ABSTRACT
Non-small-cell lung cancer (NSCLC) is a major cause of cancer-related death worldwide. In recent years, the discovery of actionable molecular alterations has changed the treatment paradigm of the disease. Tissue biopsies have been the gold standard for the identification of targetable alterations but present several limitations, calling for alternatives to detect driver and acquired resistance alterations. Liquid biopsies reveal great potential in this setting and also in the evaluation and monitoring of treatment response. However, several challenges currently hamper its widespread adoption in clinical practice. This perspective article evaluates the potential and challenges associated with liquid biopsy testing, considering a Portuguese expert panel dedicated to thoracic oncology point of view, and providing practical insights for its implementation based on the experience and applicability in the Portuguese context.
Subject(s)
Carcinoma, Non-Small-Cell Lung , Circulating Tumor DNA , Lung Neoplasms , Humans , Lung Neoplasms/diagnosis , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , Carcinoma, Non-Small-Cell Lung/diagnosis , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/genetics , Mutation , Liquid BiopsySubject(s)
Humans , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive , Foreign Bodies/diagnosis , Inhalation , Bronchoscopy , BronchiSubject(s)
Foreign Bodies , Pulmonary Disease, Chronic Obstructive , Humans , Foreign Bodies/diagnosis , Bronchi , Inhalation , BronchoscopyABSTRACT
INTRODUCTION: Lung cancer is the leading cause of cancer-related mortality. In patients with nonsquamous non-small-cell lung cancer (NSCLC) stage IIIB/IV treatment with chemotherapy plus bevacizumab led to significant improvements in progression-free and median overall survival (OS). AIM: To report the experience of five Portuguese centers in treating patients with nonsquamous NSCLC in stage IIIB or IV with bevacizumab and chemotherapy regarding survival and toxicity outcomes. MATERIALS AND METHODS: This was a retrospective, multicenter study on patients with nonsquamous stage IIIB/IV NSCLC treated with bevacizumab and chemotherapy from November 2007 to August 2010 through special use permits. We reviewed the medical records, registry of demographic characteristics, treatments provided, treatment responses, adverse events, and dates of death. Statistical analysis was performed with SPSS statistics software. Median OS and event-free survival (EFS) were calculated using the Kaplan-Meier method. RESULTS: From an eligible population of 41 patients, 37 participants were registered. Study participants were predominantly male (78.4%) with a median age of 53 years (29-75 years). In total, 83.8% patients had stage IV disease (TNM, 6th Ed.). The OS was 21.5 months (95% confidence interval [CI]: 12.6-30.5] and median EFS was 9.4 months (95% CI9: 7.1-11.7). Hematologic toxicity grade 3/4 occurred in 35.1% of patients, and nonhematologic toxicity in 24.3% patients. One fatal thromboembolic event was recorded (2.7%). CONCLUSIONS: The results of chemotherapy plus bevacizumab treatment for nonsquamous NSCLC obtained from the daily clinical practice of the centers involved in this study were similar to those of published clinical trials. Collaboration between the different Portuguese centers is crucial for this kind of study.
ABSTRACT
In this paper we present a study whose main aim is the measurement of the Health Related Quality of Life (HRQoL) of patients with asthma and the presentation of a first draft of normative values as measured by the SF-6D for asthma patients. In addition, we investigate how far non-disease-specific HRQoL measures can distinguish groups in terms of sociodemographic characteristics. The Portuguese versions of the EQ-5D, SF-6D, AQLQ(S) and ACQ were administered using personal interviews to a representative sample of the Portuguese population with asthma. Most of the individuals did not report significant problems in the dimensions used, with the exception of the physical functioning, where individuals reported moderate limitations. The mean utility value was 0.86. Male gender, young, single, individuals with high educational attainment level, employed, individuals with high income and those residing in urban areas reported higher utility levels. As expected, those who were in a severe stadium of the disease reported lower mean utility levels than those who were in a less severe stadium of the disease. Normative values for the SF-6D were computed for patients with asthma by gender, age, marital status, educational attainment level, employment status, area of residence and average monthly net income. The preference-based measures used in this study distinguish patient groups with asthma in terms of socio- demographic groups. The normative values can be used in economic evaluation and clinical studies as they incorporate patients' preferences and translate the value attributed to patients' health state.
