Updates in pharmacotherapy for non-small cell lung cancer: a focus on emerging tubulin inhibitors.

INTRODUCTION: The treatment landscape of non-small cell lung cancer (NSCLC) has seen significant advancements in recent years, marked by a shift toward target agents and immune checkpoint inhibitors (ICIs). However, chemotherapy remains a cornerstone of treatment, alone or in combination. Microtubule-targeting agents, such as taxanes and vinca alkaloids, play a crucial role in clinical practice in both early and advanced settings in NSCLC. AREA COVERED: This review outlines the mechanisms of action, present significance, and prospective advancements of microtubule-targeting agents (MTAs), with a special highlight on new combinations in phase 3 trials. The online databases PubMed, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched using the terms 'Microtubule-targeting agents' and 'non-small cell lung cancer' or synonyms, with a special focus over the last 5 years of publications. EXPERT OPINION: Despite the emergence of immunotherapy, MTA remains crucial, often used alongside or after immunotherapy, especially in squamous cell lung cancer. Next-generation sequencing expands treatment options, but reliable biomarkers for immunotherapy are lacking. While antibody-drug conjugates (ADCs) show promise, managing toxicities remain vital. In the early stages, MTAs, possibly with ICIs, are standard, while ADCs may replace traditional chemotherapy in the advanced stages. Nevertheless, MTAs remain essential in subsequent lines or for patients with contraindications.

Immunotherapy-chemotherapy combinations for non-small cell lung cancer: current trends and future perspectives.

INTRODUCTION: In recent years, immunotherapy has become a pillar in the treatment of advanced, non-oncogene-addicted non-small cell lung cancer (NSCLC). Programmed death ligand 1 (PD-L1) expression is currently the only factor used to predict response to immunotherapy in clinical practice. Specifically, single-agent pembrolizumab as first-line therapy is approved for tumors with high expression of PD-L1 (≥50%) while immunotherapy and chemotherapy are approved for any PD-L1. However, combinations of immune-checkpoint inhibitors (ICIs) and other agents may confer higher benefit than immunotherapy alone in some circumstances. AREAS COVERED: We reviewed the available data regarding the combined use of ICIs and chemotherapy in patients with advanced, treatment-naïve NSCLC. In light of the benefit demonstrated in advanced disease, these combinations have been subsequently tested in other settings. We collected the most relevant findings regarding efficacy and safety of chemo-immunotherapy combinations in early and locally advanced NSCLC. EXPERT OPINION: Immune-chemotherapy combinations demonstrated benefit in the advanced setting, and this strategy in now being applied in the early and local advanced settings. A description of clinical and biological predictors of response is required in order to identify patients who may benefit the most from combination therapy.

A systematic review of microsurgical reconstruction of the jaws using vascularized fibula flap technique in patients with bisphosphonate-related osteonecrosis.

OBJECTIVE: The aim of this systematic review was to assess the role of microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis, and biological complications after an observation period of at least 12 months. MATERIAL AND METHODS: An electronic MEDLINE search supplemented by manual searching was conducted to identify studies reporting data of at least 12 months observation on the microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis. RESULTS: Four studies resulted eligible for the analysis yielded. Three out of five studies were free of complications, with a success rate of 100% as no recurrence of osteonecrosis was registered. CONCLUSIONS: Microsurgical reconstruction of the jaws represents a valid treatment modality in patients with bisphosphonate-related osteonecrosis at 3rd stage of the disease.

A systematic review of microsurgical reconstruction of the jaws using vascularized fibula flap technique in patients with bisphosphonate-related osteonecrosis

OBJECTIVE: The aim of this systematic review was to assess the role of microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis, and biological complications after an observation period of at least 12 months. Material and methods: An electronic MEDLINE search supplemented by manual searching was conducted to identify studies reporting data of at least 12 months observation on the microsurgical reconstruction of the jaws in patients with bisphosphonate-related osteonecrosis. RESULTS: Four studies resulted eligible for the analysis yielded. Three out of five studies were free of complications, with a success rate of 100 percent as no recurrence of osteonecrosis was registered. CONCLUSIONS: Microsurgical reconstruction of the jaws represents a valid treatment modality in patients with bisphosphonate-related osteonecrosis at 3rd stage of the disease.

Differences in oral health among Italian adolescents related to the type of secondary school attended.

PURPOSE: The aim of the present study was to evaluate the possible interaction between the type of secondary school attended, oral clinical data and self-perceived oral health (SPOH) behaviour among Italian adolescents. MATERIALS AND METHODS: A total of 913 adolescents living in Milan (Italy), attending two different types of secondary schools, grammar and technical secondary schools, were examined regarding dental caries and gingival conditions. Oral health behaviour data were collected using an anonymous questionnaire. The presence of caries was recorded using the decayed missed filled tooth (DMFT) index, gingival conditions with community periodontal index (CPI) following World Health Organization recommendations. Stepwise logistic regression was applied to determine whether the type of school attended was associated with the clinical outcome variables and subjects' SPOH and with oral health or lifestyle behaviour. RESULTS: The prevalence of caries was 59.8% (95% CI = 41.3 to 76.8); a third of participants showed a CPI = 0, whereas 34.9% had bleeding at probing and 37.9% had calculus. Caries distribution was significantly related to the type of school attended in each score of the DMFT categorisation (P < 0.01). Experience of tooth discomfort was claimed by 23.6% of subjects from grammar schools and 35.3% from technical schools (P < 0.01). In males, CPI > or = 1 was associated with the type of school, OR = 1.6 (95% CI = 1.1 to 2.5), the highest DMFT score and experience of self-perceived tooth discomfort, OR = 1.6 (95% CI = 1.2 to 2.0) and OR = 1.2 (95% CI = 1.4 to 2.6), respectively. In females, only CPI > or = 1 and highest DMFT score were associated with the type of school, OR = 2.1 (95% CI = 1.3 to 3.3) and OR = 1.6 (95% CI = 1.2 to 2.0), respectively. CONCLUSIONS: The type of school is a sensitive indicator of oral health status among adolescents.

Caries risk profiles in Sardinian schoolchildren using Cariogram.

OBJECTIVE: The aim of our study was to assess the caries risk profile in a group of Sardinian schoolchildren and to compare the outcome with their history of caries. MATERIAL AND METHODS: Using the computer-based program "Cariogram", 957 subjects aged 7, 8, and 9 years were enrolled in this cross-sectional study. The children were examined to evaluate dmfs/DMFS and gingival conditions. Data on dietary and oral hygiene habits were collected and saliva was analyzed, including levels of mutans streptococci (MS) and lactobacilli (Lb). Based on the Cariogram profiles, the children were divided into five risk groups in accordance with "chance of avoiding caries". RESULTS: Almost 50% of the children had a low caries risk, while more than a quarter had less than 40% "chance of avoiding caries". A significant linear trend between the five Cariogram categories and dmfs/DMFS was observed in the three age groups (p<0.001). CONCLUSIONS: The Cariogram risk profile showed strong correlations to the caries experience of Sardinian schoolchildren and that efforts to reduce caries risk are necessary.

Changing trend of caries from 1989 to 2004 among 12-year old Sardinian children.

BACKGROUND: During the past decades, the prevalence of caries disease in the population of Western industrialized countries has decreased markedly. In children also, a reduction of dental caries experience has been reported by many authors. The aim of this paper was to evaluate the trend of dental caries prevalence in 12-year-old children living in the city of Sassari, (Italy), by five cross-sectional studies conducted in 1989, 1992, 1995, 1998 and 2004. METHODS: In all cohorts, dental caries (DMFT and SiC Index according to WHO indications), was measured. For each variable measured (DMFT and sub-indices, SiC Index), differences in proportions among the five cohorts during the fifteen years were tested using chi2-square test. RESULTS: The mean DMFT index decreased from 4.3 +/- 3.1 in 1989 to 0.8 +/- 1.5 in 2004. The prevalence of untreated caries (DT) had a notable decrease between 1992 and 1995, increased slightly between 1995 and 1998 and had the greatest decrease in 2004. The number of filled teeth remains low. The percentage of caries-free children increased from 10% to 64%, whereas the percentage of untreated caries changed from 44% in 1989 to 62% in 2004. SiC Index decreased from 7.8 in 1989 to 3.9 in 2004. CONCLUSION: On the basis of the results of DMFT and SiC Index, caries experience has been reduced. The vigilance and the promotion of a higher standard of personal oral hygiene and dental check-ups are necessary to obtain an improvement of oral status in the future adult population and to reach the new WHO global goals.