Description:

Although lung cancer screening (LCS) with low dose computed tomography has been shown to reduce lung cancer mortality, benefits and harms of screening vary among eligible adults. The goal of this study was to evaluate whether LCS is more commonly used among populations most likely to benefit, namely adults with high lung cancer risk and low comorbidity. In this cohort study of patient’s eligible for LCS, we used data from the electronic health record to evaluate the relationship between lung cancer risk, comorbidity, and receipt of LCS. We also evaluated use of diagnostic chest CT. Analyses used a nonparametric test for trend across quartiles of lung cancer risk and comorbidity. The study sample included 551 LCS-eligible adults who were followed for a mean 2.9 years (SD 1.6 years). A cumulative 190 (34 %) received at least 1 LCS, and 141 (26 %) had a diagnostic chest CT. Receipt of LCS increased across quartiles of lung cancer risk (5 per 100 person years in the lowest quartile vs 13 per 100 person-years in the highest, p < 0.001 for test of trend). LCS receipt decreased across increasing quartiles of comorbidity (14 vs 8 per 100 person-years, p = 0.008). Diagnostic CT was more common in among patient with higher levels of comorbidity (15 vs 5 per 100 person-years, p < 0.001). In conclusion, lung cancer screening was more commonly used in patients with greater lung cancer risk and lower comorbidity. Results suggest that both patient characteristics and use of diagnostic imaging may shape current patterns of LCS use. This study evaluated a different form of autoantibody, which is on small extracellular vesicles (sEVs), as a biomarker for early detection of lung cancer. The sEVs were isolated from plasma by ultracentrifugation and validated with morphology and typical markers. The autoantibody levels were quantified by enzyme-linked immunosorbent assay, and further analysis indicated that the autoantibody panel on sEVs was better than that from serum to distinguish benign lung disease (n = 32) from lung cancer (n = 90). In the prospective study, autoantibody on sEVs performed better in identification of patients with a higher risk of lung cancer. Furthermore, with immunogold labeling transmission electron microscopy, Nanoflow cytometer and binding tests, we illustrated that the autoantibodies could bind to the antigens on sEVs, which may explain the detected autoantibodies on sEVs. Besides, the binding resulted in the attenuation of complement-mediated cytotoxicity, which may contribute to the immune escape of lung cancer.

As novel therapeutic regimens continue to lead to increased survival of lung cancer patients, it is imperative to remain mindful of the accompanying increase in the incidence of new primary malignancies. While the most common secondary malignancies in patients with lung cancer have historically included colon, rectal, esophageal, and thyroid cancers, we report here two rare cases of new primary hepatocellular carcinomas (HCC) in patients receiving immune checkpoint inhibitor (ICI) therapy for non-small cell lung cancer (NSCLC). In both cases, the diagnosis of HCC, rather than assuming a hepatic metastasis, was crucial for determining the appropriate approach for treatment. These cases thus underscore the importance of appropriate diagnostics to ensure that the proper therapeutics are chosen and present important considerations for the lung cancer community going forward. Lung cancer remains the most significant cause of cancer death, accounting for about 20% of all cancer-related mortality. A significant reason for this is delayed diagnosis, either due to lack of symptoms in early-stage disease or presentation with non-specific symptoms common with a broad range of alternative diagnoses. More is needed in terms of increasing public awareness, providing adequate healthcare professional education and implementing clinical pathways that improve the earlier diagnosis of symptomatic lung cancer. Low-dose computed tomography screening of high-risk, asymptomatic populations has been shown to reduce lung cancer mortality, with focus now shifting towards how best to implement lung cancer screening on a wider scale in a safe, efficient and cost-effective manner. For maximum benefit, efforts must be made to optimise uptake, especially among high-risk populations with significant socioeconomic deprivation, as well as successfully incorporate tobacco-dependency treatment. Quality assured programme management will be critical to minimising screening-related harms and adequately managing incidental findings. By undertaking the above, there can be optimism that lung cancer outcomes can be improved significantly in the near future.

With Regards

Wilson
Journal Coordinator
Global Journal of Research and Review