Multidisciplinary approach for locally advanced non-small cell lung cancer (NSCLC): 2023 expert consensus of the Spanish Lung Cancer Group GECP.

INTRODUCTION: Recent advances in the treatment of locally advanced NSCLC have led to changes in the standard of care for this disease. For the selection of the best approach strategy for each patient, it is necessary the homogenization of diagnostic and therapeutic interventions, as well as the promotion of the evaluation of patients by a multidisciplinary oncology team. OBJECTIVE: Development of an expert consensus document with suggestions for the approach and treatment of locally advanced NSCLC leaded by Spanish Lung Cancer Group GECP. METHODS: Between March and July 2023, a panel of 28 experts was formed. Using a mixed technique (Delphi/nominal group) under the guidance of a coordinating group, consensus was reached in 4 phases: 1. Literature review and definition of discussion topics 2. First round of voting 3. Communicating the results and second round of voting 4. Definition of conclusions in nominal group meeting. Responses were consolidated using medians and interquartile ranges. The threshold for agreement was defined as 85% of the votes. RESULTS: New and controversial situations regarding the diagnosis and management of locally advanced NSCLC were analyzed and reconciled based on evidence and clinical experience. Discussion issues included: molecular diagnosis and biomarkers, radiologic and surgical diagnosis, mediastinal staging, role of the multidisciplinary thoracic committee, neoadjuvant treatment indications, evaluation of response to neoadjuvant treatment, postoperative evaluation, and follow-up. CONCLUSIONS: Consensus clinical suggestions were generated on the most relevant scenarios such as diagnosis, staging and treatment of locally advanced lung cancer, which will serve to support decision-making in daily practice.

Molecular profiling of advanced solid tumours. The impact of experimental molecular-matched therapies on cancer patient outcomes in early-phase trials: the MAST study.

INTRODUCTION: Molecular-matched therapies have revolutionized cancer treatment. We evaluated the improvement in clinical outcomes of applying an in-house customized Next Generation Sequencing panel in a single institution. METHODS: Patients with advanced solid tumors were molecularly selected to receive a molecular-matched treatment into early phase clinical trials versus best investigators choice, according to the evaluation of a multidisciplinary molecular tumor board. The primary endpoint was progression-free survival (PFS) assessed by the ratio of patients presenting 1.3-fold longer PFS on matched therapy (PFS2) than with prior therapy (PFS1). RESULTS: Of a total of 231 molecularly screened patients, 87 were eligible for analysis. Patients who received matched therapy had a higher median PFS2 (6.47 months; 95% CI, 2.24-14.43) compared to those who received standard therapy (2.76 months; 95% CI, 2.14-3.91, Log-rank p = 0.022). The proportion of patients with a PFS2/PFS1 ratio over 1.3 was significantly higher in the experimental arm (0.33 vs 0.08; p = 0.008). DISCUSSION: We demonstrate the pivotal role of the institutional molecular tumor board in evaluating the results of a customized NGS panel. This process optimizes the selection of available therapies, improving disease control. Prospective randomized trials are needed to confirm this approach and open the door to expanded drug access.

Crizotinib and renal insufficiency: a case report and review of the literature.

A 69 year old man with idiopathic chronic kidney disease was diagnosed with relapsing EGFR negative, ALK positive lung adenocarcinoma, and treated with chemotherapy and antiangiogenic treatment, under which his renal insufficiency worsened. During second line crizotinib treatment, further worsening of the renal function was seen, with very clear correlation with crizotinib withdrawal and rechallenge. No further drug causes for the worsening blood creatinine values were detected.

[Prognostic factors of localized malignant melanoma: study of 639 patients]. / Factores pronósticos en el melanoma maligno cutáneo localizado: estudio de 639 pacientes.

BACKGROUND AND OBJECTIVE: Several clinical and histological prognostic factors have been identified in localized melanoma. However, further studies with better defined and more reproducible histological parameters are needed. Our aim was to identify the prognostic factors for survival in cutaneous melanoma in the Spanish population. PATIENTS AND METHOD: Six hundred and thirty nine patients with localized melanoma, stages I and II of the last version of the American Joint Committee on Cancer staging system for cutaneous melanoma, with 2 years of follow-up or documented relapse, were selected from the database of the Department of Dermatology. Univariate and multivariate Cox regression analyses were performed for overall and disease free survival. RESULTS: Tumor thickness appeared as the most important prognostic factor for both overall and disease free survival in the multivariate analysis. Inflammatory infiltrate and sex were only significant for overall survival, and location, age and ulceration were significant for disease free survival. Other variables, such as histological type, mitotic rate or level of invasion, lost their prognostic significance in the multivariate analysis. CONCLUSIONS: Tumor thickness is the most important prognostic factor to predict survival in localized melanoma. Other factors such as sex, inflammatory infiltrate, location, age or ulceration, have also an important role in prognosis.

Factores pronósticos en el melanoma maligno cutáneo localizado: estudio de 639 pacientes / Prognostic factors of localized malignant melanoma: study of 639 patients

FUNDAMENTO Y OBJETIVO: Se han identificado múltiples factores pronósticos, tanto clínicos como histológicos, en los pacientes con melanoma localizado. Sin embargo, hacen falta nuevos estudios con definiciones más claras y reproducibles de las variables histológicas. El objetivo de este estudio es identificar factores pronósticos para la supervivencia de pacientes con melanoma cutáneo en una muestra de la población española. PACIENTES Y MÉTODO: Se seleccionó a 639 pacientes con melanoma cutáneo localizado, estadios Iy II de la última versión del sistema de estadificación del American Joint Committee on Cancer, con un mínimo período de seguimiento de 2 años o recaída bien documentada, de la base de datos del Servicio de Dermatología del hospital. Se hizo un estudio de la supervivencia global y de la supervivencia libre de enfermedad mediante los métodos de Kaplan-Meier y Cox. RESULTADOS: El espesor tumoral fue el factor pronóstico más importante tanto para la supervivencia global como para la supervivencia libre de enfermedad tras el estudio multivariado. El infiltrado inflamatorio y el sexo lo fueron sólo para la supervivencia global, y la localización, la edad y la ulceración para la supervivencia libre de enfermedad. Otras variables como el tipo histológico, el índice mitótico o el grado de invasión, a pesar de tener significación estadística en el estudio univariado, la perdieron en el estudio multivariado. CONCLUSIONES: El espesor tumoral es el factor pronóstico más importante para predecir la supervivencia en pacientes con melanoma localizado. Otros factores como el sexo, el infiltrado inflamatorio, la localización, la edad o la ulceración también tienen un papel relevante en el pronóstico

BACKGROUND AND OBJECTIVE: Several clinical and histological prognostic factors have been identified in localized melanoma. However, further studies with better defined and more reproducible histological parameters are needed. Our aim was to identify the prognostic factors for survival in cutaneous melanoma in the Spanish population. PATIENTS AND METHOD: Six hundred and thirty nine patients with localized melanoma, stages I and II of the last version of the American Joint Committee on Cancer staging system for cutaneous melanoma, with 2 years of follow-up or documented relapse, were selected from the data base of the Department of Dermatology. Univariate and multivariate Cox regression analyses were performed for overall and disease free survival. RESULTS: Tumor thickness appeared as the most important prognostic factor for both overall and disease free survival in the multivariate analysis. Inflammatory infiltrate and sex were only significant for overall survival, and location, age and ulceration were significant for disease free survival. Other variables, such as histological type, mitotic rate or level of invasion, lost their prognostic significance in the multivariate analysis. CONCLUSIONS: Tumor thickness is the most important prognostic factor to predict survival in localized melanoma. Other factors such as sex, inflammatory infiltrate, location, age or ulceration, have also an important role in prognosis