Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Diagnostic Algorithms

Keywords: Diagnosis; lung cancer; mind mapping; molecular; staging Summary of Key Points Mind maps are used as a tool to illustrate the principles involved in the diagnostic evaluation of a patient with known or suspected lung cancer. Addressed are factors important in establishing the diagnosis and defining the extent of disease; the histologic and molecular classifications of lung cancer; and the potential role for repeat biopsy…

The Role of Health Services Research in Improving the Outcomes for Patients With Lung Cancer

Summary of Key Points Health services research aims to improve the outcomes to treatment for lung cancer by optimizing the accessibility, quality, and efficiency of treatment programs. Achieving optimal outcomes for patients with lung cancer requires that every patient should receive optimal treatment, but many patients today do not receive optimal treatment or experience optimal outcomes. Deviations from optimal treatment may be due to resource limitations…

The Role of Advocacy Groups in Lung Cancer

Summary of Key Points † Deceased. To describe the functions of advocacy. To describe how lung cancer advocacy groups accomplish their goals. To describe how they can influence lung cancer outcomes. Advocacy is defined as the act or process of supporting a cause or proposal. Effective advocates in the health-care field influence disease awareness and education, research and drug development, public policy, and legislative and governmental…

How to Promote and Organize Clinical Research in Lung Cancer

Summary of Key Points Despite two decades of progress, the prognosis for patients with lung cancer remains poor. Therefore forming new hypotheses and conducting clinical trials to investigate this patient population are still important. Accordingly, in the past 25 years, the number of clinical trials involving patients with lung cancer has increased dramatically ( Fig. 60.1 ); however, only a minority of these trials have been…

Clinical Trial Methodology in Lung Cancer : Study Design and End-Point Considerations

Summary of Key Points Lung cancer is increasingly understood at the molecular level; N-of-1 trials are becoming more relevant with the use of biomarker assessment and targeted therapies. The failure of promising agents in randomized studies has prompted reconsideration of the standard dose-finding paradigm in early phase trials, with the recognition that improved drug development strategies for single agents and combination therapies are required. The choice…

The Role of Palliative Care in Lung Cancer

Summary of Key Points The best palliative outcomes are obtained when palliative care is involved early in advanced lung cancer. Integration of palliative care early in the advanced cancer patient has important health utilization and economic outcomes besides patient-related outcomes. Supportive oncology and palliative care are not the same. Supportive oncology involves therapies to treat or minimize anticancer therapy toxicity. There is in general a misunderstanding…

Lung Cancer Emergencies

Summary of Key Points The main oncologic emergencies most germane and specific to lung cancer are central airway obstruction, massive hemoptysis, and massive pleural effusion. Central airway obstruction due to lung cancer is traditionally classified as exophytic (intraluminal tumor), extrinsic (compression of the airway by tumor within or external to the wall of the airway), or mixed. Treatment of central airway obstruction generally correlates with the…

Thymic Tumors

Summary of Key Points Thymic tumors are rare malignancies and represent a wide array of tumors. Histologic classification distinguishes three separate entities: thymomas, thymic carcinomas, and neuroendocrine thymic tumors. Thymomas are characterized by variability in histologic appearance as well as in clinical behavior. Systemic paraneoplastic syndromes occur in almost 40% of patients, with myasthenia gravis being the most commonly reported. Patients with thymoma have an increased…

Neuroendocrine Tumors of the Lung Other Than Small Cell Lung Cancer

Summary of Key Points Neuroendocrine cancers of the lung share some fundamental pathology features but span a broad range of clinical behaviors. The clinical behavior varies with the degree of differentiation: typical carcinoids are more indolent and localized, atypical carcinoids are intermediate and tend to spread systemically, and large cell neuroendocrine cancers are high grade and aggressive similar to small cell cancers. Unlike midgut carcinoids, bronchial…

Mediastinal Tumors

Summary of Key Points Knowledge of the anatomy of the mediastinum is critical to establishing the differential diagnosis and choosing the best diagnostic and therapeutic interventions. A wide variety of possible etiologies must be considered including solid and lymphatic malignancies, benign cysts, and benign neoplasms. Computed tomography (CT) and magnetic resonance imaging (MRI) are essential tools for the diagnosis and planning of surgical approach and choice…

Malignant Mesothelioma

Summary of Key Points Development of malignant mesothelioma is usually associated with asbestos exposure. The most common genetic alterations in mesothelioma are deletion of CDKN2A/ARF , inactivation of NF2 , and mutation or deletion in BAP1. The eighth edition of the American Joint Commission on Cancer/Union for International Cancer Control staging manual has altered the T and N components for staging from the previous edition. Clinical,…

Treatment of Extensive-Stage Small Cell Lung Cancer

Summary of Key Points Performance status is universally recognized as an independent prognostic factor and typically correlates with the extent of tumor burden. As first-line therapy, platinum agent plus etoposide or irinotecan remains the standard of care for the treatment of small cell lung cancer (SCLC). The ideal number of chemotherapy cycles for SCLC has not been defined; however, four to six cycles are considered the…

Adjuvant and Neoadjuvant Chemotherapy for Early-Stage Nonsmall Cell Lung Cancer

Summary of Key Points Surgery remains the most effective curative approach for early-stage (IA–IIB) NSCLC. Selected cases with clinical stage IIIA disease equally benefit from radical resection. Stereotactic radiotherapy may be an alternative for selected medically inoperable patients. Long-term survival after surgical resection is stage-related, with the likelihood of recurrence increasing with advancing cancer stage (of course this is what staging is all about). Two comprehensive…

Immunotherapy and Lung Cancer

Summary of Key Points Immunotherapy has entered a new era in lung cancer and is rapidly changing the standard of care. Vaccines as monotherapies have shown marginal efficacy in certain settings. Program death-1 (PD1) and PD1 ligand (PDL1) inhibitors have showed marked and durable responses for a broad subset of lung cancer patients with overall survival rates that far exceed what has been seen with chemotherapy.…

Management of Toxicities of Targeted Therapies

Summary of Key Points Epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), BRAF, C-ros oncogene 1 (ROS1), ret proto-oncogene (RET) tyrosine kinase inhibitors (TKIs), several antiangiogenesis agents, and antiprogram death 1 (anti-PD1) immunotherapy are effective targeted treatments for lung cancer patients. Each class of agents has class side effects. In addition, each drug may have its own unique side effects. Dermatologic and gastrointestinal side effects…

New Targets for Therapy in Lung Cancer

Summary of Key Points Treatment of lung cancer is rapidly evolving. Large cell carcinomas as a group have therapeutically relevant driver mutations in nearly 40% of cases. Despite the recent failures of some agents, in 2015 the US Food and Drug Administration issued seven approvals of agents for the treatment of lung cancer. Many additional promising agents that target several aberrant signaling pathways are under development.…

Pharmacogenomics in Lung Cancer: Predictive Biomarkers for Chemotherapy

Summary of Key Points Discussed are tumor factors that affect treatment responses and outcome and host genetic elements that affect drug metabolism. Only pharmacogenomics elements that interact with chemotherapeutic agents are described. Prognostic biomarkers describe a specific tumor characteristic that allows for dichotomization of a cohort of patients into different groups based on an outcome that is independent of the treatment rendered. How biomarkers are measured…

Maintenance Chemotherapy for Nonsmall Cell Lung Cancer

Summary of Key Points Maintenance therapy offers the possibility of continued active treatment to delay disease progression and symptom deterioration and, more importantly, improved overall survival of patients with advanced nonsmall cell lung cancer (NSCLC) already treated with induction chemotherapy. The target population for maintenance are patients who achieved objective response or disease stabilization with induction chemotherapy with minimal cumulative toxicity. Meta-analyses and patients’ preference support…

Systemic Options for Second-Line Therapy and Beyond

Summary of Key Points There are a growing proportion of patients who are candidates for second-line therapy and beyond. Treatment choices are dictated by tumor histology, molecular phenotype (e.g., EGFR , ALK , ROS1 , etc.), and components of frontline chemotherapy including also the use of maintenance and bevacizumab. In patients with no actionable molecular targets, several options are available that include chemotherapy (docetaxel, pemetrexed), epidermal…

Frontline Systemic Therapy Options in Nonsmall Cell Lung Cancer

Summary of Key Points The determination of tumor histology in nonsmall cell lung cancer (NSCLC) has become essential in treatment decision-making due to differential efficacy and toxicities seen with newer therapies. International Association for the Study of Lung Cancer (IASLC) guidelines recommend testing all patients with lung adenocarcinoma for both EGFR mutations and ALK rearrangements. Further molecular profiling of both adenocarcinoma and squamous cell lung cancers…