Pulmonary Adenocarcinoma: Approaches to Treatment, 1e

Description

Get a quick, expert overview of the latest treatment and management approaches for adenocarcinoma of the lung, including novel therapeutics in immunotherapy and targeted therapies. This practical title, edited by Dr. Leora Horn, offers succinct coverage of clinically-focused topics and guidelines, making it an ideal resource for practicing and trainee oncologists and other members of the cancer care team. Discusses surgical approaches, molecular testing, adjuvant therapy, first- and second-line therapy, and much more. Helps you translate current research and literature into practical information for daily practice. Consolidates today's available information on this timely topic into one convenient resource. Cover Pulmonary Adenocarcinoma: Approaches to Treatment Copyright List of Contributors Preface 1. The Surgical Management of Pulmonary Adenocarcinoma INTRODUCTION STAGING Initial Staging: Imaging Pathologic Staging: Tissue Diagnosis for Suspected Lung Cancer Endobronchial and Transbronchial Biopsy Surgical Lung Biopsy Pathologic Mediastinal Assessment ASSESSING SURGICAL CANDIDACY Smoking Cessation Assessment of Cardiovascular Risk Assessment of Pulmonary Function SURGICAL MANAGEMENT OF LUNG CANCER Early-Stage Lung Cancer Locally Advanced Lung Cancer T3N1 Tumors N2 Disease T4 Tumors Superior Sulcus Tumors Oligometastatic Disease SURGICAL APPROACH TO LUNG CANCER Open Lobectomy Video-Assisted Thoracoscopic Surgery Lobectomy Robotic Lobectomy Uniportal and Subxiphoid Lobectomy IMPORTANT SURGICAL CONSIDERATIONS Extent of Resection Extent of Lymph Node Resection CONCLUSION REFERENCES FURTHER READING 2. Pulmonary Adenocarcinoma—Pathology and Molecular Testing INTRODUCTION HISTOLOGICAL CLASSIFICATION CLINICAL RELEVANCE OF ADENOCARCINOMA SUBTYPE CLASSIFICATION Lepidic Predominant Adenocarcinoma (Good Prognosis) Acinar/Papillary Predominant Adenocarcinoma (Intermediate Prognosis) Micropapillary and Solid Predominant Adenocarcinoma (Poor Prognosis) Invasive Mucinous Adenocarcinoma PATHOLOGICAL STAGING OF LUNG ADENOCARCINOMA—UICC/AJCC EIGHTH EDITION MOLECULAR CLASSIFICATION TRANSCRIPTOMIC CLASSIFICATIONS Terminal Respiratory Unit Subtype Proximal Inflammatory Subtype Proximal Proliferative Subtype ONCOGENIC DRIVER MUTATIONS AND MOLECULAR TESTING IN LUNG ADENOCARCINOMA Molecular Testing Methods EPIDERMAL GROWTH FACTOR RECEPTOR Secondary Resistance Mutations Activation of Bypass Pathways Activation of Downstream Pathways Histologic Transformation Epidermal Growth Factor Receptor Mutation Testing Nontargeted assays Targeted assays ANAPLASTIC LYMPHOMA KINASE ROS1 ALK AND ROS1 TESTING Break Apart FISH Assay Reverse Transcription-Polymerase Chain Reaction Fusion Protein Detection of ALK and ROS1 by IHC Next-Generation Sequencing OTHERS DRIVER ONCOGENES MET KRAS BRAF RET NTRK1 HER2 LIQUID BIOPSIES Circulating Tumor Cells Circulating Tumor DNA Targeting Specific Molecular Alterations Targeting Multiple Molecular Alterations Clinical Applications Assessing Tumor Burden Characterizing Resistance Mechanisms Monitoring Response to Therapy PROGRAM DEATH LIGAND 1 Program Death Ligand 1 Testing CONCLUSIONS REFERENCES 3. Adjuvant and Neoadjuvant Therapy in Non–Small-Cell Lung Cancer INTRODUCTION ADJUVANT CHEMOTHERAPY STAGE I DISEASE CHOICE OF CHEMOTHERAPY ADJUVANT RADIATION THERAPY NEOADJUVANT CHEMOTHERAPY MOLECULARLY TARGETED THERAPY IMMUNOTHERAPY NEOADJUVANT IMMUNOTHERAPY CONCLUSIONS AND FUTURE DIRECTIONS REFERENCES 4. Management of Locally Advanced Lung Cancer INTRODUCTION ANATOMY SCREENING MANIFESTATIONS Symptoms Paraneoplastic Syndromes WORKUP Imaging Sputum Cytology Mediastinoscopy Endobronchial Ultrasound–Guided Transbronchial Needle Aspiration Fiberoptic Bronchoscopy with Bronchoalveolar Lavage HISTOLOGY Adenocarcinoma Squamous Cell Carcinoma Large-Cell Lung Carcinoma Molecular Analysis STAGING (EIGHTH EDITION) (TABLES 4.3 AND 4.4) Pleural Invasion MANAGEMENT Smoking Cessation RESECTABLE LA-NSCLC Induction Chemotherapy Trimodality SUPERIOR SULCUS TUMORS Postoperative Radiation Therapy Radiation Alone Postoperative Chemoradiation Adjuvant Chemotherapy UNRESECTABLE LA-NSCLC Radiation Alone Sequential Chemoradiation Sequential and Concurrent Chemoradiotherapy Consolidation Chemotherapy TARGETED THERAPIES Epidermal Growth Factor Receptor Cetuximab Gefitinib Erlotinib Bevacizumab and Thalidomide Anaplastic Lymphoma Kinase IMMUNOTHERAPY Programmed Death Ligand 1 Combining Immunotherapy and Radiotherapy RADIOTHERAPY Dose VOLUMES Gross Tumor Volume Clinical Target Volume Planned Target Volume MODALITIES Photons: 2-D, 3-D, and Intensity-Modulated Radiotherapy Planning Protons Carbon Ions REFERENCES 5. First-Line Therapy for Wild-Type Patients CHEMOTHERAPY DURATION OF CHEMOTHERAPY BEVACIZUMAB MAINTENANCE THERAPY IMMUNOTHERAPY ELDERLY PATIENTS IMPAIRED PERFORMANCE STATUS CONCLUSIONS REFERENCES 6. Lung Adenocarcinoma: Second-Line Treatment INTRODUCTION CYTOTOXIC CHEMOTHERAPY–MONOTHERAPY Docetaxel Pemetrexed Other Cytotoxic Agents COMBINATION CHEMOTHERAPY TARGETED AGENTS Epidermal Growth Factor Receptor Vascular Endothelial Growth Factor Mitogen-Activated Protein Kinase Kinase IMMUNOTHERAPY Nivolumab Pembrolizumab Atezolizumab CONCLUSION REFERENCES 7. Epidermal Growth Factor Receptor–Mutant Non–Small-Cell Lung Cancer EPIDEMIOLOGY DIAGNOSIS TREATMENT First- and Second- Generation EGFR TKIs ACQUIRED RESISTANCE TO FIRST- AND SECOND-GENERATION TKIS AND THE DEVELOPMENT OF THIRD-GENERATION EGFR TKIS CYTOTOXIC CHEMOTHERAPY IMMUNE THERAPY ADJUVANT THERAPY TREATMENT BEYOND PROGRESSION AND OLIGOPROGRESSIVE DISEASE CNS METASTASES SMALL-CELL LUNG CANCER TRANSFORMATION EXON 20 INSERTION MUTATIONS TREATMENT OF SELECTED TKI TOXICITIES SUMMARY OF CURRENT TREATMENT RECOMMENDATIONS FUTURE DIRECTIONS REFERENCES 8. Approach to Anaplastic Lymphoma Kinase (ALK) Gene Rearranged Non–Small Cell Lung Cancer (NSCLC) INTRODUCTION CLINICAL FEATURES OF ANAPLASTIC LYMPHOMA KINASE POSITIVE NON–SMALL CELL LUNG CANCER TESTING FOR ANAPLASTIC LYMPHOMA KINASE APPROACH TO ADVANCED-STAGE ANAPLASTIC LYMPHOMA KINASE PATIENT CRIZOTINIB NEXT-GENERATION ALK INHIBITORS IN CRIZOTINIB-TREATED PATIENTS NEXT-GENERATION ALK TKIS AS FRONT-LINE THERAPY ALECTINIB AF-001JP JALEX (TABLE 8.3) ALEX (TABLE 8.3) SUMMARY OF ALEX AND JALEX CERITINIB OTHER DRUGS RESISTANCE TO NEXT-GENERATION ALK INHIBITORS SEQUENCE OF ALK INHIBITORS (FIGS. 8.1 AND 8.2) NON-ALK-DIRECTED THERAPY CENTRAL NERVOUS SYSTEM METASTASES MANAGEMENT OF PATIENTS WITH OLIGOMETASTATIC DISEASE EARLY-STAGE AND LOCALLY ADVANCED ALK POSITIVE NSCLC FUTURE DIRECTIONS REFERENCES 9. Targeted Therapy in Non–Small-Cell Lung Cancer (Beyond Epidermal Growth Factor Receptor and Anaplastic Lymphoma Kinase) INTRODUCTION ROS1 BRAF MESENCHYMAL–EPITHELIAL TRANSITION RET HUMAN EPIDERMAL GROWTH FACTOR RECEPTOR 2 NEUROTROPHIN TYROSINE RECEPTOR KINASE–MUTATED NSCLC CONCLUSIONS REFERENCES 10. Treatment of Pulmonary Adenocarcinoma With Immune Checkpoint Inhibitors INTRODUCTION PREVIOUSLY TREATED ADVANCED NON–SMALL CELL LUNG CANCER TREATMENT-NAÏVE ADVANCED NON–SMALL CELL LUNG CANCER Early Phase Studies in Treatment-Naïve NSCLC Randomized Phase III Studies in Treatment-Naïve NSCLC Combination of Chemotherapy and Checkpoint Inhibition UNRESECTABLE STAGE III NON–SMALL CELL LUNG CANCER Combination of Radiation and Immunotherapy SAFETY AND MANAGEMENT OF TOXICITY BIOMARKERS Clinicopathologic Markers Smoking status EGFR Status PD-L1 Expression Tumor Mutation Burden T-Effector Gene Signature Expression TREATMENT DURATION ONGOING STUDIES/FUTURE DIRECTIONS REFERENCES Index A B C D E F G H I J K L M N O P Q R S T U V W