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Key Clinical Updates in Bronchogenic Carcinoma

The FDA approved sotorasib (AMG 510) for the treatment of KRAS G12C mutated lung cancers after progression on first-line treatment.

Atezolizumab (PD-L1 inhibitor) can be given for 1 year post–adjuvant chemotherapy for resected stage II to IIIA NSCLC, based on a phase 3 trial showing improvement in disease-free survival compared with adjuvant chemotherapy without atezolizumab. For stage III NSCLCs, a phase 3 trial has shown improved survival outcomes by adding durvalumab (PD-L1 inhibitor) as consolidation therapy post–definitive chemoradiation.

Five-year follow-up data for patients with 50% or greater PD-L1 expression show that patients who received pembrolizumab versus chemotherapy alone had improved median overall survival of 26 months versus 13 months.

Skoulidis F et al. N Engl J Med. [PMID: 34096690]

Reck M et al. J Clin Oncol. [PMID: 33872070]

Felip E et al. Lancet. [PMID: 34555333]

ESSENTIALS OF DIAGNOSIS

  • New cough or change in chronic cough.

  • Dyspnea, hemoptysis, anorexia, weight loss.

  • Enlarging lung nodule or mass; persistent opacity, atelectasis, or pleural effusion on chest radiograph or CT scan.

  • Cytologic or histologic findings of lung cancer in sputum, pleural fluid, or biopsy specimen.

GENERAL CONSIDERATIONS

Lung cancer is the leading cause of cancer deaths in both men and women. The American Cancer Society (ACS) estimates 235,760 new diagnoses and 131,880 deaths from lung cancer in the United States in 2021, accounting for approximately 12% of new cancer diagnoses and 22% of all cancer deaths. More Americans die of lung cancer than of colorectal, breast, and prostate cancers combined. In 2012 worldwide, an estimated 1.8 million cases of lung cancer and 1.5 million deaths due to lung cancer were reported.

Cigarette smoking causes 85–90% of cases of lung cancer. The causal connection between cigarettes and lung cancer is established not only epidemiologically but also through identification of carcinogens in tobacco smoke and analysis of the effect of these carcinogens on specific oncogenes expressed in lung cancer.

Starting in the early 1990s, mortality from lung cancer fell among US men, reflecting changing patterns of tobacco use over the past 30 years (see Chapter 1). Among US women, mortality rates have started to fall since the early 2000s. Other environmental risk factors for the development of lung cancer include exposure to environmental tobacco smoke, radon, asbestos (60- to 100-fold increased risk in smokers with asbestos exposure), diesel exhaust, ionizing radiation, metals (arsenic, chromium, nickel, iron oxide), and industrial carcinogens. A familial predisposition to lung cancer is recognized. Certain diseases are associated with an increased risk of lung cancer, including pulmonary fibrosis, COPD, and sarcoidosis. Second primary lung cancers are more frequent in patients who survive their initial lung cancer.

The median age at diagnosis of lung cancer in the United States is 71 years; it is unusual under the age of 40 years. The combined relative 5-year survival rate for ...

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