AimsThis study aimed to predict post-transplant malignancy risks at multiple levels among lung transplant recipients using machine learning (ML) and to identify key clinical and immunogenetic predictors.Materials and methodsA dataset of 30,917 lung transplant recipients with no prior cancer history was analyzed using pre-, peri-, and post-transplant variables. Multiple ML algorithms—gradient boosting, random forest, neural networks, and logistic regression—were applied to predict: (1) overall de novo malignancies (DNM), (2) skin versus non-skin cancers, and (3) skin cancer subtypes, including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).ResultsGradient boosting achieved the highest AUC for overall malignancies (0.746) and skin versus non-skin cancers (0.642), while random forest performed best for BCC versus SCC classification (AUC = 0.726). Significant predictors included HLA-DR alleles (DR52, DR1, DR53), A locus mismatch, recipient ethnicity, BMI, serum albumin, CMV/EBV serostatus, and cardiac-related measures (LV remodeling, cardiac output, prior cardiac surgery). Additional subtype predictors included peak PRA Class I sensitization, insulin signaling, donor-derived transfusions, and waiting list duration.ConclusionsML-driven predictive modeling enables personalized assessment of post-transplant malignancy risk, supporting early detection, targeted surveillance, and optimized long-term care for lung transplant recipients.

Multiple primary lung cancersare becoming increasingly recognised and pose diagnostic and staging uncertainties with challenging management options and prognostication. We describe a case of synchronous multiple primary lung canceroccurring bilaterally, and the steps in reaching the diagnosis, initial surgical management, the intensive follow-up this underwent, and how its subsequent recurrence led to treatment with radiation therapy in light of the patient's declining fitness. This case highlighted that cytological recurrence could occur prior to radiological recurrence, especially for endobronchial tumors, and intensive follow-up both radiologically and endoscopically with multidisciplinary input is crucial in the management of these challenging cases where evidence-based guidelines are limited.

This retrospective study aimed to assess the efficacy and safety of ensartinib in Chinese patients with ALK-positive advanced NSCLCin real-world clinical practice. Clinical data from ALK-positive NSCLC patients treated with ensartinib in China were collected and analyzed. Efficacy end points included objective response rate and progression-free survival. Safety profiles were also evaluated. A total of 682 patients were included in this study. The study demonstrated promising efficacy with an objective response rate of 54.0%, and the median progression-free survival was not estimable. Ensartinib exhibited a manageable safety profile with treatment-related adverse events (TRAEs) consistent with prior clinical trials. The most common TRAE was rash (21.1%) and no TRAE led to death. Ensartinib is active and well tolerated for ALK-positive NSCLC patients in real-world clinical settings.

Aim:Immune checkpoint inhibitors (ICIs) are a cornerstone in cancer treatment but they can induce immune-related adverse events (irAEs). Furthermore, patients with pre-existing autoimmune and/or inflammatory disease (AID) have been excluded from clinical trials. The objective of this study is to evaluate the efficacy and safety of ICIs in patients with cancer and AID.Materials & methods:This is an observational, retrospective study carried out at the Medical Oncology Department of Hospital Universitario Puerta de Hierro, Majadahonda, Madrid between January 2016 and December 2018.Results:A total of 202 cancer patients treated with ICIs were included, 15 (7, 4%) of them had pre-existing autoimmune diseases. The most frequent pre-existing AID were thyroid diseases (33.3%): autoimmune hypothyroidism, Graves–Basedow disease and Hashimoto’s thyroiditis. Three patients had psoriasis, two antinuclear antiboides + polyarthritis, one rheumatoid arthritis, another latent autoimmune diabetes in adults, another systemic lupus erythematosus and the last one, a polymyalgia rheumatica. In this series, the majority of patients (73.33%) did not experience any flare up of their autoimmune disease. In patients who had AID flare up, this was treated with corticosteroids. The most frequent cause of immunotherapy discontinuation was tumor progression (40%). A total of 20% of patients had to discontinue immunotherapy due to toxicity.Conclusion:In our series, AID flare ups or irAEs in patients with pre-existing AID who receive immunotherapy are not very common and can often be controlled without interrupting treatment. Prospective studies are needed to establish the incidence of irAEs in patients with pre-existing autoimmune conditions, evaluate risk–benefit and elaborate management clinical guidelines in this population.

Globally, engagement of patients in the self management of disease and symptom problems has become a health policy priority to improve health outcomes in cancer. Unfortunately, little attention has been focused on the provision of self-management support (SMS)in cancer and specifically for complex cancer symptoms such as breathlessness. Current management of breathlessness, which includes treatment of underlying disease, pharmacological agents to address comorbidities and opiates and anxiolytics to change perception and reduce the sense of breathing effort, is inadequate. In this perspective paper, we review the rationale and evidence for a structured, multicomponent SMS program in breathlessness including four components: breathing retraining, enhancing positive coping skills, optimizing exertional capacity and reducing symptom burden and health risks. The integration of SMS in routine lung cancer care is essential to improve breathlessness, reduce psychological distress, suffering and improve quality of life.

Aim:We evaluated the efficacy of a novel switch protocol for EGFR-TKIs for EGFR mutation-positive NSCLC.Materials & methods:Clinical records were collected from the patients who had received one of two sequential combination strategies of EGFR-TKIs: Salvage use of osimertinib for T790M-mediated acquired resistance to an prior EGFR-TKI or switch use of osimertinib where an EGFR-TKI was switched to osimertinib before disease progression.Results:Progression-free survival of osimertinib and time from the start of treatment until progression to osimertinib was comparable between the salvage use and switch use of osimertinib.Conclusion:Switch use of osimertinib seemed to produce improved efficacy for patients with activating EGFR mutations, because of the lack of patient selection via T790M.

Stage I/II NSCLC surgical patients with MRD undergoing liquid biopsy postoperatively would be the ideal target population for assessment of the impact of adjuvant targeted systemic therapy on disease-free survival.

Aim:To determine whether PET/CT and brain MRI used in staging NSCLC can be accurate, reliable and cost-effective tools. NSCLC represents 80–85% of lung cancer and adequate information on the initial tumor staging is critical for planning an optimal therapeutic strategy.Patients & methods:Data from 30 newly diagnosed NSCLC patients in Greece were collected and prospectively recorded. Patients with potential resectable disease were evaluated to ensure that there are no detectable metastases that would rule out the possibility of a curative surgery.Results:Divergence occurred in 50% of cases of staging with CT or PET/CT alone, while metastases undetectable by the CT were revealed using PET/CT. Unnecessary thoracotomies were avoided by 10% of patients and another 10% was operated on after chemotherapy with a better prognosis.Conclusion:PET/CT and brain MRI combined are reliable for correct staging, reducing avoidable thoracotomies, morbidity rates and costs.