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Background: Coronavirus disease (COVID-19) is interfering heavily with the screening, diagnosis and treatment of cancer patients. Better knowledge of the seroprevalence and immune response after Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection in this population is important to manage them safely during the pandemic. Methods: 922 cancer patients, 100 non-cancer patients and 94 health care workers (HCW) attending the Multidisciplinary Oncology Unit of Antwerp University Hospital from 24th of March 2020 till 31st of May 2020, and the Oncology Unit of AZ Maria Middelares Hospital, Ghent, from 13th of April 2020 till 31st of May 2020 participated in the study. The Alinity (A; Abbott) and Liaison (D; DiaSorin) commercially available assays were used to measure SARS-CoV-2 IgG, while total SARS-CoV-2 Ig was measured by Elecsys (R; Roche). Results: In the overall study population IgG/total SARS-CoV-2 antibodies were found in respectively 32/998 (3.2%), 68/1020 (6.7%), 37/1010 (3.7%) and of individuals using the A, D or R test. Forty-six out of 618 (7.4%) persons had a positive SARS-CoV-2 polymerase chain reaction (RT-PCR) test. Seroprevalence in cancer patients (A:2.2%, D:6.2%, R:3.0%), did not significantly differ from that in non-cancer patients (A:1.1%, D:5.6%, R:0.0%), but was lower than the HCW (A:13%, D:12%, R:12%; respectively Fisher’s exact test p Z 0.00001, p Z 0.046, p Z 0.0004). A positive SARS-CoV-2 RT-PCR was found in 6.8% of the cancer patients, 2.3% of the non-cancer patients and 28.1% of the HCW (Fisher’s exact test p Z 0.0004). Correlation between absolute values of the different Ig tests was poor in the cancer population. Dichotomising a positive versus negative test result, the A and R test correlated well (kappa 0.82 p McNemar test Z 0.344), while A and D and R and D did not (respectively kappa 0.49 and 0.57; result significantly different p McNemar test Z 75%) and median absolute antibody levels (A: 7.0 versus 4.7; D 74.0 versus 26.6, R: 16.34 versus 7.32; all >P Mann Whitney U test Z 0.28) in cancer patients and HCW with a positive RT-PCR at least 7 days earlier did not show any differences. However, none (N Z 0/4) of the patients with hematological tumours had seroconversion and absolute antibody levels remained much lower compared to patients with solid tumours (R: 0.1 versus 37.6, p 0.003; D 4.1 versus 158, p 0.008) or HCW (all p < 0.0001). Conclusion: HCW were at high risk of being infected by SARS-CoV-2 during the first wave of the pandemic. Seroprevalence in cancer patients was low in the study period. Although Ig immune response in cancer patients with solid tumours does not differ from healthy volunteers, patients with hematological tumours have a very poor humoral immune response. This has to be taken into account in future vaccination programmes in this population. SARS-CoV-2 antibody tests have divergent results and seem to have little added value in the management of cancer patients.

Patients with advanced lung cancer and depressive/anxiety symptoms experience worse quality of life (QoL) We examined whether and how coping strategy influenced QoL in these patients. A multicenter cross-sectional study of 125 patients with advanced lung cancer was conducted. Patients using positive reframing as coping strategy, experience less anxiety and depressive symptoms leading to a better QoL. Introduction: Patients with advanced lung cancer experience high physical symptom burden with substantial psychological distress. Depressive and anxiety symptoms are common and associated with worse quality of life (QoL). Early palliative care (EPC) addresses the complex supportive care needs improving QoL and mood. The mechanisms of EPC are uncertain. We examined whether and how coping strategy, a primary component of EPC, influenced QoL in these patients. Materials and Methods: We conducted a multicenter cross-sectional study of patients with advanced lung cancer. A total of 125 patients completed assessments of QoL (QLQ-C15-PAL), depressive and anxiety symptoms (HADS), and coping (brief COPE questionnaire). The data were analyzed by descriptive statistics. To determine whether and how coping strategy influences QoL, correlations and logistic regressions were performed. Results: Positive refraining correlates significantly with global QoL (r 0.25, P

Purpose of review Controversy exists regarding the optimal treatment of patients with stage IIIA-N2 nonsmall cell lung cancer because of its heterogeneity. Patients are at risk for both local and distant disease relapse after primary local treatment. However, there may be a window of opportunity for surgery, if mediastinal downstaging has been obtained after induction therapy. This manuscript reviews the outcome of patients treated by neo-adjuvant chemotherapy (NA-C) followed by surgery, compared with patients treated with either definitive sequential or concurrent chemoradiotherapy (cCRT), illustrated by a single-centre retrospective case series. Recent findings Of 53 eligible patients, 19 received NA-C and underwent surgical resection, whilst 20 and 14 received concurrent or sequential definitive CRT, respectively. A significant difference in progression-free survival favouring NA-C followed by surgery over both CRT modalities was found. However, this translated only in an overall survival benefit in comparison with sequential definitive CRT. A trend for better outcome was observed in selected surgical patients with single-level mediastinal involvement and complete resection. Summary Our case series results are consistent with the present standard of care of CRT, which restricts surgical resection to carefully selected patients. Immunotherapy will likely change the treatment paradigm.

Simple Summary SARS-CoV-2 infection has been associated with broad dysregulation of the circulating immune system and inflammation that could persist for a long period. Chronic inflammation has been shown to play a significant role in cancer development and progression. Here we showed that several immune-related factors were altered in cancer patients who had previously been exposed to the virus. Several of these immune factors observed to be elevated even after 3 months of infection are also tumour-promoting factors. The results of this study suggest that we need to pay more attention to cancer patients who have recovered from COVID-19 for any increased rate of cancer progression. Abstract Cytokines, chemokines, and (angiogenic) growth factors (CCGs) have been shown to play an intricate role in the progression of both solid and haematological malignancies. Recent studies have shown that SARS-CoV-2 infection leads to a worse outcome in cancer patients, especially in haematological malignancy patients. Here, we investigated how SARS-CoV-2 infection impacts the already altered CCG levels in solid or haematological malignancies, specifically, whether there is a protective effect or rather a potentially higher risk for major COVID-19 complications in cancer patients due to elevated CCGs linked to cancer progression. Serially analysing immune responses with 55 CCGs in cancer patients under active treatment with or without SARS-CoV-2 infection, we first showed that cancer patients without SARS-CoV-2 infection (n = 54) demonstrate elevated levels of 35 CCGs compared to the non-cancer, non-infected control group of health care workers (n = 42). Of the 35 CCGs, 19 were common to both the solid and haematological malignancy groups and comprised previously described cytokines such as IL-6, TNF-α, IL-1Ra, IL-17A, and VEGF, but also several less well described cytokines/chemokines such as Fractalkine, Tie-2, and T cell chemokine CTACK. Importantly, we show here that 7 CCGs are significantly altered in SARS-CoV-2 exposed cancer patients (n = 52). Of these, TNF-α, IFN-β, TSLP, and sVCAM-1, identified to be elevated in haematological cancers, are also known tumour-promoting factors. Longitudinal analysis conducted over 3 months showed persistence of several tumour-promoting CCGs in SARS-CoV-2 exposed cancer patients. These data demonstrate a need for increased vigilance for haematological malignancy patients as a part of long COVID follow-up.

Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has overwhelmed the capacity of healthcare systems worldwide. Cancer patients, in particular, are vulnerable and oncology departments drastically needed to modify their care systems and established new priorities. We evaluated the impact of SARS-CoV-2 on the activity of a single cancer center. Methods We performed a retrospective analysis of (i) volumes of oncological activities (2020 vs 2019), (ii) patients’ perception rate of the preventive measures, (iii) patients’ SARS-CoV-2 infections, clinical signs thereof, and (iv) new diagnoses made during the SARS-CoV-2 pandemic. Results As compared with a similar time frame in 2019, the overall activity in total numbers of outpatient chemotherapy administrations and specialist visits was not statistically different ( P = .961 and P = .252), while inpatient admissions decreased for both medical oncology and thoracic oncology (18% ( P = .0018) and 44% ( P < .0001), respectively). Cancer diagnosis plummeted (−34%), but no stage shift could be demonstrated. Acceptance and adoption of hygienic measures was high, as measured by a targeted questionnaire (>85%). However, only 46.2% of responding patients regarded telemedicine, although widely deployed, as an efficient surrogate to a consultation. Thirty-three patients developed SARS-CoV-2, 27 were hospitalized, and 11 died within this time frame. These infected patients were younger, current smokers, and suffered more comorbidities. Conclusions This retrospective cohort analysis adds to the evidence that continuation of active cancer therapy and specialist visits is feasible and safe with the implementation of telemedicine. These data further confirm the impact of SARS-CoV-2 on cancer care management, cancer diagnosis, and impact of infection on cancer patients.

Small cell lung cancer (SCLC) comprises about 15% of all lung cancers. It is an aggressive disease, with early metastasis and a poor prognosis. Until recently, SCLC treatment remained relatively unchanged, with chemotherapy remaining the cornerstone of treatment. In this overview we will highlight the recent advances in the field of staging, surgery, radiotherapy and systemic treatment. Nevertheless, the prognosis remains dismal and there is a pressing need for new treatment options. We describe the progress that has been made in systemic treatment by repurposing existing drugs and the addition of targeted treatment. In recent years, immunotherapy entered the clinic with high expectations of its role in the treatment of SCLC. Unravelling of the genomic sequence revealed new possible targets that may act as biomarkers in future treatment of patients with SCLC. Hopefully, in the near future, we will be able to identify patients who may benefit from targeted therapy or immunotherapy to improve prognoses.

Introduction: Health Care System - The kingdom of Belgium with its capital Brussels is located in Western Europe (Fig. 1) and has a population of 11,492,641 inhabitants (January 2020) for a surface of 30,689 km2. The country is a member of the European Union (EU) and federally organized with a Dutch-speaking majority in the northern Flemish region, a French-speaking region (Wallonia) in the south, and the Brussels capital region. Its population is mainly of Caucasian ethnicity, with 10% immigrants from different non-EU countries, mostly Africa and Middle East. [...]

Urinary tract infections (UTI) rank among the most common bacterial infections in humans and are routinely treated with empirical antibiotics. However, due to increasing microbial resistance, the efficacy of the most used antibiotics has declined. To find alternative treatment options, there is a great need for a better understanding of the UTI pathogenesis and the mechanisms that determine UTI susceptibility. In order to investigate this in an animal model, a reproducible, non-invasive assay to study the course of UTI is indispensable. For years, the gold standard for the enumeration of bacterial load has been the determination of Colony Forming Units (CFU) for a particular sample volume. This technique requires post-mortem organ homogenates and serial dilutions, limiting data output and reproducibility. As an alternative, bioluminescence imaging (BLI) is gaining popularity to determine the bacterial load. Labeling pathogens with a lux operon allow for the sensitive detection and quantification in a non-invasive manner, thereby enabling longitudinal follow-up. So far, the adoption of BLI in UTI research remains limited. This manuscript describes the practical implementation of BLI in a mouse urinary tract infection model. Here, a step-by-step guide for culturing bacteria, intravesical instillation and imaging is provided. The in vivo correlation with CFU is examined and a proof-of-concept is provided by comparing the bacterial load of untreated infected animals with antibiotic-treated animals. Furthermore, the advantages, limitations, and considerations specific to the implementation of BLI in an in vivo UTI model are discussed. The implementation of BLI in the UTI research field will greatly facilitate research on the pathogenesis of UTI and the discovery of new ways to prevent and treat UTI.

Simple Summary The tumor microenvironment (TME) is increasingly believed to be involved in therapy resistance and disease progression of different cancer types. Cancer-associated fibroblasts (CAFs) are prominent components and a central player in creating this TME. In particular, lung and pancreatic cancer, two solid tumor types associated with therapy resistance and poor long-term prognosis have clear evidence of CAFs. In order to provide a more holistic approach of therapy resistance, we highlight different mechanisms of CAF contribution to tumor progression and provide a comprehensive review on how CAFs affect their response to clinical therapy and prognosis, and present an overview of novel therapies and future perspectives involving CAF-targeting agents for both cancer types. Abstract Cancer arises from mutations accruing within cancer cells, but the tumor microenvironment (TME) is believed to be a major, often neglected, factor involved in therapy resistance and disease progression. Cancer-associated fibroblasts (CAFs) are prominent and key components of the TME in most types of solid tumors. Extensive research over the past decade revealed their ability to modulate cancer metastasis, angiogenesis, tumor mechanics, immunosuppression, and drug access through synthesis and remodeling of the extracellular matrix and production of growth factors. Thus, they are considered to impede the response to current clinical cancer therapies. Therefore, targeting CAFs to counteract these protumorigenic effects, and overcome the resistance to current therapeutic options, is an appealing and emerging strategy. In this review, we discuss how CAFs affect prognosis and response to clinical therapy and provide an overview of novel therapies involving CAF-targeting agents in lung and pancreatic cancer.

In this study, we investigated serum epidermal growth factor (EGF) in an oncological population of head- and neck and pulmonary neoplasms and whether serum EGF could serve as a prognostic marker of survival and as a predictive marker for treatment response to platinum-based chemotherapy. A total of 59 oncological patients and a control group of age- and sex-matched healthy volunteers were included in this study. Pre-treatment serum EGF from both groups was determined. Patient's and tumour characteristics and mortality were recorded during a 5-year follow up period. Baseline serum EGF significantly differed between the oncological patients and the healthy volunteers (p

Background Telehealth modalities were introduced during the SARS-CoV-2 pandemic to assure continuation of cancer care and maintain social distance. Methods This is a retrospective cohort analysis of our telehealth expansion programme. We adapted two existing patient-reported outcome (PRO) telemonitoring tools that register and (self-)manage toxicities to therapy, while screening for SARS-CoV-2-related symptoms. Outpatients from a tertiary cancer centre were enrolled. The adapted PRO interface allowed for uniform registration of SARS-CoV-2-related symptoms and effective triage of patients at home where we also implemented systematic throat washings, when available. Results Three hundred and sixty patients registered to the telemonitoring systems from March 13 to May 15, 2020. Four prespecified SARS-CoV-2 alarms resulted in three patients with positive PCR testing. Other Covid-19 symptoms (fever 5× and cough 2×) led to pretreatment triage resulting in 1 seroconversion after initial negative testing. One of the 477 throat washings proved positive. Conclusions The rapid adoption of an amended PRO (self-)registrations and toxicity management system was feasible and coordinated screening for Covid-19. Continued clinical cancer care was maintained, with significant decreased waiting time. The systemic screening with throat washings offered no real improvement.

Morvan's syndrome (MoS) is a rare autoimmune disorder characterized by central nervous system involvement, autonomic dysfunction and peripheral nerve hyperexcitability. MoS is believed to be caused by autoantibodies targeting contactin-associated protein 2 (Caspr2), a subunit of the neuronal voltage-gated potassium channel (VGKC) complex, usually in association with thymoma, less commonly with other malignancies. This case highlights an exceptional case of severe sleep disturbances and behavioural changes due to MoS, in a patient who would present with and be treated successfully for a second relapse of thymoma 30 months later. Originally he suffered from ocular myasthenia, another autoimmune disorder, which led to diagnosis of his original thymoma and first relapse.

Background: Lung cancer causes impairment of health-related quality of life (QoL), but little is known about gender aspects in QoL and symptom burden of lung cancer patients. The aim of this study was to investigate gender differences in QoL as assessed by the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the updated lung cancer module. Methods: In a prospective, international, cross-cultural, multicenter study that was undertaken to update the lung cancer-specific module EORTC QLQ-LC13, patients filled in the core questionnaire EORTC QLQ-C30 and the updated lung cancer module. Gender differences were calculated for all QoL scores using ANCOVAs that controlled for known and suspected confounders. Comparisons with historic data were drawn. Results: A total of 200 patients (82 female and 118 male, median age 65 years) were recruited. With the exception of coughing (estimated marginal means: women 33.86 and men 43.52, P=0.022) and diarrhea (estimated marginal means: women 26.01 and men 17.93, P=0.038) there were no significant QoL gender differences. Fatigue was the most pronounced symptom in both, men and women, outpacing typical respiratory symptoms. Quite generally, our sample of lung cancer patients showed considerably worse QoL in all scores when compared to EORTC reference data (lung cancer and combined cancer diagnoses, mean differences up to 13.70 and 21.54 score points, respectively) and to a German norm reference sample (up to 35.37 score points). Conclusions: This study adds to the literature in showing that the typical QoL gender difference effect (women doing worse than men) may not be generalizable across all patient samples.

Highlights • Cancer patients with COVID-19 have a higher morbidity and mortality. • Particularly patients with ongoing or recent cancer treatment, metastatic solid tumors and hematological malignancies are at risk. • Underlying immunosuppression, elevated cytokine levels, altered expression of the angiotensin converting enzyme (ACE-2) and TMPRSS2, and a prothrombotic status in cancer patients may fuel the effects of a SARS-CoV-2 sepsis. • The gene expression level of ACE2 may be an indicator of the susceptibility to SARS-CoV-2 infection, while TMPRSS2 plays a supporting role. • Better knowledge of the mechanisms involved may be a tool to identify high risk patients and to prevent severe complications by targeting the involved pathways., The outbreak of the SARS-CoV-2 pandemic has overwhelmed health care systems in many countries. The clinical presentation of the SARS-CoV-2 varies between a subclinical or flu-like syndrome to that of severe pneumonia with multi-organ failure and death. Initial reports have suggested that cancer patients may have a higher susceptibility to get infected by the SARS-CoV-2 virus but current evidence remains poor as it is biased by important confounders. Patients with ongoing or recent cancer treatment for advanced active disease, metastatic solid tumors and hematological malignancies are at higher risk of developing severe COVID-19 respiratory disease that requires hospitalization and have a poorer disease outcome compared to individuals without cancer. However it is not clear whether these are independent risk factors, or mainly driven by male gender, age, obesity, performance status, uncontrolled diabetes, cardiovascular disease and various other medical conditions. These often have a greater influence on the probability to die due to SARS-CoV-2 then cancer. Delayed diagnosis and suboptimal cancer management due to the pandemic results in disease upstaging and has considerable impact cancer on specific death rates. Surgery during the peak of the pandemic seems to increase mortality, but there is no convincing evidence that adjuvant systemic cancer therapy and radiotherapy are contraindicated, implicating that cancer treatment can be provided safely after individual risk/benefit assessment and some adaptive measures. Underlying immunosuppression, elevated cytokine levels, altered expression of the angiotensin converting enzyme (ACE-2) and TMPRSS2, and a prothrombotic status may fuel the effects of a SARS-CoV-2 in some cancer patients, but have the potential to be used as biomarkers for severe disease and therapeutic targets. The rapidly expanding literature on COVID-19 should be interpreted with care as it is often hampered by methodological and statistical flaws.

Background The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Lung Cancer 13 (QLQ-LC13) assesses quality of life (QOL) in patients with lung cancer and was the first EORTC module developed for use in international clinical trials. Since its publication in 1994, major treatment advances with possible effects on QOL have occurred. These changes called for an update of the module and its international psychometric validation. We aimed to investigate the scale structure and psychometric properties of the updated lung cancer module, QLQ-LC29, in patients with lung cancer. Methods This international, observational field study was done in 19 hospitals across 12 countries. Patients aged older than 18 years with a confirmed diagnosis of lung cancer and no other previous primary tumour, and who were mentally fit with sufficient language skills to understand and complete the questionnaire were included. Patients were asked during a hospital visit to fill in the paper versions of the core questionnaire EORTC QLQ-C30 plus QLQ-LC29, and investigators selected half of these patients to complete the questionnaire again 2-4 weeks later. Our primary aim was to assess the scale structure and psychometric properties of EORTC QLQ-LC29. We analysed scale structure using confirmatory factor analysis; reliability using Cronbach's a value (internal consistency) and intra-class coefficient (test-retest reliability); sensitivity using independent t tests stratified by Karnofsky performance status; and responsiveness to change over time by ANOVA. This study is registered with ClinicalTrials.gov, NCT02745691. Findings Between April 12, 2016, and Sept 26, 2018, 523 patients with a confirmed diagnosis of either non-small-cell lung cancer (n=442) or small-cell lung cancer (n=81) were recruited. Confirmatory factor analysis provided a solution composed of five multi-item scales (coughing, shortness of breath, fear of progression, hair problems, and surgery-related symptoms) plus 15 single symptom or side-effect items: chi(2)=370.233, root mean square error of approximation=0.075, and comparative-fit index=0.901. Cronbach's alpha for internal consistencies of all multi-item scales were above the threshold of 0.70. Intra-class coefficients for test retest reliabilities ranged between 0.82 and 0.97. Three (shortness of breath, fear of progression, and hair problems) of the five multi-item scales showed responsiveness to change over time (p values

Our current thoracic oncology practice could/should be adapted to the COVID-19 pandemic by reducing time in hospital and patient contacts with healthcare workers, whilst maintaining quality of care. This letter offers expert advice on how to do so.https://bit.ly/2JR2IoT

Exhaustion of antigen-specific T-cells in order to escape immune destruction is frequently seen in chronic viral infection and different types of cancer. Blockade of overexpressed negative co-stimulatory pathways, a process known as immune checkpoint modulation, is a promising novel therapy that could improve the treatment of liver diseases with features of T cell exhaustion. We present a case of a 54-year-old hepatitis C virus (HCV) positive patient with an acute flare of hepatitis during nivolumab treatment for a stage IV lung carcinoma, an anti-programmed death-1 (PD-1) immunotherapy. Retrospective testing of HCV RNA documented infection more than 6 months ago. Nivolumab treatment was associated with an alanine aminotransferase (ALT) flare reaching a peak value of 663 U/L, along with bilirubin levels of 0.74 mg/dL and no signs of coagulopathy. The assumption of a nivolumab-associated autoimmune hepatitis led to the interruption of the immune checkpoint inhibitor treatment. However, a subsequent 1-log decrease of HCV RNA load was noticed, which raised the possibility of an immune reconstitution against the HCV-infected hepatocytes with cell lysis. Liver biopsy specimen demonstrated no evidence for autoimmune liver disease or fibrosis. Clinical evolution was favorable and serum transaminases returned to normal levels and HCV RNA load increased to baseline values following nivolumab cessation. The current case suggests an anti-HCV activity of anti-PD-1 treatment in the setting of concomitant HCV viremia and lung carcinoma.

COVID-19 is an infectious pandemic disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus with varying presentations ranging from asymptomatic, sensation of a mild cold or influenza to severe bilateral pneumonia and death.1 Patients with cancer and COVID-19 are at a significantly higher likelihood of poor disease outcomes.2 3 In the absence of a vaccine or adequate treatment of COVID-19 current measures to minimise the infectious risk of SARS-CoV-2 in a cancer patient population are focused on physical distancing and protective measures. As it is clear that a hospital is a high-risk setting to contract COVID-19, one of the strategies we can use to treat patients with cancer as safe as possible is to reduce hospital visits to a strict minimum. We previously reported on AMTRA …

Lung cancer patients often experience potentially life-threatening medical urgencies and emergencies, which may be a direct or indirect result of the underlying malignancy. This pictorial review addresses the most common thoracic, neurological and musculoskeletal medical emergencies in lung cancer patients, including superior vena cava syndrome, pulmonary embolism, spontaneous pneumothorax, cardiac tamponade, massive haemoptysis, central airway obstruction, oesophagorespiratory fistula, malignant spinal cord compression, carcinomatous meningitis, cerebral herniation and pathological fracture. Emphasis is placed on imaging findings, the role of different imaging techniques and a brief discussion of epidemiology, pathophysiology and therapeutic options. Since early diagnosis is important for adequate patient management and prognosis, radiologists have a crucial role in recognising and communicating these urgencies and emergencies. • Multiplanar multidetector computed tomography is the imaging examination of choice for thoracic urgencies and emergencies. • Magnetic resonance imaging is the imaging modality of choice for investigating central nervous system emergencies. • Urgencies and emergencies can be the initial manifestation of lung cancer. • Radiologists have a crucial role in recognising and in communicating these urgencies/emergencies.

Lung cancer is often associated with a poor quality of life, as reflected by patient-reported outcome measures (PROMs). The aim of this paper is to describe and compare the PROMs that are available. In this manuscript, we review the impact of PROMs on the management of lung cancer. Quality of the study and risk of bias were assessed using the appraisal tools recommended by the Dutch Cochrane Center. Out of 51 studies included in this review, ten instruments were identified and categorized as either generic, cancer- or lung cancer-specific. PROMs are primarily applied in scientific research to compare the therapy outcomes and in drug development to support labeling claims. The interest for the routine use of PROMs in daily practice is growing, which has positive effects on the communication with the patient, mutual decision making and the monitoring and managing of the patient. Besides that, PROMs have an independent prognostic value for survival in lung cancer and economic evaluations can be conducted using their results. Electronic platforms simplify the implementation of PROMs in the daily clinic. The EORTC QLQ-C30 and its lung cancer-specific module QLQ-LC13 are the most frequently used instruments in lung cancer patients. PROMs have the potential to improve the quality of care with a proper implementation in the routine practice. PROMS are needed to value and understand the experience of the patient.

Background Implementation of early palliative care (EPC) into daily oncology practice remains difficult. One of the barriers preventing oncologists from starting EPC is open communication about the palliative setting. The aim of this study was to investigate the relevance of this communication barrier. Patients and Methods In this cross-sectional multicenter study, 106 patients with advanced thoracic cancer were issued a questionnaire to survey 3 dimensions of interest: illness understanding, observation of conversation regarding prognosis and end-of-life (EoL) care, and information preferences of the patients. Results Only 45% of subjects were aware that their treatment was not curative. When comparing presumed treatment goals between patients who were aware that their treatment could not cure them and patients likely to think that their treatment could cure them, 39% of the former chose quality of life versus 9% of the latter, whereas 36% of the former chose cure versus 13% of the latter (χ 2 = 17.7, P = .001). Seventy-five percent never had a conversation about EoL care. More than 50% found a discussion about prognosis and EoL care to be very important. Conclusion This study reveals the existence of a communication barrier and underlines the importance of sustained emphasis with regard to the palliative intent of the treatment. Patients who are aware that they could not be cured were more aware of the primary goal of their treatment, namely quality of life. Most patients did not discuss prognosis and EoL care despite their wish for such a communication.

Introduction: Patients with advanced lung cancer expierence high physical symptom burden with substantial psychological distress. Early palliative care (EPC) addresses the complex suportive care needs improving QOL and mood. The mechanisms are uncertain. We examined wether coping strategy influences QOL in patients with depressive or anxiety symptoms. Materials and Methods: We conducted a multi-centre cross-sectional study o f patients with advanced lung cancer. 125 patients completed assessments of AOL (QLQ-C15-PAL), depressive and anxiety symptoms (HADS) and coming (brief COPE questionnaire). The data were analyzed by descreptive statistics. To determine whether coping strategy has a moderating effect on the relationship between mood and QOL, the interaction term between mood and coping strategy was added in a multiple regression model. Results: Positive reframing correlates with global QOL (r=.25, p Conclusion: Patients with advanced lung cancer using positive reframing as coping strategy experience higher QOL. Self-blame leads to more insomnia and worse emotional wellbeing. Anxious patients using emotional coping have higher QOL, those using denial have lower QOL. Patients with depressive symptoms using positive refraiming as coping strategy experience higer QOL. Providing skills to cope effectively could impact QOL in these patients.

Background The implementation of early palliative care within a primary care setting is a recent academic topic. Recruiting General Practitioners (GPs) to participate in a palliative care study can be challenging. The pro-Spinoza project implemented a Care Pathway for Primary Palliative Care in 5 areas in Belgium. During this project, the feasibility of the recruitment of GPs and palliative care patients was evaluated. Methods The recruitment process was recorded in detail via an electronic logbook combining quantitative and qualitative data. Quantitative recordings included the contact types and the number of contacts with eligible GPs and were analysed descriptively. Qualitative recordings included field notes with feedback from the GPs and other stakeholders and were thematically analysed starting from the Grol and Wensing framework for professional behaviour change. Results Of 4065 eligible GPs working in 5 areas under research, 787 GPs (19%) were contacted individually, 398 GPs (9,8%) were contacted face-to-face and most of these 398 GPs showed high interest in the topic. 112 GPs (2,8%) signed the collaboration agreement, but finally only 65 GPs (1,6%) delivered at least a completed baseline-questionnaire. Despite the initial interest in participating, the unpredictable and busy daily workloads of the GPs, as well as inexperience with research protocols, impeded the ability of the GPs to fully engage in the study. This resulted in the high dropout rate. Participating GPs reported that they had underestimated the effort required to effectively participate in the project. Conclusions Recruitment of GPs to palliative care research is challenging. Primary care is a vital service to engage in palliative care research however the practical limitations reduce the ability of the service to effectively engage in the research. More research is needed to determine how GPs might be better supported in research. Trial registration ClinicalTrials.gov, NCT02266069, Registered 16th October 2014, retrospectively registered.

Introduction: To evaluate quality of life of lung cancer patients, the European Organisation for research and treatment of cancer (EORTC) updated the former module LC13, which includes symptoms with targed therapy und surgery and is used together with the QLQ-C30. Recently the influence of gender especially in lung cancer is investigated. Aims and objectives: Hence we analyzed gender differences with the help of the questionnaire QLQ-C30 and LC 29. Methods: This is a prospective, non-interventional, multicentre study, which took place in nine different countries (Germany, Great Britain, Italy, Israel, Norway, Poland, Spain, Taiwan, Cyprus). To determinate gender differences we used covarianz analyses, in which gender was a fixed factor. Following covariates were included Tumor type, therapy approach (palliative vs curative), education, surgery vs radiochemotherapy, targed therapy vs radiochemotherapy, NSCLC stage IV vs all other stages, comorbidity (yes vs no) Results: 200 patients participated in this study (women n=82 and men n=118). Median age was 65 years. Most women were non smoker (n=17, 65.4%) in comparison to men (n=9, 34.5%). Women as well as men had a median Karnofsky Performance Status of 80%. The important clinical variables are shown in the table. Conclusions: In summery the data show that there is no significant gender difference in quality of life of lung cancer patients except the symptom “coughing”. Estimated marginal means

Communication about the palliative setting remains difficult for many physicians. This seems a valid concern. Our study has shown that prognostic understanding will be associated with poorer emotional well-being and more pain but not with a worse mood. A poor mood has a detrimental effect on all aspects of quality of life. Our data suggest the need for psychological support, in addition to communication about the palliative setting. Introduction: Communication about the palliative setting remains a barrier for many physicians because they are afraid to harm the patient by giving bad news. We sought to determine whether this a valid concern; the influence of prognostic understanding on patients' quality of life (QoL); and which factors influence this relationship. Methods: The present multicenter, cross-sectional study used a questionnaire to measure patients' prognostic understanding, QoL, mood, and coping strategy. Results: We surveyed 125 patients with advanced lung cancer. Prognostic understanding correlated significantly with emotional well-being (r = -0.20; P = .01) and pain (r = 0.43; P = .00) but not with anxiety (r = 0.12, P = .12) or depression (r = 0.05; P = -.29). Patients with anxiety (r = -0.23; P = .01) and patients with depressive feelings (r = -0.63; P = .00) experienced poorer QoL. Four in 10 patients reported feelings of anxiety and/ or depression. Positive reframing as a coping strategy was associated with a better QoL (r = - 0.25; P = .00). Conclusion: Prognostic understanding was related to poorer emotional well-being and more pain but does not affect mood. Four in 10 patients reported feelings of anxiety and/or depression, which were associated with a poorer QoL. A holistic approach seems necessary when physicians communicate about the palliative setting. (C) 2018 Elsevier Inc. All rights reserved.

Liquid biopsies, consisting of the analysis of circulating cell-free (tumour) DNA (cfDNA/ctDNA), circulating tumour cells (CTCs) or tumour-derived exosomes, have shown great potential in providing personalised therapy. Presently, the analysis of ctDNA has enabled the detection and real-time follow-up of specific genetic alterations in patients with non-small cell lung cancer (NSCLC), for which targeted therapies are available. Epidermal growth factor receptor ( EGFR ) activating mutations are one of the most widely known examples of targets of tyrosine kinase inhibitors (TKIs). Several studies have described the detection of the EGFR T790M resistance mutation in blood samples 15–344 days prior to disease progression based on the RECIST (Response Evaluation Criteria In Solid Tumors) criteria.1 Importantly, similar response rates to TKI therapy have been described whether the EGFR mutations were detected in blood or tissue samples.2 These findings highlight the potential of liquid biopsy as a less invasive alternative to provide personalised therapy. However, relatively few studies report the detection of other resistance mechanisms in follow-up blood samples. In this case report, we highlight a case in which digital droplet PCR (ddPCR)-based liquid biopsy aids in the detection of an atypical disease progression. We present the case of a 46-year-old woman diagnosed with stage IV (extracranial metastases) EGFR- mutated lung adenocarcinoma in June 2013. Tissue samples were taken throughout the disease course as part of clinical care. The patient provided written informed consent that blood samples could be taken at several time points (figure 1). The human biological materials used in this publication were provided by Biobank@UZA (Antwerp, Belgium; ID: BE71030031000; Belgian Virtual Tumourbank funded by the National Cancer Plan; BBMRI-ERIC; no. access: …

Surgery and stereotactic ablative radiotherapy (SABR) are both curative treatment options for patients with stage I non-small cell lung cancer (NSCLC). Shared decision making (SDM) has been advocated in this patient group. This study explored clinician decision making in relation to the stated treatment preferences of patients.In a previous study, we conducted a binary choice experiment with hypothetical cases among 126 clinicians. Secondary data analysis was performed using multilevel logistic regression models, in which random differences between clinicians' decisions were taken into account. We analyzed the influence of patient- and clinician-related characteristics, and uncertainty as experienced by clinicians about their recommendation on the clinician's decision (either in line with the patient's preference or not).Significant interactions were observed between patient- and clinician-related characteristics, indicating that patient preferences were selectively taken into account, depending on clinicians' specialty, their views about the comparability of cancer-related outcomes following surgery and SABR, and the degree of uncertainty about the treatment recommendation.Our findings suggest that SDM for stage I NSCLC care is largely influenced by how clinicians weigh available scientific evidence.Clinicians should involve lung cancer patients more and ask for their preferences in making treatment recommendations.

We read with interest the article by Blum and Schönfeld [1]. Early introduction of palliative care (EPC) in the management of patients with advanced lung cancer is recommended because it improves quality of life and tends to produce better survival [2]. Hospital-based palliative teams mainly focus on terminal care for hospitalised patients. Involvement of the treating pulmonologist in this setting is warranted, as stated by Blum and Schönfeld [1]. We would like to show you how we started EPC in collaboration with the palliative team in our hospital (table 1).

Background: A one year pilot study, starting in February 2016 was set up to establish the operational workflow, map patient characteristics and identify trouble shooting when implementing the ICHOM lung cancer Standard Set (Mak, ERJ 2016). Methods: Incident patients (pts) with treatment-naive lung cancer, 18 years or older, able to understand and speak Dutch and treated at UZA were included. Self-reporting was conducted via a web-based interface using questionnaires and individual case-mix variables according to ICHOM v1.0. At baseline, during treatment and in follow up pts received electronic invitations. Digitally naive pts completed paper forms. Results: An operational workflow was developed within the routine clinical workflow, collecting PROMs and case-mix variables. 62 pts were screened of which 22 participated. The other 40 were ineligible because of language barrier, previous therapy, confusion or logistic failure. 6 pts are in follow up and 6 deceased. 95% of pts was of Caucasian type (median age 67 y). There were no demographic differences as compared with the group of screen failures. Baseline characteristics showed that all ICHOM pts were (ex-)smokers. Pts reported comorbidities according to Charlson show a variety being present, of which heart diseases comprise 41%. Case-mix variables linked to the first treatment characteristics show an equal distribution of treatment intent. First treatments comprise surgery as well as chemotherapy, radiotherapy and chemoradiotherapy. Conclusion: The proposed workflow allows capture of all eligible pts. Point-of care registration of PROMs remains time-consuming.Updated follow-up PROM’s and outcome indicators will be presented at the meeting.

Background: Malignant pleural mesothelioma (MPM) is a rare but aggressive neoplasm that typically originates from the mesothelial surfaces of the pleural cavity. Exposure to asbestos is the principal etiological agent of MPM. The disease is characterized by difficult stage classification and limited consensus on therapeutic approach. We have evaluated the experience with MPM in the Antwerp University Hospital over the past 15 years. Methods: A database was created with all patients diagnosed with or treated for a MPM between 2001 and 2015. A total of 101 patients were included on which different survival analyses were performed combined with a reproduction of demographic, clinical, histologic and therapeutic data, and these were compared to literature data. Results: Vast majority of our 101 patients were male (80%) with a median age of 66 years at diagnosis with predominantly epitheloid histology (81%). Overall median survival was 18.3 months and overall 1-, 2- and 5-year survival rates were 68%, 37% and 7%, respectively. Kaplan-Meier analysis showed a non-significant difference in survival between the several best (b) TNM-stages (p = .356). A significant difference in survival was observed in patients undergoing surgery versus no surgery (p = .008), between the different histological types (p < .0001) and treatment with chemotherapy alone versus chemotherapy with surgery (p < .0001). Smoking at diagnosis and epitheloid histology have been identified as significant prognostic factors in the multivariate Cox regression model (HR 3.13 and 0.53, respectively). Conclusion: Descriptive and survival analysis of our patient database confirmed the limitations of the current staging system and were concordant with literature regarding MPM.

Background The European Organization for Research and Treatment of Cancer (EORTC) QLQ-LC13 was the first module to be used in conjunction with the core questionnaire, the QLQ-C30. Since the publication of the LC13 in 1994, major advances have occurred in the treatment of lung cancer. Given this, an update of the EORTC QLQ-LC13 was undertaken. Methods The study followed phases I to III of the EORTC Module Development Guidelines. Phase I generated relevant quality-of-life issues using a mix of sources including the involvement of 108 lung cancer patients. Phase II transformed issues into questionnaire items. In an international multicenter study (phase III), patients completed both the EORTC QLQ-C30 and the 48-item provisional lung cancer module generated in phases I and II. Patients rated each of the items regarding relevance, comprehensibility, and acceptance. Patient ratings were assessed against a set of prespecified statistical criteria. Descriptive statistics and basic psychometric analyses were carried out. Results The phase III study enrolled 200 patients with histologically confirmed lung cancer from 12 centers in nine countries (Cyprus, Germany, Italy, Israel, Spain, Norway, Poland, Taiwan, and the UK). Mean age was 64 years (39 − 91), 59% of the patients were male, 82% had non-small-cell lung cancer, and 56% were treated with palliative intent. Twenty-nine of the 48 questions met the criteria for inclusion. Conclusions The resulting module with 29 questions, thus currently named EORTC QLQ-LC29, retained 12 of the 13 original items, supplemented with 17 items that primarily assess treatment side-effects of traditional and newer therapies.

A 58-year-old man was being treated for squamous non-small-cell lung cancer with nivolumab. At the 17th of biweekly administrations he presented with global dysphasia, dysarthria and myoclonus in the right upper extremity. MRI showed multiple T2/FLAIR hyperintense lesions in the left hemisphere; lumbar puncture showed lymphocytic pleiocytosis in the CSF without identifiable pathogens. Hu antibodies were present in serum and CSF. Nivolumab was discontinued and corticosteroids were administered. The neurological symptoms gradually improved; MRI showed complete remission of cerebral lesions. After rechallenge with nivolumab his symptoms and cerebral lesions recurred, proving the causal relationship with nivolumab. After tapering of corticosteroids, a second relapse occurred.

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) is the recommended first-line treatment in metastatic EGFR-mutation-positive non-small cell lung cancer (NSCLC) patients. Such a personalized treatment requires fast EGFR mutation testing. This study was performed to determine the turn around time (TAT) for EGFR mutation testing on tumour samples of NSCLC in the clinical care in the region of Antwerp (Belgium). The secondary aim was to determine the frequency of EGFR mutations in this Flemish population. Tumour tissue was prospectively obtained from lung cancer patients in participating hospitals and sent from the local pathology laboratory (lab) to two central laboratories (labs) where EGFR-mutation analysis was performed. Results were returned from the central labs to the clinicians and the local pathology lab. TAT was defined as the interval between the request from the oncologist and the result obtained by the oncologist. One hundred and seven specimens were analysed. The clinician got the result from the local lab in a median time of 10 days (3-37 days) and from the central lab in 9 days (3-29 days). We detected seven mutations (7%) in this study population, all occurring in tumours with an adenocarcinoma histology, four (57%) in men and five (71%) in (ex-) smokers. There were six exon 19 deletions and one L858R mutation. It is possible to implement EGFR-mutation testing with timely reporting of the EGFR-mutation status. EGFR-mutation occurs in 7% of Flemish patients with NSCLC. Patients with advanced non-squamous NSCLC should be tested for EGFR mutation regardless of their gender and smoking history.

Anatomical cancer extent is an important predictor of prognosis and determines treatment choices. In non-small-cell lung cancer (NSCLC) the tumour–node–metastasis (TNM) classification developed by Pierre Denoix replaced in 1968 the Veterans Administration Lung cancer Group (VALG) classification, which was still in use for small-cell lung cancer (SCLC). Clifton Mountain suggested several improvements based on a database of mostly surgically treated United States (US) patients from a limited number of centres. This database was pivotal for a uniform reporting of lung cancer extent by the American Joint Committee of Cancer (AJCC) and the International Union against Cancer (IUCC), but it suffered increasingly from obsolete diagnostic and staging procedures and did not reflect new treatment modalities. Moreover, its findings were not externally validated in large Japanese and European databases, resulting in persisting controversies which could not be solved with the available database. The use of different mediastinal lymph-node maps in Japan, the (US) and Europe facilitated neither the exchange nor the comparison of treatment results. Peter Goldstraw, a United Kingdom (UK) thoracic surgeon, started the process of updating the sixth version in 1996 and brought it to a good end 10 years later. His goals were to improve the TNM system in lung cancer by addressing the ongoing controversies, to validate the modifications and additional descriptors, to validate the TNM for use in staging SCLC and carcinoid tumours, to propose a new uniform lymph-node map and to investigate the prognostic value of non-anatomical factors. A staging committee was formed within the International Association for the Study of Lung Cancer (IASLC) – which supervised the collection of the retrospective data from >100,000 patients with lung cancer – treated throughout the world between 1990 and 2000, analyse them with the help of solid statistics and validate externally with the Surveillance, Epidemiology and End Results (SEER) database. The ten modifications and the mediastinal lymph-node map – which were proposed in 2007 and adopted by the AJCC and IUCC in their respective seventh revision of the TNM system – were implemented as of 2010 and were rapidly adopted by the thoracic oncology community and cancer registries. As expected, not all controversies could be fully addressed, and the need for a prospective data set containing more granular information was felt early on. This data set of 25,000 consecutive incident cases will form the base for the eighth revision in 2017 and is currently being collected. Other threats are the role of stage migration and the increasing number of biological factors interfering with disease extent for prognostication. The latter issue will be addressed by the creation of a prognostic index, including several prognostic factors, of which stage will be one. For the time being, the seventh TNM classification is considered the gold standard for the description of disease extent, initial treatment allocation and the reporting of treatment results. The uniform use of the TNM descriptors and the lymph-node map by all involved in lung cancer care is to be considered a process indicator of quality.

Early palliative care (EPC) should be introduced from the start of the treatment of patients with advanced lung cancer. Unfortunately, this is often not integrated in daily oncologic care. This letter wants to emphasize the importance of offering a holistic approach, meaning EPC to optimize quality of life (QoL). Illness understanding is important because patients with better understanding of their disease choose more often for symptom control and less for an aggressive treatment at the end of life. This illness understanding should be achieved during communication with the treating oncologist. Based on the limited available literature about illness understanding, it seems that an EPC program is necessary when breaking bad news, in order to maintain or improve QoL in patients.

A clinicoradiological presentation of thoracic sarcoidosis requires histopathology in order to establish the diagnosis. Flexible bronchoscopy has a reasonable diagnostic yield and is the procedure of first choice for diagnosis. Endoscopic ultrasound (endoscopic ultrasound-guided fine needle aspiration/endobronchial ultrasound-guided transbronchial needle aspiration) can help in the diagnosis of sarcoidosis. An implementation strategy of endoscopic ultrasound for the diagnosis of sarcoidosis following negative flexible bronchoscopy results was examined prospectively in 15 clinics. A total of 137 patients (92 males; median age 43 yrs) were included, and sarcoidosis was found in 115 (84%). Alternative diagnoses were tuberculosis, lymphangitis carcinomatosa, pneumoconiosis and alveolitis. All patients were sent for flexible bronchoscopy, which was performed in 121 (88%), resulting in a definite diagnosis in 57 (42%). A total of 80 patients were sent for endoscopic ultrasound, which could be performed in 72 (90%), yielding a definite diagnosis in 47 (59%). Endoscopic ultrasound following negative flexible bronchoscopy avoided a surgical procedure in 47 out of 80 patients. The sensitivity of flexible bronchoscopy for sarcoidosis was 45% (95% confidence interval 3554%), but 62% (5072%) if biopsy specimens were taken. The sensitivity of endoscopic ultrasound following negative flexible bronchoscopy results was 71% (5882%). With this strategy, 97 out of 115 (84% (7690%)) of proven sarcoidosis was diagnosed using endoscopy. This large prospective implementation study (trial number NCT00888212 [ClinicalTrials.gov] ; ClinicalTrials.gov) shows that endoscopic ultrasound is valuable for diagnosing sarcoidosis after negative flexible bronchoscopy results.

A 61-yr-old Caucasian female patient was investigated because of right-sided pleuritic chest pain. The patient had a 2-month history of chronic, nonproductive cough, extreme fatigue, night sweats and reduced exercise tolerance. Initially, the patient was treated with antibiotics for presumed pneumonia. She had smoked for >20 pack-yrs and her medical history included parotidectomy for Warthin tumour, resection of a benign cyst in the left breast and varicectomy. Physical examination showed no clinical signs of respiratory distress. Sinus rhythm was present with a heart rate of 88 bpm and blood pressure of 135/80 mmHg. Cardiopulmonary auscultation revealed no significant abnormalities and there was no hepatomegaly or limb oedema. No lymphadenopathy was found in the neck, supraclavicular, axillary or inguinal regions. The laboratory results showed an elevated C-reactive protein of 5.02 mg·dL−1. Low haemoglobin and haematocrit values were in keeping with anaemia. Studies of coagulability were all within normal ranges. Arterial blood gas analysis while breathing ambient air showed an arterial oxygen tension of 66 mm Hg, carbon dioxide arterial tension of 40 mmHg, pH of 7.43 and arterial oxygen saturation of 94%. Pulmonary function tests revealed a mild restrictive defect with a reduced diffusing capacity. A chest radiograph (fig. 1⇓) and computed tomography (CT) scans (figs 2⇓ and 3⇓) were performed and the patient underwent bronchoscopy and mediastinoscopy. Bronchoscopy revealed no endobronchial involvement. Subsequent biopsies were all found to be negative. Fig. 1— Chest radiograph. Fig. 2— Axial contrast-enhanced chest computed tomography scan. Extensive soft tissue mass in the right pulmonary artery, extending in different side branches, is indicated by the arrows. Fig. 3— Axial contrast-enhanced chest computed tomography scan. a) Mediastinal window and b) lung window. Two peripherally located wedge-shaped focal consolidations areas at the right lung base are indicated by the arrows. All accessible lymph nodes in the superior mediastinum and the region of the right mainstem bronchus …

Background: Airway stenting has become a common technique in inoperable benign strictures. An ideal stent does not yet exist for these conditions. Recently, fully covered self-expandable metallic stents (SEMS) have been commercialized with potential use in benign airway strictures. Objective: We retrospectively reviewed the clinical effectiveness of fully covered SEMS in the management of benign strictures. Methods: A total of 17 patients received 20 stents: 7 Silmet®, 8 Taewoong® and 5 Alveolus® stents. Ten stents were deployed in a structural postintubation tracheal stenosis. Other indications were multinodular goiter, anastomotic stricture, endobronchial posttuberculosis scar, damaged cartilage and relapsing polychondritis. Results: In our series, the short-term (Conclusion: The use of fully covered SEMS for the treatment of benign airway strictures is associated with a high short-term complication rate requiring stent removal. We have abandoned in our clinical practice the use of fully covered SEMS for benign airway strictures.

Early introduction of palliative care in the management of patients with metastatic lung cancer is recommended since it improves quality of life and improves survival rates. In many hospitals the focus of palliative teams is often on terminal care due to limited resources. How is Early palliative care (EPC) in this setting implemented in daily oncologic care? It seems obvious that thoracic oncologists will have to become involved in EPC for lung cancer patients. In this review we want to determine the assignments for the thoracic oncologist in EPC and to give some practical tools how we started EPC in collaboration with the palliative team. (C) 2015 Published by Elsevier Ireland Ltd.

Cardiopulmonary bypass triggers systemic inflammation and systemic oxidative stress. Recent reports suggest that continuous ventilation during cardiopulmonary bypass (CPB) can affect the outcome of patients after cardiac surgery. We investigated the influence of lung ventilation on inflammatory and oxidative stress markers during coronary artery bypass graft (CABG) with CPB in 13 patients with (Group 2) or without (Group 1) ventilation of the lungs with small tidal volume (4 ml/kg). IL-10 and elastase in blood were elevated in both groups with a peak at the end of CPB (P

Surgical resection is a potential curative therapy for patients with early-stage non-small cell lung cancer (NSCLC). Comorbid chronic obstructive pulmonary disease (COPD) is frequently present in these patients [1], stressing the importance of an accurate estimation of post-operative (po) forced expiratory volume in 1 s (FEV1) [2]. A predicted poFEV1 (PpoFEV1) must be calculated whenever the pre-operative FEV1 or diffusing capacity for carbon monoxide is

e20030 Background: Cetuximab is a chimeric monoclonal antibody targeting the epidermal growth factor receptor (EGFR). Previous studies suggested that cetuximab enhances chemotherapy activity in the presence of EGFR overexpression, which is present in a majority of MPM specimens. We investigated the activity and safety of the combination of platinum-based chemotherapy and cetuximab in EGFR immunohistochemical positive (IHC+) MPM patients (pts). Methods: This is an open, single arm multicenter phase II study according to a Simon 2-step design with progression-free survival (PFS) rate at 18 weeks as primary endpoint. PFS rate at 18 weeks in MPM pts with cisplatin-pemetrexed is 0.67. We hypothesized that the combination of cetuximab and chemotherapy would increase the PFS rate with 30% to 0.87 (alpha = 0.05, power 90%). 18 chemotherapy-naïve pts with epithelioid MPM and PS 0-1, EGFR IHC+ (assessed by DAKO kit with at least 1% of cells showing staining), were included in step 1 of in the study. If ≥14 were alive and free of progression at 18 weeks, sample size was to be increased to 43 pts. Treatment consisted of cisplatin (75 mg/m², day 1 of each 3-week cycle) or carboplatin AUC 5 (day 1 of each 3-week cycle) and pemetrexed (500mg/m2, day 1 of each 3-week cycle) and cetuximab (loading dose of 400 mg/m² followed by 250 mg/m² weekly) during chemotherapy until disease progression. Chemotherapy was given up to 6 cycles. Secondary end points were overall survival (OS), toxicity and response rate. Results: We enrolled 18 eligible pts between June 2010 and June 2013; 89% males, median age 68 years (range 57-80), 83% PS 1. Median number of cycles was 4 (range 2-6). Median number of weekly administrations of cetuximab was 25 (range 8-51). 13 pts were alive and without progression at 18 weeks, median PFS was 24 weeks (95% CI 18.5-29.5), median OS 49 weeks (95% CI 38.6-59.4). 44% (8/18) of patients obtained a partial response. The treatment was well tolerated; the most common adverse event was skin rash (89%), mainly grade 1-2. Conclusions: As platinum-based chemotherapy in combination with cetuximab in pts with epithelioid MPM did not reach the predefined threshold, the study was not continued. No new safety signal was observed. Clinical trial information: NCT00996567.

Immunotherapy has been studied for many years in lung cancer without significant results, making the majority of oncologists quite skeptical about its possible application for non-small cell lung cancer treatment. However, the recent knowledge about immune escape and subsequent cancer immunoediting has yielded the development of new strategies of cancer immunotherapy, heralding a new era of lung cancer treatment. Cancer vaccines, including both whole-cell and peptide vaccines have been tested both in early and advanced stages of non-small cell lung cancer. New immunomodulatory agents, including anti-CTLA4, anti-PD1/PDL1 monoclonal antibodies, have been investigated as monotherapy in metastatic lung cancer. To date, these treatments have shown impressive results of efficacy and tolerability in early clinical trials, leading to testing in several large, randomized Phase III trials. As these results will be confirmed, these drugs will be available in the near future, offering new exciting therapeutic options for lung cancer treatment.