Targeted therapeutic options in early and metastatic NSCLC-overview.

The complex therapeutic strategy of non-small cell lung cancer (NSCLC) has changed significantly in recent years. Disease-free survival increased significantly with immunotherapy and chemotherapy registered in perioperative treatments, as well as adjuvant registered immunotherapy and targeted therapy (osimertinib) in case of EGFR mutation. In oncogenic-addictive metastatic NSCLC, primarily in adenocarcinoma, the range of targeted therapies is expanding, with which the expected overall survival increases significantly, measured in years. By 2021, the FDA and EMA have approved targeted agents to inhibit EGFR activating mutations, T790 M resistance mutation, BRAF V600E mutation, ALK, ROS1, NTRK and RET fusion. In 2022, the range of authorized target therapies was expanded. With therapies that inhibit KRASG12C, EGFR exon 20, HER2 and MET. Until now, there was no registered targeted therapy for the KRAS mutations, which affect 30% of adenocarcinomas. Thus, the greatest expectation surrounded the inhibition of the KRAS G12C mutation, which occurs in ∼15% of NSCLC, mainly in smokers and is characterized by a poor prognosis. Sotorasib and adagrasib are approved as second-line agents after at least one prior course of chemotherapy and/or immunotherapy. Adagrasib in first-line combination with pembrolizumab immunotherapy proved more beneficial, especially in patients with high expression of PD-L1. In EGFR exon 20 insertion mutation of lung adenocarcinoma, amivantanab was registered for progression after platinum-based chemotherapy. Lung adenocarcinoma carries an EGFR exon 20, HER2 insertion mutation in 2%, for which the first targeted therapy is trastuzumab deruxtecan, in patients already treated with platinum-based chemotherapy. Two orally administered selective c-MET inhibitors, capmatinib and tepotinib, were also approved after chemotherapy in adenocarcinoma carrying MET exon 14 skipping mutations of about 3%. Incorporating reflex testing with next-generation sequencing (NGS) expands personalized therapies by identifying guideline-recommended molecular alterations.

[Endobronchial ultrasonography in postintubation tracheal stenosis]. / Endobronchialis ultrahangvizsgálat postintubatiós tracheastenosisban.

INTRODUCTION: The correct evaluation of the tracheal wall's structure is necessary for the management of postintubation tracheal stenosis (PTS). Endobronchial ultrasonography (EBUS) is suitable for visualisation of layers of the tracheal wall and the assessment of cartilages' damage. AIM: The authors assessed the usefulness of EBUS in the anatomical characterization of PTS and in the decision making in its therapy. PATIENTS, METHODS: Between March 2002, and September 2003, 22 patients with PTS were examined by bronchoscopy together with EBUS. RESULTS: 13 patients had complex stenosis and from them destruction of tracheal cartilage was demonstrated in 5 patients. Of them bronchoscopic intervention resulted in only short term symptom free period in 3 patients. CONCLUSION: The destruction of tracheal cartilage detected by EBUS might be an indication for an early surgical intervention. According to author's results EBUS can be a useful method in evaluation of PTS.

[Our experience using autofluorescence bronchoscopy]. / Autofluoreszcens bronchoszkópiával szerzett tapasztalataink.

INTRODUCTION: Lung cancer is responsible for most cancer deaths in the world. The main reason for the poor prognosis is late diagnosis. Many patients could be successfully treated in early stage. AIMS: The authors performed 369 bronchological examination on 336 patients using autofluorescence bronchoscopy between 1998 and 2003 to detect preinvasive lesions and early forms of lung cancer. METHODS: Storz D-Light autofluorescence system has been used to perform the examinations. RESULTS: In one third of these patients invasive lung cancer developed during follow-up. Combining traditional white light and autofluorescence technique 50% more intraepithelial lesions have been observed and sensitivity has been increased by 69% compared to the lone use of white light bronchoscopy. CONCLUSIONS: Supported by most international studies these results emphasise that autofluorescence bronchoscopy has a major role in the early diagnosis of preinvasive bronchial lesions and may help in the prevention and early therapy of lung cancer.

[Tumor-like tracheal and lung diseases in biopsy samples]. / Hörgó- és tracheatumort utánzó elváltozások biopsiás anyagunkban.

Tumor like miscellaneous lung diseases are rare conditions. They can be confused with benign and malignant tumors. We describe the clinicopathological features some of this conditions i.e.: two cases of osteoplastic tracheopathy, one inflammatory tracheal polyp, two cases of tumor mimicking foreign body aspiration, and one case of tracheobronchial amyloidosis.

[Benign pulmonary and tracheal tumors in our biopsies]. / Jóindulatú trachea- és hörgótumorok biopsiás anyagunkban.

INTRODUCTION: Benign lung and trachea tumors account for only a small percentage of a bronchologist's and a histopathologist's everyday practice. AIMS: The authors describe the clinicopathological features some of these tumors because they may be confused with malignant conditions. To avoid misdiagnosis of malignancy the knowledge of bronchologic and histologic appearance of these tumors is important. RESULTS: In the past three years 1453 cases were examined and 14 cases of benign tumors were diagnosed, which is 1% of the total number of biopsies and 2.68% of the tumor cases. The diagnoses were: granular cell tumor (Abrokosoff's tumor), neurilemmoma, hemangioma, endobronchial hamartoma, and papillary adenoma. Two of the reported tumors: granular cell tumor and papillary adenoma appeared in the trachea. Tracheal granular cell tumor and bronchial hemangioma were incidental findings beside bronchial carcinoma. CONCLUSION: To our best knowledge this is the fifth reported case of the coexistence of Abrikossoff's tumor with bronchial carcinoma.

[Endobronchial ultrasonography]. / Endobronchialis ultrahangvizsgálat.

Endobronchial ultrasonography is an imaging method which has been developed during the last decade. It can be performed by applying tools that are used today during conventional bronchofiberscopy. This method is recommended for identifying processes that affect the bronchial wall and the mediastinal lesions next to central airways as well as for localizing peripheral lung lesions. The authors present a compilation of publications and summarize their own experiences based on 44 cases of application of this method.