Imprecision in the Era of Precision Medicine in Non-Small Cell Lung Cancer (2017 Frontiers of Medicine free full text)

Over the past decade, major advances have been made in the management of advanced non-small cell lung cancer (NSCLC). There has been a particular focus on the identification and targeting of putative driver aberrations, which has propelled NSCLC to the forefront of precision medicine. Several novel molecularly targeted agents have now achieved regulatory approval, while many others are currently in late-phase clinical trial testing. 

These antitumor therapies have significantly impacted the clinical outcomes of advanced NSCLC and provided patients with much hope for the future. Despite this, multiple deficiencies still exist in our knowledge of this complex disease, and further research is urgently required to overcome these critical issues. This review traces the path undertaken by the different therapeutics assessed in NSCLC and the impact of precision medicine in this disease. We also discuss the areas of “imprecision” that still exist in NSCLC and the modern hypothesis-testing studies being conducted to address these key challenges.

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Tracking the Evolution of Non–Small-Cell Lung Cancer (Free full text NEJM 2017)

Lung cancer is the leading cause of cancer-related death worldwide, with non–small-cell lung cancer (NSCLC) being the most common type. Large-scale sequencing studies have revealed the complex genomic landscape of NSCLC and genomic differences between lung adenocarcinomas and lung squamous-cell carcinomas. However, in-depth exploration of NSCLC intratumor heterogeneity (which provides the fuel for tumor evolution and drug resistance) and cancer genome evolution has been limited to small retrospective cohorts. Therefore, the clinical significance of intratumor heterogeneity and the potential for clonality of driver events to guide therapeutic strategies have not yet been defined.

Tracking Non–Small-Cell Lung Cancer Evolution through Therapy (TRACERx) is a multicenter, prospective cohort study, which began recruitment in April 2014 with funding from Cancer Research UK. The target enrollment is 842 patients from whom samples will be obtained for high-depth, multiregion whole-exome sequencing of surgically resected NSCLC tumors in stages IA through IIIA. One primary objective of TRACERx is to investigate the hypothesis that intratumor heterogeneity — in terms of mutations (single or dinucleotide base substitutions or small insertions and deletions) or somatic copy-number alterations (reflecting gains or losses of chromosome segments) - is associated with clinical outcome. Here, we report on the first 100 patients who were prospectively recruited in the study.
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http://www.nejm.org/doi/full/10.1056/NEJMoa1616288#t=articleTop

Pathways connecting inflammation and Lung Cancer (2016 American Journal of Respiratory and Critical Care Medicine)

Lung cancer is the leading cause of cancer mortality worldwide, and at only 18%, it has one of the lowest 5-year survival rates of all malignancies. With its highly complex mutational landscape, treatment strategies against lung cancer have proved largely ineffective. However with the recent success of immunotherapy trials in lung cancer, there is renewed enthusiasm in targeting the immune component of tumors. Macrophages make up the majority of the immune infiltrate in tumors and are a key cell type linking inflammation and cancer. Although the mechanisms through which inflammation promotes cancer are not fully understood, two connected hypotheses have emerged: an intrinsic pathway, driven by genetic alterations that lead to neoplasia and inflammation, and an extrinsic pathway, driven by inflammatory conditions that increase cancer risk. Here, we discuss the contribution of macrophages to these pathways and subsequently their roles in established tumors. We highlight studies investigating the association of macrophages with lung cancer prognosis and discuss emerging therapeutic strategies for targeting macrophages in the tumor microenvironment.

Read More: http://www.atsjournals.org/doi/abs/10.1164/rccm.201508-1545CI#.VrOZtuZJ-Ul

World Cancer Day - 4 February 2016

In recognition of World Cancer Day on February 4, we are supporting the World Cancer Day 2016: ‘We Can. I Can.’ campaign. The global campaign highlights how everyone, as a collective or as individuals, can do their part to reduce the global burden of cancer. 

Next year alone, nearly 9 million people are likely to die of cancer, and left unchecked, the number of deaths will increase to 13 million per year by 2030. World Cancer Day is a chance to reflect on what you can do: make a pledge and take action. Whatever you choose to do ‘We Can. I Can.’ will make a difference to the fight against cancer. The initiative outlines nine targets to be achieved by 2025 with the overarching goal to reduce cancer deaths by 25% by 2025. The targets include strengthening health systems, measuring cancer burden and impact of cancer plans in all countries, reducing exposure to cancer risk factors, universal coverage of HPV and HBV vaccination, reduction of stigma and dispelling myths about cancer, universal access to screening and early detection for cancer, improvement in access to services across the cancer care spectrum, universal availability of pain control and distress management, and improvement in education and training of healthcare professionals.

According to the World Health Organization, lung cancer is the most common cancer worldwide, accounting for 1.8 million new cases in 2012, and is responsible for nearly one in five deaths. While most understand that smoking is the single greatest risk factor for lung cancer, regular exposure to secondhand smoke also increases the risk. In addition, environmental exposure to radon, asbestos, arsenic, beryllium, and uranium have all been linked to lung cancer. The risk of lung cancer also increases with a history of cancer in another part of the body, age, family history, radiation to the chest area, and lung diseases like COPD and tuberculosis.

Pink ribbon with L.O.V.E. for Breast Cancer Awareness

These days masterpiece L.O.V.E. (Milan, Italy) by famous Italian artist Maurizio Cattelan was laying with the pink ribbon for Breast Cancer Awareness! Action was organised by Lega Tumori Lilt Milano!

The controversial monument is made in marble, about 4 meters high and has been allocated on a base that brings the sculpture to a total height of 11 meters. during the making process, the famed italian artist changed the title from ‘omnia munda mundis’ – literally meaning ‘to the pure [men], all things [are] pure’, a latin sentence that has entered a relatively common usage in many countries – to ‘L.O.V.E.’