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Current Oncology
Special Issues
Clinical Management and Outcomes of Lung Cancer Patients
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Clinical Management and Outcomes of Lung Cancer Patients

A special issue of Current Oncology (ISSN 1718-7729). This special issue belongs to the section "Thoracic Oncology".

Deadline for manuscript submissions: 31 December 2024 | Viewed by 14613

Special Issue Editors

Dr. Jason S. Agulnik

E-Mail Website
Guest Editor
Peter Brojde Lung Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
Interests: lung cancer
Dr. Victor Cohen

E-Mail Website
Guest Editor
Peter Brojde Lung Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
Interests: clinical trials; molecularly-targeted therapy; cancer prevention; lung cancer

Special Issue Information

Dear Colleagues,

Dr. Victor Cohen and I are guest editors for an upcoming Special Issue on Clinical Management and Outcomes of Lung Cancer Patients. Lung cancer represents the most-diagnosed malignancy and the leading cause of cancer-related mortality in the world. There have been significant breakthroughs in the treatment and management of lung cancer, which have increased survival rates among patients with all stages of lung cancer. Thanks to new and novel therapies such as targeted therapies and immunotherapy, lung cancer survival has improved in all stages of disease. Treatments are now tailored to a patient’s particular type of lung cancer. These new therapeutic advancements have drastically improved patients’ conditions with better prognosis and quality of life.

With this Special Issue, we aim at obtaining an overview of the latest advancements available in the clinical management and outcomes of lung cancer patients. We welcome original research articles and reviews. We look forward to receiving your contributions. 

Dr. Jason S. Agulnik
Dr. Victor Cohen
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Current Oncology is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • targeted therapy
  • immunotherapy
  • ctDNA and NGS
  • neoadjuvant and periadjuvant
  • advanced/metastatic disease
  • mutations (EGFR, ALK, BRAF, MET, ROS1)

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Published Papers (9 papers)

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Research

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11 pages, 579 KiB  
Article
Sex-Related Differences in Immunotherapy Outcomes of Patients with Advanced Non-Small Cell Lung Cancer
by Sara Frida Cohen, Diane Cruiziat, Jeremy Naimer, Victor Cohen, Goulnar Kasymjanova, Alan Spatz and Jason Agulnik
Curr. Oncol. 2024, 31(11), 7379-7389; https://doi.org/10.3390/curroncol31110544 - 20 Nov 2024
Viewed by 337
Abstract
Background: Immunotherapy with ICIs has revolutionized the treatment for NSCLC. The impact of sex on treatment outcomes remains unclear. The aim of this study was to evaluate sex-related differences in immunotherapy outcomes in a real-world population of NSCLC patients. Methods: Demographics, clinical, pathological [...] Read more.
Background: Immunotherapy with ICIs has revolutionized the treatment for NSCLC. The impact of sex on treatment outcomes remains unclear. The aim of this study was to evaluate sex-related differences in immunotherapy outcomes in a real-world population of NSCLC patients. Methods: Demographics, clinical, pathological characteristics, and treatment-related variables were analyzed to understand the differences in efficacy and safety outcomes in relation to sex. Results: 174 advanced NSCLC patients receiving first-line ICIs, either alone or in conjunction with chemotherapy, were included. No differences based on gender were observed in PFS and OS. Prognostic factors for OS and PFS included liver metastases and CRP levels at treatment discontinuation (TD). IrAE-related TD occurred at a significantly higher rate in females. GI toxicity, including hepatitis and colitis, was predominantly observed in females, whereas pneumonitis was the most frequent irAE leading to TD in males. Conclusions: Despite no significant differences based on gender being observed in survival outcomes, our study showed that female patients with advanced NSCLC receiving ICIs are at a substantially greater risk of severe symptomatic irAEs and TD. This finding indicates that broad-based sex differences could potentially exist and emphasizes the need for further investigations into the role played by gender in immunity and cancer immunotherapy treatment. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)
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11 pages, 499 KiB  
Article
Effects of Symptom Burden on Quality of Life in Patients with Lung Cancer
by Ling-Jan Chiou, Yun-Yen Lin and Hui-Chu Lang
Curr. Oncol. 2024, 31(10), 6144-6154; https://doi.org/10.3390/curroncol31100458 - 12 Oct 2024
Viewed by 980
Abstract
Lung cancer patients suffer from numerous symptoms that impact their quality of life. This study aims to identify the symptom burden on quality of life in lung cancer patients. This survey used a structured questionnaire to collect data from 8 March 2021 to [...] Read more.
Lung cancer patients suffer from numerous symptoms that impact their quality of life. This study aims to identify the symptom burden on quality of life in lung cancer patients. This survey used a structured questionnaire to collect data from 8 March 2021 to 12 May 2021. Patient demographic information was collected. The data on symptom burden and quality of life (QOL) of patients were obtained from the QLQ-C30 and the QLQ-LC13. The stepwise multiple regression analysis was used to estimate lung cancer-related symptom burden in relation to quality of life. The study included 159 patients with lung cancer who completed the questionnaire. The mean age of the patients was 63.12 ± 11.4 years, and 64.8% of them were female. The Global Quality of Life score of the QLQ-C30 was 67.87 ± 22.24, and the top five lung cancer-related symptoms were insomnia, dyspnea, and fatigue from the QLQ-C30, and coughing and dyspnea from the QLQ-LC13. The multiple regression analysis showed that appetite loss was the most frequently associated factor for global QOL (β = −0.32; adjusted R2: 27%) and cognitive function (β = −0.15; adjusted R2: 11%), while fatigue was associated with role function (β = −0.35; adjusted R2: 43%), emotional function (β = −0.26; adjusted R2: 9%), and social function (β = −0.26; adjusted R2: 27%). Dyspnea was associated with physical function (β = −0.45; adjusted R2: 42%). Appetite loss, fatigue, and dyspnea were the main reasons causing symptom burdens on quality of life for lung cancer patients. Decreasing these symptoms can improve the quality of life and survival for patients with lung cancer. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)
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9 pages, 804 KiB  
Communication
Potential Impact of Omega 6/3 Ratio and CD68+ Macrophage Infiltration on Survival in NSCLC Patients Undergoing Pulmonary Resection
by Carlos Déniz, Camilo Moreno, Iván Macía, Francisco Rivas, Anna Ureña, Anna Muñoz, Ines Serratosa, Samantha Aso, Marta García, Cristina Masuet-Aumatell, Ignacio Escobar and Ricard Ramos
Curr. Oncol. 2024, 31(9), 5098-5106; https://doi.org/10.3390/curroncol31090377 - 30 Aug 2024
Viewed by 943
Abstract
Background: Lung cancer remains the leading cause of cancer-related mortality worldwide with non-small cell lung cancer (NSCLC) accounting for the majority of cases. The stage of detection significantly influences survival rates with early-stage diagnosis offering the best prognosis. This study investigates the prognostic [...] Read more.
Background: Lung cancer remains the leading cause of cancer-related mortality worldwide with non-small cell lung cancer (NSCLC) accounting for the majority of cases. The stage of detection significantly influences survival rates with early-stage diagnosis offering the best prognosis. This study investigates the prognostic impact of the omega-6/omega-3 ratio and tumor infiltration by CD8+ lymphocytes and CD68+ macrophages on overall survival (OS) and disease-free survival (DFS) in NSCLC patients undergoing pulmonary resection. Methods: We conducted a retrospective analysis of 53 patients with early-stage NSCLC who underwent pulmonary resection between September 2017 and January 2020. The omega-6/omega-3 ratio was quantified using gas chromatography and spectrometry. Tumor infiltration by CD8 and CD68 was assessed through immunohistochemistry. Survival outcomes were evaluated using Kaplan-Meier and Cox regression analyses. Results: An increased omega-6/omega-3 ratio and higher CD68+ macrophage infiltration were associated with a trend towards worse OS and DFS in NSCLC patients, though these results did not reach statistical significance. CD8+ T-cell infiltration was associated with improved survival outcomes, confirming its role as a favorable prognostic marker. Comparative analysis with existing datasets revealed similar demographic and clinical characteristics, reinforcing the generalizability of our findings. Conclusions: The omega-6/omega-3 ratio and CD68+ macrophage infiltration serve as important factors potentially influencing prognosis in NSCLC patients undergoing pulmonary resection. These findings highlight the need for further research to refine the prognostic utility of these biomarkers and to explore therapeutic strategies targeting inflammation and immune cell infiltration. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)
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14 pages, 1100 KiB  
Article
Real-World Analysis of Post-Progression Treatment Patterns and Outcomes for EGFR Mutation-Positive Patients Treated with First-Line Osimertinib
by Amanda Jane Williams Gibson, Michelle Liane Dean, Ishjot Litt, Adrian Box, Winson Y. Cheung and Vishal Navani
Curr. Oncol. 2024, 31(5), 2427-2440; https://doi.org/10.3390/curroncol31050182 - 26 Apr 2024
Viewed by 1942
Abstract
Introduction: The use of osimertinib in the first-line (1L) setting is an effective treatment option for sensitizing EGFR-mutations (EGFRm+) and has significantly altered the standard of care practice for EGFRm+ disease in Canada. Unfortunately, acquired resistance to osimertinib is [...] Read more.
Introduction: The use of osimertinib in the first-line (1L) setting is an effective treatment option for sensitizing EGFR-mutations (EGFRm+) and has significantly altered the standard of care practice for EGFRm+ disease in Canada. Unfortunately, acquired resistance to osimertinib is almost universal, and outcomes are disparate. Post-progression treatment patterns and the outcome of real-world Canadian EGFRm+ patients receiving 1L osimertinib were the focus of this retrospective review. Methods: The Glans-Look Lung Cancer Research database was used to identify and collect demographic, clinical, treatment, and outcome data on EGFRm+ patients who received 1L osimertinib in the Canadian province of Alberta between 2018 and 2022. Results: A total of 150 patients receiving 1L osimertinib were identified. In total, 86 developed progressive disease, with 56 (65%) continuing systemic therapy, 73% continuing osimertinib, and 27% switching to second-line (2L) systemic therapy. Patients were similar both in clinical characteristics at 1L osimertinib initiation and patterns of treatment failure at progression; those continuing 1L osimertinib post-progression had a longer time to progression (13.5 vs. 8.8 months, p = 0.05) and subsequent post-osimertinib initiation survival (34.7 vs. 22.8 months, p = 0.11). Conclusions: The continuation of osimertinib post-progression is an effective disease management strategy for select real-world EGFRm+ patients, providing continued clinical benefit, potentially due to different underlying disease pathogenesis. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)
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10 pages, 550 KiB  
Article
Real-World Evidence of the Impact of the COVID-19 Pandemic on Lung Cancer Survival: Canadian Perspective
by Jason Agulnik, Goulnar Kasymjanova, Carmela Pepe, Jennifer Friedmann, David Small, Lama Sakr, Hangjun Wang, Alan Spatz, Khalil Sultanem and Victor Cohen
Curr. Oncol. 2024, 31(3), 1562-1571; https://doi.org/10.3390/curroncol31030119 - 19 Mar 2024
Viewed by 1365
Abstract
Background: The effect of COVID-19 on treatment outcomes in the literature remains limited and is mostly reported either as predictive survival using prioritization and modeling techniques. We aimed to quantify the effect of COVID-19 on lung cancer survival using real-world data collected at [...] Read more.
Background: The effect of COVID-19 on treatment outcomes in the literature remains limited and is mostly reported either as predictive survival using prioritization and modeling techniques. We aimed to quantify the effect of COVID-19 on lung cancer survival using real-world data collected at the Jewish General Hospital, Montreal. Methods: This is a retrospective chart review study of patients diagnosed between March 2019 and March 2022. We compared three cohorts: pre-COVID-19, and 1st and 2nd year of the pandemic. Results: 417 patients were diagnosed and treated with lung cancer at our centre: 130 in 2019, 103 in 2020 and 184 in 2021. Although the proportion of advanced/metastatic-stage lung cancer remained the same, there was a significant increase in the late-stage presentation during the pandemic. The proportion of M1c (multiple extrathoracic sites) cases in 2020 and 2021 was 57% and 51%, respectively, compared to 31% in 2019 (p < 0.05). Median survival for early stages of lung cancer was similar in the three cohorts. However, patients diagnosed in the M1c stage had a significantly increased risk of death. The 6-month mortality rate was 53% in 2021 compared to 47% in 2020 and 29% in 2019 (p = 0.004). The median survival in this subgroup of patients decreased significantly from 13 months in 2019 to 6 months in 2020 and 5 months in 2021 (p < 0.001). Conclusions: This study is, to our knowledge, the largest single-institution study in Canada looking at lung cancer survival during the COVID-19 pandemic. Our study looks at overall survival in the advanced/metastatic setting of NSCLC during the COVID-19 pandemic. We have previously reported on treatment pattern changes and increased wait times for NSCLC patients during the pandemic. In this study, we report that the advanced/metastatic subgroup had both an increase in the 6-month mortality rate and worsening overall survival during this same time period. Although there was no statistical difference in the proportion of patients with advanced disease, there was a concerning trend of increased M1c disease in cohorts 2 and 3. The higher M1c disease during the COVID-19 pandemic (cohorts 2 and 3) likely played a crucial role in increasing the 6-month mortality rate and leading to a reduced overall survival of lung cancer patients during the pandemic. These findings are more likely to be better identified with longer follow-up. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)
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15 pages, 3239 KiB  
Article
Real-World Treatment Patterns, Clinical Outcomes, and Healthcare Resource Utilization in Early-Stage Non-Small-Cell Lung Cancer
by Dylan E. O’Sullivan, Devon J. Boyne, Chelsea Ford-Sahibzada, Jessica A. Inskip, Christopher J. Smith, Kaushik Sripada, Darren R. Brenner and Winson Y. Cheung
Curr. Oncol. 2024, 31(1), 447-461; https://doi.org/10.3390/curroncol31010030 - 12 Jan 2024
Viewed by 1940
Abstract
The prognosis of early non-small-cell lung cancer (eNSCLC) remains poor. An understanding of current therapies and outcomes can provide insights into how novel therapies can be integrated into clinics. We conducted a large, retrospective, population-based cohort study of patients with de novo eNSCLC [...] Read more.
The prognosis of early non-small-cell lung cancer (eNSCLC) remains poor. An understanding of current therapies and outcomes can provide insights into how novel therapies can be integrated into clinics. We conducted a large, retrospective, population-based cohort study of patients with de novo eNSCLC (stages IB, IIA, IIB, and IIIA) diagnosed in Alberta, Canada, between 2010 and 2019. The primary objectives were to describe treatment patterns and survival outcomes among patients with eNSCLC. A total of 5126 patients with eNSCLC were included. A total of 45.3% of patients were referred to a medical oncologist, ranging from 23.7% in stage IB to 58.3% in IIIA. A total of 23.6% of patients initiated systemic therapy (ST), ranging from 3.5% in stage IB to 38.5% in IIIA. For stage IIB and IIIA individuals who received surgery, adjuvant ST was associated with a decreased likelihood of death (hazard ratios (HR) of 0.77 (95% CI: 0.56–1.07) and 0.69 (95% CI: 0.54–0.89), respectively). In a Canadian real-world setting, stage IIB and IIIA patients who received adjuvant ST tended to have better survival than patients who did not, but future studies that provide adjustment of additional confounders are warranted. Examining referral pathways that account for disparities based on age, sex, and comorbidities in the real world would also provide further insights. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)
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Review

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29 pages, 3730 KiB  
Review
Antibody–Drug Conjugates for the Treatment of Non-Small Cell Lung Cancer with Central Nervous System Metastases
by David J. H. Bian, Sara F. Cohen, Anna-Maria Lazaratos, Nathaniel Bouganim and Matthew Dankner
Curr. Oncol. 2024, 31(10), 6314-6342; https://doi.org/10.3390/curroncol31100471 - 18 Oct 2024
Viewed by 2407
Abstract
Antibody–drug conjugates (ADCs) represent an emerging class of targeted anticancer agents that have demonstrated impressive efficacy in numerous cancer types. In non-small cell lung cancer (NSCLC), ADCs have become a component of the treatment armamentarium for a subset of patients with metastatic disease. [...] Read more.
Antibody–drug conjugates (ADCs) represent an emerging class of targeted anticancer agents that have demonstrated impressive efficacy in numerous cancer types. In non-small cell lung cancer (NSCLC), ADCs have become a component of the treatment armamentarium for a subset of patients with metastatic disease. Emerging data suggest that some ADCs exhibit impressive activity even in central nervous system (CNS) metastases, a disease site that is difficult to treat and associated with poor prognosis. Herein, we describe and summarize the existing evidence surrounding ADCs in NSCLC with a focus on CNS activity. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)
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18 pages, 301 KiB  
Review
A Review of Immunotherapy in Non-Small-Cell Lung Cancer
by Mariana Pilon Capella, Steph A. Pang, Marcos A. Magalhaes and Khashayar Esfahani
Curr. Oncol. 2024, 31(6), 3495-3512; https://doi.org/10.3390/curroncol31060258 - 17 Jun 2024
Cited by 3 | Viewed by 2356
Abstract
Cancer immunotherapy in the form of immune checkpoint inhibitors has led to a dramatic increase in the survival of patients with lung cancer across all stages. Over the past decade, the field has experienced rapid maturation; however, several challenges continue to complicate patient [...] Read more.
Cancer immunotherapy in the form of immune checkpoint inhibitors has led to a dramatic increase in the survival of patients with lung cancer across all stages. Over the past decade, the field has experienced rapid maturation; however, several challenges continue to complicate patient management. This review aims to highlight the data that led to this dramatic shift in practice as well as to focus on key challenges. These include determining the optimal therapy duration, managing frail patients or those with brain metastases, addressing the challenges posed by immune-related adverse events, and defining the various patterns of clinical and radiological responses to immunotherapy. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)

Other

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7 pages, 2613 KiB  
Case Report
A Locally Advanced NSCLC Patient Harboring a Rare KIF13A-RET Fusion Benefited from Pralsetinib: A Case Report
by Zenghao Chang, Tengfei Zhu, Hao Jiang, Wei Ou and Siyu Wang
Curr. Oncol. 2024, 31(7), 3808-3814; https://doi.org/10.3390/curroncol31070281 - 30 Jun 2024
Viewed by 1409
Abstract
The application of adjuvant treatment has significantly enhanced the survival of patients with resectable non-small cell lung cancer (NSCLC) carrying driver gene mutations. However, adjuvant-targeted therapy remains controversial for some NSCLC patients carrying rare gene mutations such as RET, as there is currently [...] Read more.
The application of adjuvant treatment has significantly enhanced the survival of patients with resectable non-small cell lung cancer (NSCLC) carrying driver gene mutations. However, adjuvant-targeted therapy remains controversial for some NSCLC patients carrying rare gene mutations such as RET, as there is currently a lack of confirmed randomized controlled trials demonstrating efficacy. In this report, we describe the case of a 58-year-old man with stage IIIA NSCLC who underwent complete lobectomy with selective lymph node dissection. Postoperative next-generation sequencing revealed that the patient harbored a rare KIF13A-RET fusion. The patient elected to receive adjuvant treatment with pralsetinib monotherapy and underwent serial circulating tumor DNA (ctDNA) monitoring after surgery. During follow-up, despite experiencing dose reduction and irregular medication adherence, the patient still achieved a satisfactory disease-free survival (DFS) of 27 months. Furthermore, ctDNA predicted tumor recurrence 4 months earlier than imaging techniques. The addition of bevacizumab to the original regimen upon recurrence continued to be beneficial. Pralsetinib demonstrated promising efficacy as adjuvant therapy, while ctDNA analysis offered a valuable tool for early detection of tumor recurrence. By leveraging targeted therapies and innovative monitoring techniques, we aim to improve outcomes and quality of life for NSCLC patients in the future. Full article
(This article belongs to the Special Issue Clinical Management and Outcomes of Lung Cancer Patients)
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