IMpower210:A phase Ⅲ study of second-line atezolizumab vs. docetaxel in East Asian patients with non-small cell lung cancer

Objective: IMpower210(NCT02813785) explored the efficacy and safety of single-agent atezolizumab vs.docetaxel as second-line treatment for advanced non-small cell lung cancer(NSCLC) in East Asian patients.Methods: Key eligibility criteria for this phase Ⅲ, open-label, randomized study included age ≥18 years;histologically documented advanced NSCLC per the Union for International Cancer Control/American Joint Committee on Cancer staging system(7th edition);Eastern Cooperative Oncology Group performance status of 0 or 1;and disease progression following platinum-based chemotherapy for advanced or metastatic NSCLC. Patients were randomized 2:1 to receive either atezolizumab(1,200 mg) or docetaxel(75 mg/m^(2)). The primary study endpoint was overall survival(OS) in the intention-to-treat(ITT) population with wild-type epidermal growth factor receptor expression(ITT EGFR-WT) and in the overall ITT population.Results: Median OS in the ITT EGFR-WT population(n=467) was 12.3 [95% confidence interval(95% CI),10.3-13.8] months in the atezolizumab arm(n=312) and 9.9(95% CI, 7.8-13.9) months in the docetaxel arm[n=155;stratified hazard ratio(HR), 0.82;95% CI, 0.66-1.03]. Median OS in the overall ITT population was 12.5(95% CI, 10.8-13.8) months with atezolizumab treatment and 11.1(95% CI, 8.4-14.2) months(n=377) with docetaxel treatment(n=188;stratified HR, 0.87;95% CI, 0.71-1.08). Grade 3/4 treatment-related adverse events(TRAEs) occurred in 18.4% of patients in the atezolizumab arm and 50.0% of patients in the docetaxel arm.Conclusions: IMpower210 did not meet its primary efficacy endpoint of OS in the ITT EGFR-WT or overall ITT populations. Atezolizumab was comparatively more tolerable than docetaxel, with a lower incidence of grade3/4 TRAEs.

Advances in lung cancer screening and early detection

Lung cancer is associated with a heavy cancer-related burden in terms of patients’physical and mental health worldwide.Two randomized controlled trials,the US-National Lung Screening Trial(NLST)and Nederlands-Leuvens Longkanker Screenings Onderzoek(NELSON),indicated that low-dose CT(LDCT)screening results in a statistically significant decrease in mortality in patients with lung cancer,LDCT has become the standard approach for lung cancer screening.However,many issues in lung cancer screening remain unresolved,such as the screening criteria,high false-positive rate,and radiation exposure.This review first summarizes recent studies on lung cancer screening from the US,Europe,and Asia,and discusses risk-based selection for screening and the related issues.Second,an overview of novel techniques for the differential diagnosis of pulmonary nodules,including artificial intelligence and molecular biomarker-based screening,is presented.Third,current explorations of strategies for suspected malignancy are summarized.Overall,this review aims to help clinicians understand recent progress in lung cancer screening and alleviate the burden of lung cancer.

Video-assisted thoracic surgery for ambiguous lung or mediastinal masses in response assessments for hematological malignancies

To the Editor:The morbidity of thoracic lesions is very high during the treatment of malignant hematological diseases,and tumor recurrence or invasion is common,in addition to infections.Percutaneous lung biopsy or bronchoscopy could result in severe hemoptysis,pneumothorax,or infection because of low platelets and hypo-immunity,and treatment is often ineffective due to the ambiguous diagnosis.Even when a patient is diagnosed with a fungal disease,it is difficult to eliminate the lesion with only antifungal medicine.