Patients with stage IIIB or IV non–small-cell lung cancer, with performance status from 0 to 3, were eligible if they had received one or two prior chemotherapy regimens. The patients were stratified according to center, performance status, response to prior chemotherapy, number of prior regimens, and prior platinum-based therapy and were randomly assigned in a 2:1 ratio to receive oral erlotinib, at a dose of 150 mg daily, or placebo. results The median age of the 731 patients who underwent randomization was 61.4 years; 49 percent had received two prior chemotherapy regimens, and 93 percent had received platinum-based chemotherapy. The response rate was 8.9 percent in the erlotinib group and less than 1 percent in the placebo group (P<0.001); the median duration of the response was 7.9 months and 3.7 months, respectively. Progression-free survival was 2.2 months and 1.8 months, respectively (hazard ratio, 0.61, adjusted for stratification categories; P<0.001). Overall survival was 6.7 months and 4.7 months, respectively (hazard ratio, 0.70; P<0.001), in favor of erlotinib. Five percent of patients discontinued erlotinib because of toxic effects. conclusions Erlotinib can prolong survival in patients with non–small-cell lung cancer after firstline or second-line chemotherapy.

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Erlotinib in previously treated non-small-cell lung cancer.

https://www.jto.org/article/S1556-0864(15)00017-9/pdf

The IASLC Lung Cancer Staging Project: Proposals for Revision of the TNM Stage Groupings in the Forthcoming (Eighth) Edition of the TNM Classification for Lung Cancer.

New blood vessel formation (angiogenesis) is a fundamental event in the process of tumor growth and metastatic dissemination. Hence, the molecular basis of tumor angiogenesis has been of keen interest in the field of cancer research. The vascular endothelial growth factor (VEGF) pathway is well established as one of the key regulators of this process. The VEGF/ VEGF-receptor axis is composed of multiple ligands and receptors with overlapping and distinct ligand-receptor binding specificities, cell-type expression, and function. Activation of the VEGF-receptor pathway triggers a network of signaling processes that promote endothelial cell growth, migration, and survival from pre-existing vasculature. In addition, VEGF mediates vessel permeability, and has been associated with malignant effusions. More recently, an important role for VEGF has emerged in mobilization of endothelial progenitor cells from the bone marrow to distant sites of neovascularization. The well-established role of VEGF in promoting tumor angiogenesis and the pathogenesis of human cancers has led to the rational design and development of agents that selectively target this pathway. Studies with various anti-VEGF/VEGF-receptor therapies have shown that these agents can potently inhibit angiogenesis and tumor growth in preclinical models. Recently, an anti-VEGF antibody (bevacizumab), when used in combination with chemotherapy, was shown to significantly improve survival and response rates in patients with metastatic colorectal cancer and thus, validate VEGF pathway inhibitors as an important new treatment modality in cancer therapy.

Role of the Vascular Endothelial Growth Factor Pathway in Tumor Growth and Angiogenesis

Important advancements in the treatment of non-small cell lung cancer (NSCLC) have been achieved over the past two decades, increasing our understanding of the disease biology and mechanisms of tumour progression, and advancing early detection and multimodal care. The use of small molecule tyrosine kinase inhibitors and immunotherapy has led to unprecedented survival benefits in selected patients. However, the overall cure and survival rates for NSCLC remain low, particularly in metastatic disease. Therefore, continued research into new drugs and combination therapies is required to expand the clinical benefit to a broader patient population and to improve outcomes in NSCLC.

The biology and management of non-small cell lung cancer

https://iris.unito.it/bitstream/2318/1677658/1/OP-ANNO180277%20192..237.pdf

Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up †

https://www.annalsthoracicsurgery.org/article/S0003-4975(00)01749-5/pdf

Reversed-T upper mini-sternotomy for extended thymectomy in myasthenic patients

A complete surgical resection represents the cornerstone of the therapy of the thymic tumours. Pleural disease may already be present at the diagnosis representing an advanced stage thymoma (Masaoka IVA) or it may appear during the follow-up, representing a pleural recurrence. The treatment of Stage IVA thymoma is quite examined in the medical literature; however just a few reports analysed the surgical treatment of thymoma recurrences, whose exclusive pleural recurrences represent more than 90%. Our aim was to review the literature laying the stress on the incidence, diagnosis, treatment options and prognosis of this highly selected group of patients with pleural recurrence from thymoma.

/pdf/surgical-treatment-of-pleural-recurrence-from-thymoma-1bifysrbap.pdf

Surgical treatment of pleural recurrence from thymoma

During a 14-year period (1980-1993) second primary lung cancer or relapse was treated in 44 consecutive patients. Thirty-seven patients had synchronous (n = 18) or metachronous (n = 19) second primary lung cancer. Ten synchronous tumors were ipsilateral and treated contemporarily with five pneumonectomies, three lobectomies and two double wedge resections. The bilateral synchronous lesions (8 patients) were treated by staged bilateral thoracotomy (mean interval; 2 months). The first resection consisted of a lobectomy in six patients and wedge resection in two. The second one was a wedge resection in six patients and a lobectomy in two. In the metachronous presentation 15 patients (79%) were asymptomatic and detected by follow-up chest X-ray. In this group the first operation was a lobectomy in 12 patients, a wedge resection or segmentectomy in 6 and a pneumonectomy in 1. The second one was a wedge resection in nine patients, a lobectomy in six and completion pneumonectomy in four. Seven patients, all of them asymptomatic, had local recurrence from their primary lung cancer. The first lung resection was a lobectomy in five patients and a wedge resection in two. The second one was completion pneumonectomy in five patients and completion lobectomy in two. We had no operative death. The actuarial over-all 5-year survival rate after the second pulmonary resection for second primary lung cancer was 38.3% with a median survival time of 13.5 months. The synchronous presentation had a better survival than the metachronous one (46.2% and 25.9%), respectively). The actuarial overall 5-year survival rate for patients with relapse was 38.1% with a median survival time of 37 months. We may conclude that an aggressive surgical approach is safe, effective and warranted in patients with either a second primary lung cancer or relapse from their primary lung cancer. Moreover, for early detection of the second lesions, follow-up at a maximum of 6-monthly intervals should be continued for more than 5 years after the first resection.

Marco Lucchi

Papers

Reversed-T upper mini-sternotomy for extended thymectomy in myasthenic patients

Surgical treatment of pleural recurrence from thymoma

Second primary lung cancer and relapse: treatment and follow-up.

Presence and inter-individual variability of carboxylesterases (CES1 and CES2) in human lung.

Diaphragm and lung-preserving surgery with hyperthermic chemotherapy for malignant pleural mesothelioma: A 10-year experience.