Fast Facts: Non-Small-Cell Lung Cancer

148 Pages·2022·4.681 MB·English

by  O'Brien, Mary, Besse, Benjamin, Awad, Mark M.

Mary O’Brien
Benjamin Besse
Mark M Awad
Copyright 2022. S. Karger. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. EAABNcS:cC oO3u 2nP0tu4:b3 l3ni0ss 0h;1i 1nM8g.1 8LFN2:O 'aneBBrsoidoeutkn , C eoFoBl.dl aneBceictstisntoein,os g(MnE.BM-S.C OAhwS oasdt.C); -Fm apsrt©i nFa taSecdt. s o:aKn n Na7o/nr1-g1Sle/mc2ar0l l2lP2- Cu-9eeb:l0l lC9 is LAuhMner gv riCsaae nLcetrd 2l0l21
Fast Facts for Healthcare
Professionals
Non-Small-Cell Lung Cancer
2nd edition
Mary O’Brien MD FRCP
Consultant Medical Oncologist
The Royal Marsden NHS Foundation Trust
London, UK
Benjamin Besse MD PhD
Thoracic Cancer Unit, Head
Department of Cancer Medicine
Gustave Roussy
Villejuif, France
Mark M Awad MD PhD
Clinical Director, Lowe Center for Thoracic Oncology
Assistant Professor, Harvard Medical School
Dana-Farber Cancer Institute
Boston, Massachusetts, USA
With thanks to Drs Merina Ahmed, Wanyuan Cui, Michael Davidson, Simon Page and Shuai Zhang,
The Royal Marsden NHS Foundation Trust, London, UK; Dr Rajiv Kumar, University of Otago,
Dunedin, and St George’s Hospital, Christchurch, New Zealand; Dr Daisy Mak, Auckland Regional
Cancer and Blood Service, Auckland City Hospital, New Zealand; Dr Jordi Remon, Hospital HM
Delfos, Barcelona, Spain; and Dr David Walder, King’s College Hospital, London, UK.
Declaration of Independence
This book is as balanced and practical as we can make it.
Ideas for improvement are always welcome: [email protected]

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Fast Facts: Non-Small-Cell Lung Cancer
First published 2016
Second edition 2022
Text © 2022 Mary O’Brien, Benjamin Besse, Mark M Awad
© 2022 in this edition S. Karger Publishers Ltd
S. Karger Publishers Ltd, Elizabeth House, Queen Street, Abingdon,
Oxford OX14 3LN, UK
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Book orders can be placed by telephone or email, or via the website.
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All rights reserved. No part of this publication may be reproduced, stored in a retrieval
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Patents Act 1988 Sections 77 and 78.
The publisher and the authors have made every effort to ensure the accuracy of this book,
but cannot accept responsibility for any errors or omissions.
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A CIP record for this title is available from the British Library.
ISBN 978-3-318-07010-1
O’Brien M (Mary)
Fast Facts: Non-Small-Cell Lung Cancer/
Mary O’Brien, Benjamin Besse, Mark M Awad
Medical illustrations by Annamaria Dutto, Withernsea, UK
and Graeme Chambers, Belfast, UK.
Typesetting by Amnet, Chennai, India.
Printed in the UK with Xpedient Print.

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List of abbreviations 5
Introduction 7
Prevention and screening 9
Diagnosis and staging 21
Surgery 33
Radiotherapy 41
Systemic therapy in non-metastatic NSCLC 53
Systemic therapy in advanced-stage/metastatic 79
disease without a molecular driver
Personalized treatment in advanced NSCLC 87
Oligometastatic disease and brain metastases 125
Useful resources 141
Index 143

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List of abbreviations
AE: adverse event ICH: intracranial hemorrhage
AR: acquired resistance ICI: immune checkpoint inhibitor/
inhibition
ATP: adenosine triphosphate
IGRT: image-guided radiotherapy
BM: brain metastasis/metastases
IHC: immunohistochemistry
CHART: continuous
hyperfractionated accelerated ILD: interstitial lung disease
radiotherapy
IMA: invasive mucinous
CI: confidence interval adenocarcinoma
CNS: central nervous system IMRT: intensity-modulated
radiotherapy
COPD: chronic obstructive
pulmonary disease LAT: local ablative therapy
CT: computed tomography LDCT: low-dose computed
tomography
ctDNA: circulating tumor DNA
MPR: major pathological response
CTLA-4: cytotoxic T lymphocyte-
associated protein 4 MRC: Medical Research Council
DFS: disease-free survival MRD: minimal residual disease
DNA: deoxyribonucleic acid MRI: magnetic resonance imaging
ECOG: Eastern Cooperative Oncology NGS: next-generation sequencing
Group
NLST: National Lung Screening Trial
ECS: extracapsular nodal spread
NSCLC: non-small-cell lung cancer
EFS: event-free survival
(NSCLC) NOS: not otherwise specified
EMA: European Medicines Agency
OM: oligometastatic
FDA: (US) Food and Drug
OS: overall survival
Administration
pCR: pathological complete response
FDG: fluorodeoxyglucose
PCR: polymerase chain reaction
FISH: fluorescence in situ hybridization
PD-1: programmed cell death
GGO: ground-glass opacity
protein 1
HIV: human immunodeficiency virus
PD-L1: programmed cell death
HR: hazard ratio ligand 1
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Non-Small-Cell Lung Cancer
PET: positron emission tomography T-Dxd: trastuzumab deruxtecan
PFS: progression-free survival
TKI: tyrosine kinase inhibitor
PORT: postoperative radiotherapy
TMB: tumor mutation burden
PS: performance status
RATS: robotic-assisted thoracoscopic TNM: tumor-node-metastasis
surgery
TPS: tumor proportion score
RCT: randomized controlled trial
TRK: tropomyosin receptor kinase
RNA: ribonucleic acid
RR: response rate VATS: video-assisted thoracoscopic
SABR: stereotactic ablative surgery
radiotherapy
VDT: volume doubling time
SACT: systemic anticancer treatment
SBRT: stereotactic body radiotherapy VEGFR2: vascular endothelial growth
factor receptor 2
SCLC: small-cell lung cancer
SoC: standard of care VMAT: volumetric arc therapy
SRS: stereotactic radiosurgery
WBRT: whole-brain radiotherapy
T-DM1: trastuzumab and
ado-trastuzumab emtansine WHO: World Health Organization
6

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Introduction
Despite an overall decrease in tobacco use, lung cancer (80–85% of
which is non-small-cell lung cancer [NSCLC]) is still the leading cause
of cancer death in both men and women worldwide.
Annual low-dose CT screening of high-risk individuals has
the potential to detect early-stage tumors, which can usually be
successfully treated with a combination of surgery, radiotherapy
and chemotherapy and, in some cases, targeted therapy. However,
most patients with NSCLC still present with advanced or metastatic
disease. For these patients, initial therapy is guided by the tumor’s
molecular characteristics and patient’s performance status. Targeted
therapies have significantly improved clinical outcomes and, for some
patients with no targetable genetic alterations, immunotherapy has
demonstrated significant overall survival benefit.
This insightful guide is designed to bring you up to speed with
the latest developments and is important reading for all health
professionals and medical trainees working in this fast-moving field.
7

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1   Prevention and screening
David Walder MBBS BSc MRCP(UK)
Consultant Respiratory Physician,
King‘s College Hospital, London, UK

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