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Although most patients with stage I non-small cell lung cancer (NSCLC) can achieve long-term survival, some still remain at high risk of relapse (1-3). The excellent outcomes and increasing use of stereotactic ablative radiotherapy (SABR) for stage I NSCLC has recently posed a challenge to surgery (4,5). Nevertheless, lobectomy with mediastinal lymph node dissection or sampling has remained the standard of care for operable, stage I NSCLC. Adjuvant chemotherapy should be considered for patients with stage IB (>4 cm) and high-risk NSCLC after surgery (6). Moreover, as a recent randomized phase III trial showed, adjuvant EGFR tyrosine kinase inhibitor (TKI) can significantly prolong disease-free survival (DFS) compared with adjuvant vinorelbine plus cisplatin in patients with completely resected stage II–IIIA (N1–N2) EGFR-mutant NSCLC (7). However, whether adjuvant EGFR-TKI could benefit patients with stage I EGFR-mutant NSCLC remains unknown (8,9). In addition, oligometastasis is a common relapse patterns after complete resection (10), and the delivery of radiation therapy is increasingly being delivered in these patients to prolong their progression-free survival (PFS) (11). A question that still remains is the impact of local therapy in combination with targeted therapy for patients with oligometastatic disease. Here, we presented a case of a patient with EGFR-mutant stage IA lung adenocarcinoma clinically benefitting from adjuvant EGFR-TKI. After that, the patient had bone oligometastasis and benefited from the addition of local therapy. During the treatment process, the international multidisciplinary team (iMDT) discussion played a pivotal role in the selection and switch of therapeutic strategies.

BACKGROUND: We conducted a meta-analysis to systematically evaluate the relationship between programmed death-ligand 1 (PD-L1) expression and survival in patients with lung cancer. METHODS: The electronic databases PubMed, Embase, Cochrane, and Web of Science were searched up to January 2(nd), 2018, for articles relating to PD-L1 expression detected by immunohistochemistry (IHC) and lung cancer patient prognosis. RESULTS: Fifty studies including 11,383 patients published between 2011 and 2017 were enrolled in this meta-analysis. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) suggested that PD-L1 IHC expression was related to poor overall survival (OS) (HR =1.45, 95% CI: 1.24–1.68). In subgroup analysis categorized according to sample type, cut-off value, ethnicity and TNM stage, the pooled results demonstrated inferior survival in the PD-L1 positive group when the PD-L1 expression was detected by resection specimens (P=0.000), 5% was taken as the cutoff value (P=0.000), the patients were in early stage (I–III) (P=0.000), and the geographic setting of the study was in Asia (P=0.000). Besides, patients with high PD-L1 expression had shorter OS in NSCLC (P=0.000), ADC (P=0.000), SCC (P=0.353) and LELC (P=0.810), while no significant difference was observed in SCLC (P=0.000). The pooled odds ratios (ORs) suggested that PD-L1 expression was associated with male (P

In the last years, knowledge about immune system and cancer rapidly increased, becoming evident that immune system, when properly stimulated, can eradicate cancer cells (1,2). Immunotherapy includes two main approaches: passive and active immunotherapy. Passive immunotherapy consists in administering monoclonal antibodies targeting specific tumor-associated antigens (i.e., rituximab in lymphoma or trastuzumab in breast cancer). In lung cancer such strategy showed modest or no benefit with no agent so far approved for treatment of advanced disease. In 2009 cetuximab was not approved for first line treatment of advanced non-small cell lung cancer (NSCLC) despite the survival benefits showed by the combination of cetuximab plus chemotherapy in patients with EGFR mutation (3). Trials of trastuzumab or other HER2-targeted agents failed to demonstrate clinical benefit in NSCLC as monotherapy or combined with chemotherapy (4). Active immunotherapy includes therapeutic cancer vaccination (antigen specific immunotherapy), which aims to enhance T-cells response against specifically expressed tumor antigens, and immune check point inhibitors (non-antigen specific immunotherapies) which aim to “remove the brakes” on T-cells and restore the immune response against tumor cells (1,2,5).

Non-small-cell lung cancer (NSCLC) represents the paradigm of personalized treatment of human cancer. A number of oncogenic druggable alterations have been so far identified, with anaplastic lymphoma kinase (ALK) gene rearrangements being one of the most attractive (1). In the past 10 years, we have learned that the presence of such molecular event is associated with some specific pathological and clinical features, including a preferential seeding into the central nervous system (CNS) and, most importantly, anticipates response to anti-ALK agents (2-4). Front-line crizotinib, the first-in-class ALK-inhibitor, prolonged median progression-free survival (PFS) of 4 months respect to standard platinum-pemetrexed (11.9 versus 7.0 months; HR =0.45, P

Lung cancer is the primary cause of cancer deaths and continues to be a significant global health problem. However, remarkable progress is underway in both the prevention and treatment of lung cancer. Lung cancer therapy has now emerged as a role model for tailored cancer medicine, with several significant breakthroughs.