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Ionizing radiation therapy (RT) acts through the generation of reactive oxygen species (ROS) and the consequent formation of lethal double-strand DNA breaks. Time-restricted diet (TRD), popularly known as intermittent fasting, may reduce ROS generated during physiologic mitochondrial respiration, the largest intracellular source of ROS in normal tissues. TRD mitigates intracellular and systemic ROS production pre-clinically and both reduces hematologic toxicity and improves pathologic complete response during chemotherapy in prospective Phase II studies. We hypothesize that compared to patients receiving routine dietary counseling, TRD can mitigate DNA damage in peripheral blood mononuclear cells (PBMCs) and normal-tissue toxicity during pelvic RT. This single-institution, open-label, phase II randomized clinical trial, approved by the City of Hope Institutional Review Board, will enroll 48 patients receiving pelvic RT to dietary counseling or TRD (1:1). Patients age > 18 and ECOG 0-2 receiving curative-intent RT or chemo-RT for high-risk/node-positive or biochemically recurrent prostate cancer, locally advanced cervical cancer or locally advanced rectal cancer are eligible. Exclusion criteria include prior pelvic RT, BMI <21, pregnancy, insulin-dependent diabetes, and current adherence to a macronutrient or calorically restricted diet. On days of RT, patients randomized to TRD fast for a minimum of 14 hours (from 6-8 hours before until 4-6 hours after RT). All patients meet with a registered dietician with 20+ years of experience in radiation oncology to discuss preventative dietary recommendations without macronutrient or caloric restrictions. Patients are offered weekly meetings with the dietician during RT and receive on-demand dietary education through the Oncpatient Companion mobile phone application, which also collects food frequency questionaries and quality of life surveys. Blood, urine, and stool are collected (pre-RT, Day 1, Day 12, and Day 25 of RT, and at 12/24/52 weeks post-RT). Toxicity (CTCAEv5.0) and quality of life surveys i.e. EORTC-PR25 (prostate cancer), EORTC-CX24 (cervical cancer), and EORTC-CR29 (rectal cancer) are collected at the same time points. The primary endpoint is to compare accumulated DNA damage in PBMCs after pelvic RT between the two arms and to determine the feasibility and tolerability of TRD during pelvic RT. Secondary endpoints include clinical toxicity and patient-reported quality of life. Exploratory outcomes include progression-free survival, serum cytokine levels, stool microbiota diversity and urine DNA adducts. TBD TBD [ABSTRACT FROM AUTHOR]

Treatment logistics and symptom-directed care recommendations during radiation therapy can be complex and difficult for new patients to understand and remember. We developed a mobile application intended to be an accessible educational and clinical resource for patients during radiation treatment. This pilot study evaluated utility and usability of the mobile application to obtain feedback for future more widely distributed iterations. The mobile application was developed as part of a three-phase prospective study, with the first phase consisting of a patient needs assessment and the second phase consisting of initial testing by radiation oncologists. These phases informed the development of the version of the application deployed in the third phase, in which a pilot study was performed among patients undergoing radiation treatment. Patients undergoing radiation at a single academic institution were recruited to download the mobile application and test it during their radiation course. The app included information about the logistics and goals of radiation treatment, side effect prophylaxis and management, and automated reminders for recommended symptom management regimens (e.g., twice daily use of skin creams). Upon completion of treatment, patients answered a 13-question survey consisting of questions scored on a 5-point Likert scale and free response questions. Items from both surveys were tabulated in summary statistics. Relationships between respondent demographics and survey responses were analyzed by univariate logistic regression (UVA). 20 patients were accrued between 11/2022 and 1/2024. All patients successfully installed the application and completed radiation treatment. To date 18 (90%) have filled out the post-treatment survey. The median age of participants was 66 (range = 41-77). Most patients were male (85%), non-Hispanic white (55%), and used the application on Apple devices (85%). Head and neck (40%) and genitourinary (40%) were the most treated sites. Most users were either very comfortable (44.4%) or somewhat comfortable (27.8%) with technology. 55.6% used the application at least "almost daily". 100% were satisfied with the application and 94.4% would recommend the application to other patients. 66.7%, 72.2%, and 66.7% of patients stated the application helped them manage side effects, remember to use recommended treatments, and understand radiation, respectively. No patient or clinical features were associated with survey responses on UVA. Based on survey responses, use of the mobile application in patients is feasible and it represents a useful tool for patients receiving radiation treatment. Benefits include helping to remind patients to adhere to recommended treatment regimens to reduce or mitigate treatment toxicity. Further development, integration, and testing in a larger group of patients with more diverse demographics and treatment sites is planned. [ABSTRACT FROM AUTHOR]

The CheckMate 816 trial established a new standard of care for patients with resectable stage IB-IIIA NSCLC with the use of induction chemo-immunotherapy followed by surgery. However, only 83% of patients who received induction chemo-immunotherapy ultimately underwent surgery. Despite this, several case reports have suggested using induction chemo-immunotherapy to convert initially unresectable disease (cN3 or stage IIIB-C) to be resectable. The purpose of this study was to determine the relative likelihood of receiving post-induction surgery based on patient demographics and initial extent of disease. Retrospective data was obtained from the National Cancer Database (NCDB) for patients diagnosed with NSCLC between 2017 (FDA approval of immune checkpoint inhibitors for NSCLC) to 2021. Patients were included if they had clinical stage IB-III disease and received upfront chemo and immunotherapy simultaneously <90 days from diagnosis. Patients were classified to have received post-induction surgery if they received radical surgery >90 days from diagnosis. Linear regression was used to examine temporal trends in induction chemo-immunotherapy usage. Binary logistic regression was used to examine predictors for not receiving surgery in this population. Out of 88656 patients with stage IB-III NSCLC, only 2136 (2.4%) patients received induction chemo-immunotherapy between 2017-2021. Usage of Induction chemo-immunotherapy increased significantly from 2017 (0.7%, N = 151/20028) to 2021 (5.3%, N = 842/15962) (slope = 1.02%/year, R2 = 0.87, p = 0.02). Out of the 2136 patients who received induction chemo-immunotherapy, only 584 (27.3%) patients ultimately underwent surgery. On univariate analysis, age ≥65 (p = 0.10), higher clinical N stage (p<0.01), and higher clinical group stage (p<0.01) were negatively associated with receiving surgery. Gender, race, Charlson Deyo comorbidity index, tumor histology, and clinical T stage were not significantly associated with receipt of surgery. On multivariate analysis, factors associated with not receiving surgery included age ≥65 vs. <65 (OR 0.60, 95% CI 0.40-0.90, p = 0.01), cN3 vs. cN0 (OR 0.15, 95% CI 0.04-0.52, p<0.01), clinical stage IIIA vs. IB-IIA (OR 0.41, 95% CI 0.18-0.92, p = 0.03), and clinical stage IIIB-C vs. IB-IIA (OR 0.14, 95% CI 0.05-0.38, p<0.01). Age ≥65, cN3, and stage III disease were all negative predictors for receiving surgery following induction chemo-immunotherapy. Patients with cN3 and stage IIIB-C disease had the lowest likelihood of receiving surgery afterwards (OR <0.15), suggesting induction chemo-immunotherapy should not be used to try to convert initially unresectable disease to be resectable. For patients ≥65 years old or with stage IIIA disease, more scrutiny should be used when deciding between the CheckMate vs. PACIFIC regimen since these patients also have a lower likelihood of receiving surgery after induction chemo-immunotherapy. [ABSTRACT FROM AUTHOR]

Definitive treatment for head and neck (H&N) cancers is associated with marked toxicity. Older adults represent a population in which toxicity may be more pronounced. Data regarding impact of treatment on geriatric domains are lacking and could guide efforts of early supportive interventions. This is a prospective, longitudinal, observational pilot study collecting comprehensive geriatric assessment (CGA), and quality of life (QoL) measures from older patients (≥65 years) with non-metastatic H&N cancer treated with definitive concurrent chemoradiation (CRT) or upfront surgery (S) followed by adjuvant RT ± chemotherapy. Descriptive statistics (mean [SD]) were used to summarize CGA scores and domains and QoL measures. Using linear mixed models, the study examined change across three time points (baseline [BL], 1-month [mo] post-treatment, and 6 mo post-treatment). 13 patients (12 male) were enrolled. 4 patients underwent upfront surgery (all oral cavity cancer [3 stage II, 1 stage IVB]). 9 patients (2 oral cavity cancer [stage III], 4 oropharynx cancer [2 stage I and 2 stage III], 1 salivary gland [stage III], 1 nasopharynx [stage III], and 1 larynx [stage I]) received CRT. Significant declines in activities of daily living (ADL), instrumental ADL, mental health index (MHI), self-reported Karnofsky performance status (KPS), social activity and QoL were observed from BL to 1 mo post-adjuvant therapy, followed by recovery at 6 mo post-treatment for S patients. Patients undergoing CRT did not exhibit significant fluctuations in CGA or QoL measures. *1 month vs BL P < 0.05 ∼1 month vs 6 Month P < 0.05 Older H&N cancer patients undergoing upfront surgery but not CRT show a significant temporary decline in functional status, physical activity, and QoL, with recovery six mo post-treatment. These data highlight the need for CGA and tailored interventions to support recovery and QoL. Further research with a larger cohort is needed to confirm these findings and guide clinical practice. [ABSTRACT FROM AUTHOR]

Treatments for prostate cancer (PCa) can profoundly impact sexual health (SH). Previous studies have found that PCa patients (pts) are concerned about their SH as a consequence of treatment. Discussing and addressing these concerns upfront can help set appropriate expectations and impact treatment decisions. Limited studies have explored if SH concerns are adequately addressed by their oncologists. There is presently a lack of understanding of how to best address these concerns. This was a survey study of pts with newly diagnosed, treatment-naïve, PCa to characterize their SH concerns and identify opportunities to facilitate discussions with oncologists. Anonymous surveys were administered to pts from a comprehensive cancer center and its network sites. Pts were approached by our study team or self-recruited via flyers posted in our clinics during follow-up or consultation related to PCa treatment. Demographics such as age, sexual orientation, and race/ethnicity were collected. Baseline sexual functions were assessed using International Index of Erectile Function. Pts were asked to rate statements about their SH concerns on a 6-point Likert scale ranging from "strongly disagree" to "strongly agree". Respondents were also asked to evaluate their past discussions with their oncologists. Demographics and survey results were summarized using descriptive statistics. This study was approved by our institution's review board. From Dec 2023 to Feb 2024, a total of 36 pts participated in the study during this period, 25 (69%) pts met the screening criteria (i.e., excluded due to prior treatments) and proceeded to the actual survey. Of the 25 pts, the median age was 70 (range = 52 to 83) years. A majority identified as (non-Hispanic) White (44%), heterosexual (91%), married/living with a partner (92%), and college-educated or higher (68%). Sixteen (64%) reported that they were currently sexually active, with 44% reporting some degree of satisfaction with their overall sex life. Only four (16%) pts reported having had prior SH conversations with their oncologists, and among these, the majority (75%) were satisfied with their discussions. A sizeable number of pts reported some degree of concern about the cancer treatment's impact on their sexual performance (56%), libido (48%), erectile function (56%), and ability to satisfy their partner(s) (48%). The largest percentage (48%) of pts cited conversations with their oncologists as their preferred method of learning more about the impact of treatment on SH; others preferred educational brochures (32%) or referrals to SH specialists (20%). In this survey study, we found that SH concerns are common among patients with newly diagnosed PCa. Only a small percentage of pts have had discussions about SH with their oncologists, but many would like to discuss SH with their oncologists, suggesting an unmet need in care. [ABSTRACT FROM AUTHOR]

Introduction: Biology-guided radiotherapy (BgRT) is a novel radiation delivery approach utilizing fluorodeoxyglucose (FDG) activity on positron emission tomography (PET) imaging performed in real-time to track and direct RT. Our institution recently acquired the RefleXion X1 BgRT system and sought to assess the feasibility of targeting metastatic sites in various organs, including the liver. However, in order for BgRT to function appropriate, adequate contrast in FDG activity between the tumor and the background tissue, referred to as the normalized SUV (NSUV), is necessary for optimal functioning of BgRT., Methods: We reviewed the charts of 50 lung adenocarcinoma patients with liver metastases. The following variables were collected: SUVmax and SUVmean for each liver metastasis, SUVmean and SUVmax at 5 and 10 mm radially from the lesion, and NSUV at 5 mm and 10 mm (SUVmax of the liver metastasis divided by SUV mean at 5 mm at 10 mm respectively)., Results: 82 measurable liver metastases were included in the final analysis. The average SUVbackground of liver was 2.26 (95% confidence interval [CI] 2.17-2.35); average SUVmean for liver metastases was 5.31 (95% CI 4.87-5.75), and average SUVmax of liver metastases was 9.19 (95% CI 7.59-10.78). The average SUVmean at 5 mm and 10 mm radially from each lesion were 3.08 (95% CI 3.00-2.16) and 2.60 (95% CI 2.52-2.68), respectively. The mean NSUV at 5 mm and 10 mm were 3.13 (95% CI 2.53-3.73) and 3.69 (95% CI 3.00-4.41) respectively. Furthermore, 90% of lesions had NSUV greater than 1.45 at 5 mm and greater than 1.77 at 10 mm., Conclusions: This is the first study to comprehensively characterize FDG contrast between the liver tumor and background, referred to as NSUV. Due to the high background SUV normally found in the liver, this work will be valuable for guiding optimization of BgRT for treating liver metastases in the future using the RefleXion ® X1 and potentially other similar BgRT platforms., (© 2024. The Author(s).)

Purpose: Limited studies have described the utilization of cannabinoids among patients with cancer. This survey study aimed to characterize utilization patterns and perceptions of cannabinoid use for treatment-related side effects among patients receiving radiation treatment., Methods and Materials: This was an anonymous survey study of patients who were undergoing or recently completed radiation treatment at a comprehensive cancer center. Data on cannabinoid use during cancer treatment, reasons for the use of cannabinoids, perceived effects of cannabinoids, and formulations of usage were collected and summarized using descriptive statistics., Results: Of the 431 respondents, 111 (25.8%) patients reported cannabinoid use since their cancer diagnosis. Among the cannabinoid users, a majority (73.9%) experienced improvement in symptoms; 38.7% had better relief of cancer-treatment symptoms from cannabinoids in comparison to their prescription medications, and 16.2% lowered the amount of prescription pain medications needed after using cannabinoids. Cannabinoids appeared to be most effective in helping patients manage sleep (76.6%) and anxiety (72.1%). When asked about whether physicians should be discussing cannabinoid use, 45.1% of cannabinoid users wanted to speak with their doctors regarding its utilization. For patients who did not report cannabinoid use, a large majority (83.1%) never had discussions with their doctors regarding its utilization as part of their cancer care, and 34.8% wanted to learn more about cannabinoids from their doctors., Conclusions: About 1 in 4 patients with cancer reported cannabinoid use to assist in symptom control. A majority had subjective alleviation of treatment-related symptoms from cannabinoid use. Regardless of cannabinoid use, a sizable percentage of patients never had any discussions about cannabinoids with their oncologists, with some expressing interest in learning more. Guidelines are needed to assist radiation oncologists on how cannabinoids may play a role in caring for patients., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Durvalumab improves survival when used as consolidation therapy after chemoradiation (CRT) in patients with stage III NSCLC. The optimal consolidation therapy for patients with EGFR-mutant (EGFRmut) stage III NSCLC remains unknown., Methods: In this multi-institutional, international retrospective analysis across 24 institutions, we evaluated outcomes in patients with stage III EGFRmut NSCLC treated with concurrent CRT followed by consolidation therapy with osimertinib, durvalumab, or observation between 2015 and 2022. Kaplan-Meier method was used to estimate real-world progression-free survival (rwPFS, primary end point) and overall survival (secondary end point). Treatment-related adverse events (trAEs) during consolidation treatment were defined using Common Terminology Criteria for Adverse Events version 5.0. Multivariable Cox regression analysis was used., Results: Of 136 patients with stage III EGFRmut NSCLC treated with definitive concurrent CRT, 56 received consolidation durvalumab, 33 received consolidation osimertinib, and 47 was on observation alone. Baseline characteristics were similar across the three cohorts. With a median follow-up of 46 months for the entire cohort, the median duration of treatment was not reached (NR) for osimertinib (interquartile range: NR-NR) and was 5.5 (interquartile range: 2.4-10.8) months with durvalumab. After adjusting for nodal status, stage III A/B/C, and age, patients treated with consolidation osimertinib had significantly longer 24-month rwPFS compared to those treated with durvalumab or in the observation cohorts (osimertinib: 86%, durvalumab: 30%, observation: 27%, p < 0.001 for both comparisons). There was no difference in rwPFS between the durvalumab and the observation cohorts. No significant difference in overall survival across the three cohorts was detected, likely due to the limited follow-up. Any-grade trAE occurred in 52% (2 [6.1%] grade ≥3) and 48% (10 [18%] grade ≥3) of patients treated with osimertinib and durvalumab, respectively. Of 45 patients who progressed on consolidation durvalumab, 37 (82%) subsequently received EGFR tyrosine kinase inhibitors. Of these, 14 (38%) patients developed trAEs including five patients with pneumonitis (14%; 2 [5.4%] grade ≥3) and five patients with diarrhea (14%; 1 [2.7%] grade ≥3)., Conclusions: This study suggests that among patients with stage III unresectable NSCLC with a sensitizing EGFR mutation, consolidation osimertinib was associated with a significantly longer rwPFS compared to durvalumab or observation. No unanticipated safety signals were observed with consolidation osimertinib., Competing Interests: Disclosure Dr. Nassar receives honoraria from OncLive, TEMPUS, and Korean Society for Medical Oncology and consulting fees from Guidepoint Global. Dr. Kim is on the advisory board for Amgen. Dr. Shepherd reports having stock and other ownership interests from Eli Lilly and AstraZeneca; receiving honoraria from AstraZeneca, Merck Serono, Takeda, and Daiichi Sankyo; having consulting/advisory role at AstraZeneca and Merck Serono; and receiving research funding from Eli Lilly (inst), Pfizer (inst), Bristol-Myers Squibb (inst), AstraZeneca/MedImmune (inst), and Roche Canada (inst). Dr. Gray reports receiving grants from AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Genentech, G1 Therapeutics, Ludwig Institute of Cancer Research, Merck & Co., Inc., Novartis, and Pfizer; receiving consulting fees from AbbVie, AstraZeneca, Blueprint Medicines, EMD Serono, Gilead Sciences, Inc., Janssen Scientific Affairs, LLC, Jazz Pharmaceuticals, Loxo Oncology Inc., Merck & Co., Inc., Novartis, OncoCyte Biotechnology, Spectrum ODAC, Takeda Pharmaceuticals, and Triptych Health Partners; and having leadership role as SWOG Lung Committee Chair, IASLC Board of Director member, and ASCO Education Committee Ex-Chair. Dr. Dilling reports receiving consulting fees from AstraZeneca and support for travel from NCCN. Dr. Neal reports receiving grants from Genentech/Roche, Merck, Novartis, Boehringer Ingelheim, Exelixis, Nektar Therapeutics, Takeda Pharmaceuticals, Adaptimmune, GlaxoSmithKline, Janssen, AbbVie, and Novocure; receiving consulting fees from AstraZeneca, Genentech/Roche, Exelixis, Takeda Pharmaceuticals, Eli Lilly and Company, Amgen, Iovance Biotherapeutics, Blueprint Pharmaceuticals, Regeneron Pharmaceuticals, Natera, Sanofi/Regeneron, D2G Oncology, Surface Oncology, Turning Point Therapeutics, Mirati Therapeutics, Gilead Sciences, AbbVie, Summit Therapeutics, Novartis, Novocure, Janssen Oncology, and AnHeart Therapeutics; and receiving honorarium from CME Matters, Clinical Care Options CME, Research to Practice CME, Medscape CME, Biomedical Learning Institute CME, MLI Peerview CME, Prime Oncology CME, Projects in Knowledge CME, Rockpointe CME, MJH Life Sciences CME, Medical Educator Consortium, and HMP Education. Dr. Wakelee reports receiving grants from Arrys Therapeutics Research, AstraZeneca/Medimmune, Bristol-Myers Squibb, Genentech/Roche, Merck, Helsinn, Seagen, and Xcovery; and serving on the advisory board of Mirati (compensated)—ended November 2022, IOBiotech (compensated)—October 2023, Merck (NOT compensated), and Genentech/Roche/Bristol-Myers Squibb/AstraZeneca (NOT compensated). Dr. S.H. Lin reports receiving grants from STCube Pharmaceuticals, Beyond Spring, and Nektar Therapeutics; consulting fees from XRAD Therapeutics; serving on the advisory board of AstraZeneca; having stock/stock options from Apple, Google, Amazon, Tesla, Meta, Rivian, and CreatvMicrotech; and having other support from SEEK Diagnostics (co-founder). Dr. Patil reports receiving grants from Gilead Research Scholars and LUNGevity Foundation Award; consulting fees from AstraZeneca, Boehringer Ingelheim, Bicara, Daiichi, Janssen, Jazz Pharmaceuticals, Mirati Therapeutics, Pfizer, Sanofi, Regeneron, Roche/Genentech, Takeda, Gilead Research Scholars, and LUNGevity Foundation Award; and honorarium from Janssen. Dr. Bar reports receiving grants from Merck Sharp & Dohme, AstraZeneca, Roche, Bristol-Myers Squibb, Takeda, AbbVie, Bayer, Boehringer Ingelheim, and Pfizer; receiving consulting fees from AstraZeneca, Merck Sharp & Dohme, Boehringer Ingelheim, Roche, Bristol-Myers Squibb, Takeda, AbbVie, Pfizer, Bayer, and VBL; and having leadership role from Lung Ambition Consortium, Israel Lung Cancer Group, and IASLC committee. Dr. Marron receives grants from Regeneron, Bristol-Myers Squibb, Merck, Boehringer Ingelheim, NCI, and Cancer Research Institute; and serving on the advisory board of AbbVie, Celldex, and Rockefeller University. Dr. Yu receives grants/contracts from AstraZeneca, Pfizer, Daiichi Cullinan Oncology, Janssen, Novartis, Blueprint med, Black Diamond, and Systimmune and consulting fees from AstraZeneca, Daiichi, Taiho, Takeda, Janssen, Amgen, AbbVie, Novocure, and Ipsen. Dr. Owen receives grants/contracts from Bristol-Myers Squibb, Merck, Palobiofarma, Genentech, Onc.AI, and Pfizer; and travel support from Amgen, AstraZeneca, and Genentech. Rocha receives grants/contracts from SEOM, ESMO Fellowship, and AECC; and travel support from Merck Sharp & Dohme, AstraZeneca, and Bristol-Myers Squibb. Dr. Arriola receives grants/contracts from AstraZeneca and Bristol-Myers Squibb; honorarium from Eli Lilly, AstraZeneca, Roche, Takeda, Merck Sharp & Dohme, Pfizer, Janssen, and Bristol-Myers Squibb; and travel support from AstraZeneca, Roche, and Pfizer. Dr. Cheng receives grants/contracts from AstraZeneca and Genentech; and serving on the advisory board of Janssen, G1 Therapeutics, and AstraZeneca. Dr. Parikh receives consulting fees from Jazz Pharmaceuticals, Guardant Health, and AstraZeneca; and honorarium from MJH Life Sciences. Dr. Harris receives grants/contract from NIH P30CA062203, the UC Irvine Comprehensive Cancer Center using UCI Anti-Cancer Challenge Grant, and ACS Seed Grant 129801-IRG-16-187-13-IRG; and serving on the advisory board of UC Irvine as DSMB member. Dr. Nagasaka receives consulting fees from Caris Life Sciences; honorarium/speaker fees from AstraZeneca, Daiichi, Novartis, EMD Serono self, Pfizer, Eli Lilly, Genentech, Regeneron, Takeda, Janssen, Blueprint, and Mirati; travel support from AnHeart Therapeutics; and stock/stock options from Mbrace Therapeutics. Dr. Valazquez receives grants/contracts from ASCO, American Association for Cancer Research (AACR), LUNGevity, NIA P30AG015272, NCI 5U54CA242646-03 Conquer Cancer and Niarchos Foundation, UCSF Clinical Practice Group, and AAMC; consulting fees from AstraZeneca, Merus, Novocure, and Cadence Communications & Research; and having stock/stock options from Corbus Pharmaceuticals. Dr. J.J. Lin receives grants/contracts from Hengrui Therapeutics, Turning Point Therapeutics, Neon Therapeutics, Relay Therapeutics, Bayer, Elevation Oncology, Roche, Linnaeus Therapeutics, Nuvalent, and Novartis; consulting fees from Genentech, C4 Therapeutics, Blueprint Medicines, Nuvalent, Bayer, Elevation Oncology, Novartis, Mirati Therapeutics, AnHeart Therapeutics, Takeda, CLaiM Therapeutics, Regeneron, Pfizer, Turning Point Therapeutics, Daiichi Sankyo, AstraZeneca, and Merus. Dr. Piotrowska receives grants/contracts from Novartis, Takeda, Spectrum, AstraZeneca, Tesaro/GlaxoSmithKline, Cullinan Oncology, Daiichi Sankyo, AbbVie, Janssen, and Blueprint; consulting fees from Taiho, Janssen, Takeda, AstraZeneca, Cullinan Oncology, C4 Therapeutics, Jazz Pharmaceuticals, and Blueprint; and honorarium from Daiichi Sankyo, Janssen, and Eli Lilly (honoraria for nonpromotional educational events). Dr. Reuss receives grants/contracts from Genentech/Roche, Verastem, Nuvalent, and LUNGevity Foundation; consulting fees from Genentech/Roche, Sanofi/Genzyme, Personalis, Guardant, AstraZeneca, Bristol-Myers Squibb, Arcus, AbbVie, Daiichi Sankyo, Catalym, Seagen, and Gilead; and honorarium from AstraZeneca and Merck. Dr. Baena Espinar receives consulting fees from AstraZeneca, Roche, and Merck Sharp & Dohme; honorarium from AstraZeneca, Roche, and Merck Sharp & Dohme; payment for expert testimony from Roche; and travel support from Roche and Janssen. Leal receives research funding to institution from Pfizer, Advaxis, and Bayer, outside the submitted work. Dr. Mak receives grants/contracts from ViewRay; consulting fees from AstraZeneca, Novartis, and Sio Capital Management; and other support from Founder of HealthAI. Dr. Naqash receives grants/contracts from SWOG Hope Foundation and FDA Broad Agency Contract; serving on the advisory board of JCO Precision Oncology; receiving travel support from SITC/American Association for Cancer Research (AACR)/Conquer Cancer Foundation/BinayTara Foundation and Foundation Med/Caris Life Sciences, and Jazz Pharmaceuticals; and funding to institution for trials from Loxo@Lilly, Surface Oncology, ADC Therapeutics, IGM Biosciences, EMD Serono, Aravive, Nikang Therapeutics, Inspirna, Exelexis, Revolution Medicine, Jacobio, Pionyr, Jazz Pharmaceuticals, NGM Biopharmaceuticals, Immunophotonics, and Selexine. Dr. Goldberg receives grants/contracts from AstraZeneca, Boehringer Ingelheim, and Mirati; and serving on the advisory board of AstraZeneca, Bristol-Myers Squibb, Amgen, Sanofi, Genzyme, Daiichi Sankyo, Regeneron, Takeda, Janssen, Summit, and Merck. The remaining authors declare no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Purpose: With increased adoption of next-generation sequencing, tailored therapy on the basis of molecular status is being delivered for patients with early-stage resectable non-small-cell lung cancer (NSCLC). The purpose of this narrative review was to focus on recent developments of targeted therapies in the adjuvant and neoadjuvant/adjuvant setting for early-stage disease., Methods: A systematic search of the MEDLINE/PubMed database was performed, focusing on studies published within the past 10 years. Our search queried "early-stage NSCLC (AND) tyrosine kinase inhibitor (TKI; OR) epidermal growth factor receptor (EGFR; OR) anaplastic lymphoma kinase ( ALK )" and was limited only to prospective and ongoing studies., Results: Most studies examining the benefit of targeted therapies in early-stage resectable NSCLC have been for EGFR-TKIs in the adjuvant setting. Currently, only one study, the ADAURA trial of adjuvant osimertinib, has demonstrated an overall survival benefit with the use of an EGFR-TKI in the adjuvant setting. Future work to build on the success of the ADAURA trial is focused on determining the optimal duration of targeted therapies and using biomarkers, such as circulating tumor DNA, to risk-stratify patients and guide maintenance targeted therapy duration., Conclusion: The results of several ongoing studies are eagerly awaited regarding the use of targeted therapies in the neoadjuvant/adjuvant setting and for more uncommon or rare mutations such as ALK , ROS proto-oncogene 1, rearranged during transfection, mesenchymal-epithelial transition factor, and B-Raf proto-oncogene V600E. The treatment landscape for early-stage NSCLC harboring actionable mutations is likely to shift dramatically in the upcoming decade.

Background: Number of metastatic sites can identify patient populations with non-small cell lung cancer (NSCLC) that benefit from aggressive therapy. Total volume of disease is also relevant. We evaluated the prognostic impact of biologically active volume of disease (BaVD) on patients with metastatic lung adenocarcinoma., Materials and Methods: Positron emission tomography/computerized tomography (PET/CT) scans from patients with newly diagnosed lung adenocarcinoma prior to starting any therapy were identified. SUV thresholds of 3 and 4 were used to auto-contour all FDG avid areas. Kaplan-Meier analysis and Cox regression were performed to examine influence on OS., Results: One hundred forty-eight patients were included in the analysis. The median BaVD when using an SUV threshold of 3 was 122.8 mL. The median BaVD when using an SUV threshold of 4 was 46.2 mL When stratified by median BaVD using an SUV of 3, median OS was higher for patients with <=122.8 mL (2.12 years) compared to patients with >122.8 mL (1.46 years) (log-rank P = .001). Similarly, when stratified by median BaVD using an SUV of 4, median OS was higher for patients with <=46.2 mL (1.91 years; 95% CI: 1.65-3.22 years) compared to patients with >46.2 mL (1.48 years; 95% CI: 1.07-1.80 years) (log-rank P = .007). On multivariable analysis, BaVD was significantly associated with OS when using an SUV threshold of 3 (HR: 20.169, P < .001) and 4 (HR: 4.117, P < .001)., Conclusion: BaVD is an important prognostic factor in metastatic lung adenocarcinoma and may aid identification of patients with limited disease who may be candidates for more aggressive therapies., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Management of lung cancer has transformed over the past decade and is no longer considered a singular disease as it now has multiple sub-classifications based on molecular markers. The current treatment paradigm requires a multidisciplinary approach. One of the most important facets of lung cancer outcomes however relies on early detection. Early detection has become crucial, and recent effects have shown success in lung cancer screening programs and early detection. In this narrative review, we evaluate low-dose computed tomography (LDCT) screening and how this screening modality may be underutilized. The barriers to broader implementation of LDCT screening is also explored as well as approaches to address these barriers. Current developments in diagnosis, biomarkers, and molecular testing in early-stage lung cancer are evaluated as well. Improving approaches to screening and early detection can ultimately lead to improved outcomes for patients with lung cancer.

Introduction: Cancer patients are increasingly incorporating medical marijuana into the management of treatment-related side effects. Currently however, data is limited regarding the risks and benefits of therapeutic cannabis for cancer patients. We sought to characterize radiation oncologists' practices and opinions regarding therapeutic cannabis via a nationwide survey., Materials and Methods: An anonymous survey was distributed via email to 873 radiation oncologists in the American Society for Radiation Oncology member database. Radiation oncologists were asked their opinions and practices regarding the use of therapeutic cannabis for their patients. Bivariate analyses of potential predictors for responses were conducted using standard statistical techniques., Results: One hundred seven radiation oncologists completed the survey. According to the survey, 36% of respondents would recommend therapeutic cannabis to their patients to mitigate treatment toxicity. Physicians practicing in states where medical marijuana is legal were more likely to recommend it compared to physicians working in states that have not legalized medical marijuana (OR = 3.79, 1.19-12.1, p = 0.01). Seventy-one percent of respondents reported therapeutic cannabis as being effective at least some of the time for managing treatment-related toxicities. Fifty-eight percent of physicians reported lacking sufficient knowledge to advise patients regarding therapeutic cannabis, while 86% of respondents were interested in learning more about therapeutic cannabis for cancer patients., Conclusions: Although a majority of radiation oncologists believe there are benefits to therapeutic cannabis, many are hesitant to recommend for or against its use. Radiation oncologists appear to be interested in learning more about how therapeutic cannabis may play a role in their patients' care., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: In 2018, durvalumab was approved by the U.S. Food and Drug Administration as consolidation immunotherapy for patients with stage III NSCLC after definitive chemoradiotherapy (CRT). However, whether durvalumab benefits patients with EGFR-mutated NSCLC remains unknown., Methods: We conducted a multi-institutional retrospective analysis of patients with unresectable stage III EGFR-mutated NSCLC who completed concurrent CRT. Kaplan-Meier analyses evaluated progression-free survival (PFS) between patients who completed CRT with or without durvalumab., Results: Among 37 patients, 13 initiated durvalumab a median of 20 days after CRT completion. Two patients completed 12 months of treatment, with five patients discontinuing durvalumab owing to progression and five owing to immune-related adverse events (irAEs). Of 24 patients who completed CRT without durvalumab, 16 completed CRT alone and eight completed CRT with induction or consolidation EGFR tyrosine kinase inhibitors (TKIs). Median PFS was 10.3 months in patients who received CRT and durvalumab versus 6.9 months with CRT alone (log-rank p = 0.993). CRT and EGFR TKI was associated with a significantly longer median PFS (26.1 mo) compared with CRT and durvalumab or CRT alone (log-rank p = 0.023). Six patients treated with durvalumab initiated EGFR TKIs after recurrence, with one developing grade 4 pneumonitis on osimertinib., Conclusions: In this study, patients with EGFR-mutated NSCLC did not benefit with consolidation durvalumab and experienced a high frequency of irAEs. Patients who initiate osimertinib after durvalumab may be susceptible to incident irAEs. Consolidation durvalumab should be approached with caution in this setting and concurrent CRT with induction or consolidation EGFR TKIs further investigated as definitive treatment., (Copyright © 2021 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.)