Search

Background The aim of this study was to estimate the efficacy and safety of bevacizumab combined with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs) in advanced non‐small cell lung cancer (NSCLC) patients. Methods We searched randomized controlled trials (RCTs) on bevacizumab combined with EGFR TKIs in the NSCLC Cochrane Library, Web of Science, PubMed and Embase. The data were extracted and assessed according to the Cochrane Handbook. We calculated the hazard ratio (HR), risk ratio (RR), and confidence interval (CI), and accomplished this meta‐analysis with Stata 14 software. Results Of 1301 articles scanned, five articles were involved in this meta‐analysis. We determined that compared with using EGFR TKIs alone, combination treatment significantly prolongs progression‐free survival (PFS) (HR = 0.61, 95% CI = 0.52–0.70; p

Background The aim of this network meta‐analysis (NMA) was to evaluate the efficacy and safety of PD‐1/PD‐L1 inhibitors, alone or in combination with chemotherapy, as first‐line treatment for wild‐type advanced non‐small cell lung cancer. Methods We systematically searched databases, Clinical Trial.gov and included randomized clinical trials focusing on advanced NSCLC using PD‐1/PD‐L1 inhibitors as first‐line treatment. Hazard ratio for overall survival and progression‐free survival, odds ratio for any‐cause high‐adverse events (grade 3 or higher) were documented according to Bayesian NMA. Subgroup analysis was performed according to PD‐L1 level and histology. Results Thirteen trials including 9154 patients were included. In the PD‐L1 nonselective cohort, chemotherapy in combination with pembrolizumab and atezolizumab, respectively, were significantly better than any other treatment strategies in both OS benefit (HR = 0.63; HR = 0.85) and PFS benefit (HR = 0.52; HR = 0.63). In subgroup analysis, pembrolizumab appeared to provide the best OS benefit (HR = 0.67) as well as the best PFS benefit (HR = 0.67) in the PD‐L1 ≥ 50% cohort. In contrast, pembrolizumab combined with chemotherapy exhibited the best OS benefit in the PD‐L1

Background Epidermal growth factor receptor (EGFR) gene mutation status is essential to the optimal management of lung adenocarcinoma. Liquid biopsy has advantages such as noninvasiveness, speediness, and convenience. This study aimed to detect EGFR gene mutations using next‐generation sequencing (NGS) from different types of body fluids from patients with lung adenocarcinoma. Methods This was a prospective study of 20 patients with lung adenocarcinoma recruited between January 2017 and December 2018 at the Beijing Hospital. All patients had adenocarcinoma with confirmed sensitizing EGFR mutations. Body fluid specimens included pleural effusion, ascites, pericardial effusion, and cerebrospinal fluid. NGS was conducted to test for nine lung cancer‐related gene in body fluid supernatant free DNA, sedimentary tumor cells, and plasma free DNA. Results The EGFR gene mutation abundance of body fluid supernatant free DNA was higher than that of body fluid sedimentary tumor cells and plasma free DNA specimens (100% vs. 90% vs. 80%, respectively, all P

Acquired resistance inevitably occurs after initial treatment with first-generation EGFR-tyrosine kinase inhibitors (TKIs). Several mechanisms have been identified, including EGFR T790M mutation and HER2 amplification. Herein, we present the case of a patient who progressed on first-generation EGFR-TKIs and developed EGFR T790M mutation, HER2 amplification, and HER2 mutation. The administration of single-agent osimertinib yielded an inconsistent response, with worsened pleural effusion and a reduction to lung metastases, but remarkably, a partial response was achieved after four weeks of treatment with combined osimertinib and afatinib, with grade 1 rash and grade 2 diarrhea. Our findings indicate an overlap of T790M, HER2 amplification, and HER2 mutation, which is rarely reported. Moreover, HER2 mutation was identified during the development of resistance, suggesting that HER2 mutation may cause resistance to first-generation EGFR-TKIs.

Background Elderly patients are under-represented in studies of pure ground-glass opacity (pGGO) nodules; thus, this study analyzed the growth pattern and clinical outcomes of pGGO nodules in the elderly in order to help make treatment decisions. Methods We retrospectively reviewed patients aged over 60 years with screening-detected and pathologically confirmed growing focal pGGO nodules. Results During the study period, 858 subjects had undergone at least three low-dose computed tomography scans in our center. Twenty patients were treated for growing focal pGGO nodules. The median age at detection was 66 years (range: 60-80). The median time to an increase of at least 2 mm was 348 days (range: 98-1527) and to develop a solid portion, 1141 days (range: 480-3010). Seven patients had surgery for increased nodule size, four had surgery immediately after the solid portion appeared, and nine were treated after a median follow-up of 1153 days (range: 240-2342) since the solid portion developed. The median size of the solid component was 8 mm (2-13) before surgery. No recurrence was observed after a median follow-up of 41 months. Pathology revealed adenocarcinoma in situ in five patients, and minimally invasive or invasive adenocarcinoma in the remainder. The appearance of a solid portion was significantly associated with invasive adenocarcinoma compared to increased size alone (100% vs. 44.4%; P = 0.005). Conclusions pGGO nodules had an indolent growth pattern and good prognosis in our patient sample, even after the appearance of a solid portion. Therefore, minimally invasive surgery after the development of a solid component may be an option for the elderly.

Background Elderly patients are under‐represented in studies of pure ground‐glass opacity (pGGO) nodules; thus, this study analyzed the growth pattern and clinical outcomes of pGGO nodules in the elderly in order to help make treatment decisions. Methods We retrospectively reviewed patients aged over 60 years with screening‐detected and pathologically confirmed growing focal pGGO nodules. Results During the study period, 858 subjects had undergone at least three low‐dose computed tomography scans in our center. Twenty patients were treated for growing focal pGGO nodules. The median age at detection was 66 years (range: 60–80). The median time to an increase of at least 2 mm was 348 days (range: 98–1527) and to develop a solid portion, 1141 days (range: 480–3010). Seven patients had surgery for increased nodule size, four had surgery immediately after the solid portion appeared, and nine were treated after a median follow‐up of 1153 days (range: 240–2342) since the solid portion developed. The median size of the solid component was 8 mm (2–13) before surgery. No recurrence was observed after a median follow‐up of 41 months. Pathology revealed adenocarcinoma in situ in five patients, and minimally invasive or invasive adenocarcinoma in the remainder. The appearance of a solid portion was significantly associated with invasive adenocarcinoma compared to increased size alone (100% vs. 44.4%; P = 0.005). Conclusions pGGO nodules had an indolent growth pattern and good prognosis in our patient sample, even after the appearance of a solid portion. Therefore, minimally invasive surgery after the development of a solid component may be an option for the elderly.