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Background: Osimertinib is a third-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) that is an established standard treatment option for chemotherapy-naive patients with EGFR mutation-positive non-small cell lung cancer (NSCLC). However, of such patients who have received prior treatment with a first- or second-generation EGFR TKI, only approximately half are eligible for osimertinib therapy because its indication as second-line treatment and beyond is limited to metastatic NSCLC that is positive for the T790M resistance mutation of the EGFR gene. This study was initiated at the request of a dedicated network for patients with lung cancer in Japan., Methods: We conducted a phase II study to assess the efficacy of osimertinib in patients with EGFR mutation-positive NSCLC in whom systemic disease (T790M-negative) progressed after treatment with first- or second-generation EGFR TKIs and platinum-based chemotherapy. The primary end point was response rate (assessed by a central imaging reviewer)., Results: From August 2020 to February 2021, 55 patients from 15 institutions were enrolled in the study. The overall response for primary analysis was achieved in 16 patients (29.1 %; 95 % CI, 17.6-42.9), which exceeded the threshold response rate necessary for analysis. Stable disease was found in 16 patients (29.1 %), and progressive disease, in 18 (32.7 %). The median length of progression-free survival (PFS) was 4.07 months (95 % CI 2.10-4.30), and the rate of 12-month PFS was 17.3 %., Conclusions: Osimertinib demonstrated modest antitumor activity against progressive EGFR T790M-negative disease., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Takeda reports personal fees from Chugai Pharmaceutical Co., LTD., AstraZeneca K.K., Bristol-Myers Squibb Company, Novartis Pharma K.K., and Ono Pharmaceutical Co.,LTD. Dr Shimokawa has no conflicts of interest. Dr. Nakamura reports personal fees from MSD, AstraZeneca, Chugai Pharma, Kyowa Hakko Kirin, Nippon Boehringer Ingelheim, and Taiho Pharmaceutical. Dr. Nosaki reports personal fees from AstraZeneca K.K. Dr Watanabe has no conflicts of interest. Dr. Kato reports grants from Abbvie, Amgen, AstraZeneca, Blueprint, Chugai, Eli Lilly, Haihe, Merck Biopharma, MSD, Novartis, Pfizer, Regeneron, and Takeda, and personal fees Abbvie, Amgen, AstraZeneca, Beigene, Boehringer Ingelheim, Bristol-Myers Squibb, Chugai, Daiichi Sankyo, Eli Lilly, Glaxo, Merck Biopharma, MSD, Nippon Kayaku, Novartis, Ono, Pfizer, Roche, Taiho, and Takeda. Dr. Hayakawa has no conflicts of interest. Dr. Tanaka reports grants and personal fees from Astra Zeneca, Chugai Pharmaceutical, MSD, Ono Pharmaceutical, Bristol-Myers Squibb, Daiichi Sankyo Pharmaceutical, Eli Lilly, Takeda Pharmaceutical, Taiho Pharmaceutical, Merck, and Boehringer Ingelheim; grants from Amgen and Abbvie; and personal fees from Sun Pharmaceutical, Eisai, and Novartis. Dr. Takahashi reports grants from AstraZeneca KK, Chugai Pharmaceutical Co., LTD., Eli Lilly Japan K.K., Ono Pharmaceutical Co., LTD., MSD K.K., Pfizer Japan Inc., Amgen Inc., Boehringer Ingelheim Japan, and Merck Biopharma Co., LTD, and personal fees from AstraZeneca KK, Chugai Pharmaceutical Co., LTD., Eli Lilly Japan K.K., Ono Pharmaceutical Co., LTD., MSD K.K., Pfizer Japan Inc., Boehringer Ingelheim Japan, INC, Roche Diagnostics K.K., Takeda Pharmaceutical Co LTD., and Yakult Honsha CO. LTD. Dr. Oki reports research grants from MSD K.K., PAREXEL International Corp, Sanofi K.K., AstraZeneca K.K., and Janssen Pharmaceutical K.K. Dr. Tachihara reports grants and personal fees from AstraZeneca and personal fees from Taiho Pharmaceutical, MSD, Eli Lilly Japan K.K, Nippon Boehringer Ingelheim, Chugai Pharmaceutical, and Ono Pharmaceutical. Dr. Fujimoto reports personal fees from AstraZeneca KK, Ono Pharmaceutical Co Ltd, Bristol-Myers Squibb Co Ltd, Taiho Pharmaceutical Co Ltd, Chugai Pharmaceutical Co Ltd, MSD KK, Boehringer Ingelheim Japan Inc, Eli Lilly Japan KK, and Novartis Pharma K.K. Dr. Hayashi reports grants from AstraZeneca K.K., Astellas Pharma Inc., MSD K.K., Ono Pharmaceutical Co., Ltd., Nippon Boehringer Ingelheim Co., Ltd., Novartis Pharma K.K., grants, Pfizer Japan Inc., Bristol-Myers Squibb Company, Eli Lilly Japan K.K., Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Merck Serono Co., Ltd./ Merck Biopharma Co., Ltd., Takeda Pharmaceutical Co., Ltd., Taiho Pharmaceutical Co., Ltd., SymBio Pharmaceuticals Limited., AbbVie Inc, inVentiv Health Japan, ICON Japan K.K., GRITSONE ONCOLOGY.INC, PAREXEL International Corp., Kissei Pharmaceutical Co., Ltd., EPS Corporation., Syneos Health., Pfizer R&D Japan G.K., A2 Healthcare Corp., Quintiles Inc./IQVIA Services JAPAN K.K., EP-CRSU CO., LTD., Linical Co., Ltd., Eisai Co., Ltd., CMIC Shift Zero K.K., and Kyowa Hakko Kirin Co., Ltd, and personal fees from Bayer Yakuhin, Ltd, EPS International Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Amgen K.K, AstraZeneca K.K., Boehringer Ingelheim Japan Inc., Bristol-Myers Squibb Co. Ltd., Chugai Pharmaceutical Co. Ltd., Daiichi Sankyo Co. Ltd., Eli Lilly Japan K.K., Guardant healthcare, Kyorin Pharmaceutical Co. Ltd., Merck Biopharma Co. Ltd., MSD K.K., Novartis Pharmaceuticals K.K., Ono Pharmaceutical Co. Ltd., Shanghai Haihe Biopharm, Taiho Pharmaceutical Co. Ltd., Pfizer, and Takeda Pharmaceutical Co. Ltd. Dr. Yamaguchi has no conflicts of interest. Dr. S. Yamamoto have no conflicts of interest. Dr. Iwama reports personal fees from AstraZeneca. Dr. Azuma reports personal fees from AstraZeneca, grants and personal fees from Boehringer Ingelheim, Ono Pharmaceutical, MSD Oncology, Bristol-Myers Squibb, Chugai Pharma. Dr. N. Yamamoto reports grants and personal fees from MSD, personal fees from AstraZeneca, grants and personal fees from Ono Pharmaceutical Co., Ltd., personal fees from Thermo Fisher Scientific, grants and personal fees from Daiichi Sankyo, grants and personal fees from Taiho Pharmaceutical Co., Ltd., grants and personal fees from Takeda Pharmaceutical Co., Ltd., grants and personal fees from Chugai Pharmaceutical Co., Ltd., grants and personal fees from Eli Lilly Japan K.K., grants and personal fees from Boehringer Ingelheim, personal fees from Novartis, grants and personal fees from Pfizer, personal fees from Bristol-Myers Squibb, personal fees from Life Technologies Japan Ltd., personal fees from Nippon Kayaku, grants from Astellas Pharma Inc., grants from Shionogi, grants from Abbvie, grants from MEDICAL RESEARCH, grants from Kyorin Pharmaceutical Co., Ltd., grants from Eisai Co., Ltd., grants from TERUMO CORPORATION, grants from TOPPAN PRINTING Co., Ltd., and grants from TOSOH CORPORATION. Dr. Nakagawa reports grants and personal fees from AstraZeneca K.K.; grants and personal fees from Astellas Pharma Inc.; grants and personal fees from MSD K.K.; grants, personal fees, and other financial assistance from Ono Pharmaceutical Co., Ltd.; grants and personal fees from Nippon Boehringer Ingelheim Co., Ltd.; grants and personal fees from Novartis Pharma K.K.; grants, personal fees, and other financial assistance from Pfizer Japan Inc.; grants and personal fees from Bristol-Myers Squibb Company; grants, personal fees, and other financial assistance from Eli Lilly Japan K.K.; grants and personal fees from Chugai Pharmaceutical Co., Ltd.; grants and personal fees from Daiichi Sankyo Co., Ltd.; grants and personal fees from Merck Serono Co., Ltd./Merck Biopharma Co., Ltd., during the study; personal fees from Clinical Trial Co., Ltd.; personal fees from MEDICUS SHUPPAN, Publishers Co., Ltd.; personal fees from Care Net, Inc.; personal fees from Reno Medical K.K.; personal fees and other financial assistance from Kyorin Pharmaceutical Co., Ltd.; personal fees from Medical Review Co., Ltd.; personal fees from Roche Diagnostics K.K.; personal fees from Bayer Yakuhin, Ltd.; personal fees from Medical Mobile Communications Co., Ltd.; personal fees from 3H Clinical Trial Inc.; personal fees from Nichi-Iko Pharmaceutical Co., Ltd.; grants, personal fees, and other financial assistance from Takeda Pharmaceutical Co., Ltd.; grants and personal fees from Taiho Pharmaceutical Co., Ltd.; grants and personal fees from SymBio Pharmaceuticals Limited; personal fees from NANZANDO Co., Ltd.; personal fees from YODOSHA CO., LTD.; personal fees from Nikkei Business Publications, Inc.; personal fees from Thermo Fisher Scientific K.K.; personal fees from YOMIURI TELECASTING CORPORATION; personal fees from Nippon Kayaku Co., Ltd.; grants and personal fees from AbbVie Inc.; grants from inVentiv Health Japan; grants from ICON Japan K.K.; grants from GRITSONE ONCOLOGY INC.; grants from PAREXEL International Corp.; grants from Kissei Pharmaceutical Co., Ltd.; grants from EPS Corporation; grants from Syneos Health; grants from Pfizer R&D Japan G.K.; grants from A2 Healthcare Corp.; grants from Quintiles Inc./IQVIA Services JAPAN K.K.; grants from EP-CRSU CO., LTD.; grants from Linical Co., Ltd.; grants from Eisai Co., Ltd.; grants from CMIC Shift Zero K.K.; grants from Kyowa Hakko Kirin Co., Ltd; grants from Bayer Yakuhin, Ltd; grants from EPS International Co., Ltd.; and grants from Otsuka Pharmaceutical Co., Ltd., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: Programmed death ligand 1 and 2 (PD-L1 and PD-L2) bind programmed death 1 (PD-1). PD-L1 is an established predictive biomarker of response to immunotherapies targeting PD-1 and PD-L1 in lung adenocarcinoma (LUAD). However, the clinical relevance of PD-L2 expression in patients with LUAD remains unclear; we aimed to examine this aspect using LUAD specimens., Materials and Methods: PD-L2 expression status was immunohistochemically evaluated in 980 surgically resected LUAD specimens. PD-L2 expression status was classified based on the tumor proportion score (TPS) as negative (<1%), weakly positive (1-49%), or strongly positive (≥50%). Correlations between PD-L2 and PD-L1 expression status, clinicopathological features, driver oncogene alterations (EGFR, KRAS, ALK, ROS1, and RET), and prognosis were also analyzed., Results: PD-L2 expression was negative in 720 (73%) of 980 LUADs, weakly positive in 190 (19%), and strongly positive in 70 (7%). The concordance rate between PD-L1 and PD-L2 expression was 60%. Male sex, smokers, tumors > 3 cm in size, high-grade tumors, tumors without EGFR mutation or ALK fusion, and tumors with KRAS mutation were more common in patients with PD-L2-positive tumors (TPS ≥ 1%) than in patients with PD-L2-negative tumors (TPS < 1%). PD-L2 expression was not associated with overall survival (OS) or relapse-free survival (RFS). However, positive PD-L2 expression tended to be associated with better OS/RFS in PD-L1-positive patients and worse OS/RFS in PD-L1-negative patients., Conclusions: PD-L2-positive LUADs showed biologically aggressive characteristics. PD-L2 expression status was not associated with survival outcomes, but tended to show contrasting prognostic impacts based on PD-L1 expression status., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Objectives: Immune checkpoint inhibitors (ICIs) have become one of the standard therapies in non-small-cell lung cancer (NSCLC). Although inflammatory indices, including Glasgow prognostic score (GPS), modified Glasgow prognostic score (mGPS), and C-reactive protein/albumin ratio (CAR) were reported to be reliable predictors for survival in cancer patients, their clinical utility in NSCLC patients treated with ICIs is unknown., Materials and Methods: Advanced or recurrent NSCLC patients (n = 304) treated with ICI monotherapy at the National Hospital Organization Kyushu Cancer Center and Kyushu University Hospital between January 2016 and December 2019 were analyzed. Information on patient demographics, GPS, mGPS, and CAR at diagnosis were collected. The time-dependent area under curves (AUCs) of receiver operating characteristic curves for the prediction of overall survival (OS) for each factor were compared., Results: Of the three indices, GPS was the most significantly correlated with the degree of disease control rate (DCR) (DCR of GPS of 0, 1, and 2: 63.6 %, 49.4 %, and 41.4 %, respectively). The time-dependent AUC values of GPS for the prediction of OS were superior to those of mGPS and CAR (time-dependent AUC values of GPS, mGPS, and CAR for the prediction of 1-year OS: 0.7005, 0.6736, and 0.6565, respectively). GPS was significantly correlated with performance status (PS) (P <  0.0001) and clinical stage (P =  0.0139). GPS in combination with PS effectively predicted survival at 1 year ranging from 83.5 % (GPS = 0, PS = 0) to 25.0 % (GPS = 2, PS = 2, 3). A multivariable analysis revealed that GPS was an independent predictor of PFS and OS (P =  0.0009 and P =  0.0100, respectively)., Conclusions: We report for the first time that GPS represents a simple and useful prognostic factor in NSCLC patients treated with ICIs and should be validated prospectively., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Several serum markers have been associated with treatment response and clinical outcome in non-small cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors., Materials and Methods: We performed univariate and multivariate analyses on 226 patients with advanced or recurrent NSCLC treated with anti-programmed cell death-1 (PD-1) therapy. The cut-off values for body mass index (BMI), albumin (Alb), and serum inflammatory markers were determined by receiver operating characteristic curve analyses. Tumor response was assessed by computed tomography according to the Response Evaluation Criteria in Solid Tumors, version 1.1., Results: BMI ≥ 19.1 kg/m 2 and derived neutrophil-lymphocyte ratio (dNLR) < 2.79 were independent predictors of overall response, and Alb ≥ 3.5 g/dL and dNLR < 2.79 were independent predictors of disease control. Analyses of survival revealed that Alb < 3.5 g/dL, dNLR ≥ 2.79, lymphocyte-monocyte ratio < 2.12, and red blood cell distribution width ≥ 15.9 % were independent predictors of both progression-free and overall survival. Moreover, these markers tended to have a strong impact on survival, especially among patients with programmed cell death-ligand 1 tumor proportion score ≥ 50 %., Conclusions: dNLR might be the most important factor for predicting the efficacy in NSCLC patients treated with anti-PD-1 therapy., Competing Interests: Declaration of Competing Interest The authors have declared no conflicts of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: Combination therapy with an inhibitor of indoleamine 2, 3-dioxygenase 1 (IDO1) and an agent targeting programmed cell death-1 (PD-1)/programmed cell death-ligand 1 (PD-L1) is expected to be a novel and effective treatment option for various solid tumors including non-small cell lung cancer (NSCLC). Therefore, it is important to elucidate the clinical and pathological features of tumors with IDO1/PD-L1 co-expression and the association between IDO1/PD-L1 co-expression and efficacy of combination therapy in NSCLC patients. In this study, we examined the prognostic impact of IDO1/PD-L1 co-expression and its relationship with tumor-infiltrating lymphocytes (TILs) in primary lung squamous cell carcinoma (SCC)., Materials and Methods: The expression levels of IDO1, PD-L1, Ki-67, cluster of differentiation 3 (CD3), CD4, and CD8 in 202 patients with surgically resected primary lung SCC were evaluated by immunohistochemistry., Results: Among 202 patients, 176 (87.1%) were positive for IDO1 expression, 106 (52.5%) were positive for PD-L1 expression, and 99 (49.0%) showed co-expression of IDO1/PD-L1 proteins. Fisher's exact test showed a significant association between IDO1 and PD-L1 tumor proportion scores (P =  0.0011). Kaplan-Meier curve showed that PD-L1 alone and co-expression of IDO1 and PD-L1 were significantly associated with shorter overall survival, but IDO1 alone was not (log rank test: P =  0.0122, P =  0.0303 and P =  0.5168, respectively). The Ki-67 labeling index was significantly higher in patients with co-expression of IDO1 and PD-L1 than in patients without co-expression (Student's t-test: P =  0.0005). Moreover, IDO1/PD-L1 co-expression was significantly associated with high CD3, CD4, and CD8 expression (Fisher's exact test: P =  0.0033, P =  0.0003, and P <  0.0001, respectively)., Conclusions: IDO1 expression correlated to PD-L1 expression, and co-expression of IDO1 and PD-L1 may be important targets for immunotherapy in lung SCC., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: Platinum-based combination chemotherapy is the standard postoperative adjuvant treatment for pathological stage II/III non-small cell lung cancer (NSCLC). Oral S-1 therapy has good efficacy and relatively low toxicity for the treatment of advanced NSCLC. We investigated whether long-term S-1 monotherapy is also useful as an adjuvant therapy after surgery in patients with NSCLC., Patients and Methods: We conducted a phase II randomized open-label multi-institutional study in patients with pathological stage II/IIIA NSCLC (7 th TNM classification) who underwent complete resection from 2009 to 2013. The primary endpoint, the 2-year disease-free survival (DFS) rate, was evaluated using the Bayesian method. Eligible patients were randomly assigned to two arms: oral S-1 monotherapy (S-1 arm) and S-1 plus cisplatin combination therapy followed by S-1 (S-1 plus cisplatin arm) both for a total of 1 year., Results: A total of 70 and 71 patients were enrolled in S-1 arm and S-1 plus cisplatin arm, respectively. The 2-year DFS rates were 52% (95% confidence interval [CI], 0.40-0.63) and 61% (95% CI, 0.48-0.70) for S-1 arm and S-1 plus cisplatin arm, respectively. Both arms met the primary endpoint. Neither DFS nor OS was significantly different between the arms (log-rank test: P =  0.1695 and P =  0.8684, respectively). The main G3/4 adverse events were loss of appetite and anemia (S-1 vs. S-1 plus cisplatin: 4.3% vs. 11.6% and 0% vs. 5.8%, respectively). The treatment completion rate did not differ between the two arms (S-1 vs. S-1 plus cisplatin: 45.7%, 95% CI, 41.9-66.3% vs. 43.5% 95% CI, 44.0-68.4%)., Conclusions: Long-term adjuvant chemotherapy with S-1 was a feasible and promising treatment for patients with completely resected NSCLC, regardless of cisplatin addition. S-1 monotherapy should be investigated further, based on its low toxicity and practical convenience., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: It was reported that programmed cell death-ligand 1 (PD-L1) expression is associated with smoking and wild-type epidermal growth factor receptor (EGFR) in lung adenocarcinoma. However, the association between PD-L1 expression and EGFR mutation site in EGFR mutation-positive lung adenocarcinoma is unclear., Materials and Methods: We retrospectively examined the relationship between PD-L1 expression and EGFR status in 441 surgically resected primary lung adenocarcinomas. Membrane PD-L1 expression on tumor cells was evaluated by immunohistochemical analysis using a PD-L1 antibody (clone SP142) and defined by tumor proportion scores (TPSs) of 0%, 1-4%, 5-49%, and ≥50%, respectively., Results: Two hundred and eighteen (49.4%) patients had wild-type EGFR, and 223 (50.6%) had mutant EGFR-98 (44.0%) with exon 19 deletion, 116 (52.0%) with exon 21 L858R point mutation, and nine (4.0%) with another EGFR mutation. Overall, Fisher's exact test showed that PD-L1 positivity was associated with wild-type EGFR, and there was only one case with PD-L1 TPS ≥50% among the cases with mutant EGFR. The analysis of cases with mutant EGFR indicated no significant association between EGFR mutation site and PD-L1 expression. However, the prevalence of PD-L1 TPS 5-49% was higher among patients with EGFR exon 19 deletion than with EGFR exon 21 L858R point mutation., Conclusions: PD-L1 expression was significantly associated with wild-type EGFR, and PD-L1 TPS ≥50% seldom overlaps with presence of driver oncogene EGFR. There was no significant difference in PD-L1 expression among the EGFR mutation sites., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: The oxidized purine nucleoside triphosphatase, mutT homolog 1 (MTH1), physiologically sanitizes 8-oxo-dGTP in the nucleotide pool. Previous studies indicated that MTH1 is associated with tumor proliferation and invasion in non-small cell lung cancer (NSCLC) cell lines; however, the role of MTH1 in patients with NSCLC remains unclear., Materials and Methods: Two patient cohorts that underwent surgery for NSCLC in our institution were investigated retrospectively. In one cohort consisting of 197 patients, the associations between MTH1 expression and clinicopathological factors or prognosis were analyzed. In another cohort consisting of 41 patients, the relationship between MTH1 expression in the tumors and serum oxidative stress levels (evaluated by the diacron-reactive oxygen metabolites [d-ROMs] test) or antioxidant capacity in the patients (evaluated by the biological antioxidant potential (BAP) test) was analyzed. A total of 238 patients were assessed for MTH1 protein levels using immunohistochemistry., Results: Among the 197 patients in the former cohort, 111 (56.3%) exhibited high MTH1 expression, while 86 (43.7%) exhibited low MTH1 expression. Male sex, smoking habit of ≥20 pack-years, squamous cell carcinoma, pathological stage ≥ II, tumor diameter ≥30mm, lymph node metastases, pleural invasion, lymphatic permeation and vascular infiltration were significantly associated with high MTH1 expression (p<0.05). The high MTH1 expression group had a significantly worse prognosis than that of the low MTH1 expression group (5-year overall survival: 81.6% vs. 92.3%, p=0.0011; 5-year disease-free survival: 55.0% vs. 83.7%, p=0.0002). d-ROMs and BAP test values were significantly higher in the high than in the low MTH1 expression group (p<0.05)., Conclusion: This study showed that MTH1 protein expression was closely related to factors associated with a high malignant potential and poor patient survival. MTH1 may be a novel therapeutic target for NSCLC., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objectives: Although chemotherapy and radiotherapy are recommended for patients with limited disease small cell lung cancer (LD-SCLC), several series have reported favorable survival outcomes even in patients with stages II and III disease who underwent surgical resection. The purpose of this study is to compare the outcomes of the use of surgical resection to the other conventional non-surgical treatments in patients with LD-SCLC with respect to each clinical stage., Materials and Methods: We retrospectively reviewed 277 patients who received treatment for LD-SCLC and compared the outcomes of the use of surgical resection to the other conventional non-surgical treatments., Results: The clinical stage was stage I in 50 cases (18%), stage II in 53 cases (19%) and stage III in 174 cases (63%). Eighty-eight patients received surgical resection and 189 patients were treated with non-surgical treatment. Surgery was performed in 44 patients (88%) with stage I, 27 patients (52%) with stage II and 17 patients (10%) with stage III disease. The five-year survival rates of the patients according to clinical stage were 58% in stage I, 29% in stage II and 18% in stage III. The five-year survival rates of the patients with and without surgical resection according to clinical stage were as follows: 62% and 25% in stage I (p<0.01), 33% and 24% in stage II (p=0.95), 18% and 18% in stage III (p=0.35), respectively. In 44 propensity score-matched pairs with stages II and III disease, including matching for variables such as age, gender and the PS, the five-year survival rates was better in patients with surgical resection than in those without surgery (p=0.04)., Conclusion: Surgical resection is effective for the patients with stage I LD-SCLC and some cases of stage II or III disease., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Anaplastic lymphoma kinase (ALK) fuses echinoderm microtubule-associated protein-like 4 (EML4) to acquire a transforming activity in lung adenocarcinomas. However, the presence of an EML4-ALK fusion gene in other lung cancer histologies is an extremely rare phenomenon. A 43-year-old female was referred to our department due to dyspnea on effort and left back pain. Computed tomography (CT) showed a large mass in the upper lobe of the left lung and a massive left pleural effusion, while a CT-guided needle biopsy confirmed a diagnosis of small-cell lung cancer (SCLC). Surprisingly, the tumor was genetically considered to harbor the EML4-ALK fusion gene (variant 2). Although the patient underwent two regimens of cytotoxic chemotherapy for SCLC, she died approximately seven months after the administration of first-line chemotherapy. Our analysis of 30 consecutive patients with SCLC for EML4-ALK revealed that two patients, including the current patient and a patient we previously reported, harbored the EML4-ALK fusion gene., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)