Pulmonary Literature Review and Complex Case Presentations Post Graduate Course-Update on Lung Cancer Treatment and Screening Silvestri

Update on Lung Cancer Treatment and Screening Silvestri

Pdf Summary

The document provides an update on lung cancer treatment and screening, focusing on recent advancements and challenges. <br /><br />**Treatment for Stage 1B and 2 Lung Cancer:** <br />The treatment paradigm has evolved, with surgery followed by Osimertinib for EGFR-positive tumors, Alectinib for ALK-positive tumors, and preoperative chemo/immunotherapy followed by surgery, lacking benefit for perioperative immunotherapy with a PDL1 score of 1%. Proper testing for EGFR, ALK, and PDL1 expression is crucial for treatment decisions.<br /><br />**Screening and Diagnosis:** <br />Lung cancer screening often results in a higher rate of downstream procedures and complications, requiring better diagnostic management to enhance benefits. The presence of pulmonary nodules (PNs) often indicates early-stage lung cancer, sometimes more prevalent than findings from low-dose CT scans. Diagnostic techniques like electromagnetic navigation have varying yield rates, with complication risks prompting careful consideration of their routine use.<br /><br />**Guided Bronchoscopy Diagnostic Yield:** <br />Yield is approximately 69.4%, varying based on technology used, with robotic-assisted procedures showing higher yields.<br /><br />**Importance of Biomarker Testing:** <br />Adequate biomarker testing, particularly through EBUS (Endobronchial Ultrasound), requires a sufficient number of needle passes (six for 90% adequacy for NGS testing).<br /><br />**Late-Stage Treatment with SBRT:** <br />Stereotactic body radiotherapy (SBRT) has shown promise in managing oligoprogressive metastatic lung cancer, offering improved progression-free survival but requiring further validation through phase 3 trials.<br /><br />Key takeaways include the importance of accurate screening workups to differentiate benign from malignant disease, the changing landscape of lung cancer treatment including neo/adjuvant therapies based on molecular markers, and potential benefits of SBRT for specific advanced cancer cases. Pulmonologists play a vital role in biomarker testing and care coordination. <br /><br />Overall, while advancements in treatment and screening offer new hope, careful application and ongoing research are essential to maximize patient outcomes.

Keywords

lung cancer treatment

screening advancements

EGFR-positive tumors

ALK-positive tumors

pulmonary nodules

biomarker testing

guided bronchoscopy

SBRT

molecular markers

pulmonologists