surgical procedure (lobectomy or sublobar resection) is preferred. Clinical N stage (cN stage) is established by imaging studies, usually with contrast-enhanced computed tomography (CT) or positron emission (PET)-CT.…”

Section: Introductionmentioning

confidence: 99%

Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung

et al. 2018

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BackgroundIntrapulmonary lymph nodes (LNs, stations 11–14) are usually omitted in postoperative pathological examination. Some non‐small cell lung cancer (NSCLC) patients with intrapulmonary LN metastasis are incorrectly diagnosed as N0 cases. Furthermore, underestimation of intrapulmonary LN involvement in clinically early stage NSCLC may lead to the incorrect choice of surgical procedure: lobectomy or sublobar resection. This study was conducted to determine the status of intrapulmonary LN involvement in clinically staged IA (c‐T1N0M0) peripheral adenocarcinoma of the lung.MethodsSeventy‐five lobectomy specimens of c‐T1N0M0 peripheral adenocarcinoma of the lung were carefully dissected to find intrapulmonary LNs. The longest diameter of each intrapulmonary LN was measured and sent for pathological examination, together with hilar and mediastinal LNs, to investigate the relationship between LN metastasis and primary tumor size.ResultsIntrapulmonary LN metastasis was detected in 22.7%(17/75) of patients. Positive LNs were detected in 21.7% (10/46) of T1b patients and 45% (11/24) of T1c patients, while no metastasis (0/5) was observed in T1a patients (P = 0.036). The mean longest diameter of the 17 involved intrapulmonary LNs was only 6.5 ± 2.1 mm, which was not significantly different to the size of negative intrapulmonary LNs (5.2 ± 1.4 mm).ConclusionsIntrapulmonary LN metastasis is common in clinically staged IA peripheral adenocarcinoma of the lung. LN metastasis is related to tumor size, and this should be taken into account to determine appropriate surgical procedures and postoperative treatment. Computed tomography is not a reliable method to judge LN metastasis, particularly intrapulmonary LN metastasis.

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NCCN Guidelines Insights: Non–Small Cell Lung Cancer, Version 1.2020

Cited by 810 publications

References 33 publications

Osimertinib, a third‐generation EGFR tyrosine kinase inhibitor: A retrospective multicenter study of its real‐world efficacy and safety in advanced/recurrent non‐small cell lung carcinoma

Osimertinib, a third‐generation EGFR tyrosine kinase inhibitor: A retrospective multicenter study of its real‐world efficacy and safety in advanced/recurrent non‐small cell lung carcinoma

The role of high‐mobility group protein box 1 in lung cancer

Intrapulmonary lymph node metastasis is common in clinically staged IA adenocarcinoma of the lung

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