Lung cancer is the leading cause of cancer death worldwide. Recent research has improved the understanding of the molecular underpinnings of lung cancer, which has led to refinements in diagnosis and treatment. Specifically, lung cancers are now classified and treated according to their histology (adenocarcinoma or squamous cell carcinoma) and molecular features (such as EGFR mutations). Identification of mutations, chromosomal alterations, and other molecular aberrations has supported development of targeted therapies and served to predict prognosis or response to treatment. However, further research is still needed to fully characterize lung cancer at the molecular level and develop additional targeted therapies.
This document outlines a research protocol to study neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as predictors of systemic inflammation and chronic illness in pre-surgery patients. The study will retrospectively analyze data from 1000 patients who attended a preadmission clinic between January and April 2013. Medical history, exam findings, and blood test results will be collected to calculate NLR and PLR ratios and examine their relationship to inflammation and health conditions. The goal is to determine the prevalence of elevated ratios and their ability to predict surgical risk factors.
This document is the third edition of a book on lung cancer edited by Jack A. Roth, James D. Cox, and Waun Ki Hong. It contains chapters written by experts on various topics related to lung cancer, including smoking cessation, lung cancer genetics, detection and diagnosis of preneoplastic lung lesions, surgical and non-surgical treatments, targeted therapies, screening and prevention. The book provides a comprehensive overview of the current state of knowledge across the multidisciplinary field of lung cancer research and clinical management.
Thyroid Papillary Carcinoma and Noninvasive Follicular Thyroid Neoplasm with ...CrimsonPublishersGJEM
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. A variant called follicular variant PTC (FVPTC) has been increasing in frequency and can show more aggressive behavior. A new classification of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been proposed for less aggressive tumors previously called noninvasive encapsulated FVPTC. Further studies are needed to evaluate long-term outcomes of NIFTP and determine appropriate treatment and follow-up given its low risk of recurrence despite nuclear features resembling PTC.
Lung cancer: a 2014 update with information about immunotherapiesZeena Nackerdien
In 2006, Dana Reeve – actress, activist, and non-smoker – died of lung cancer. In 2009, Valerie Harper – actress and “Dancing with the Stars” contestant – was diagnosed with lung cancer that has since metastasized to the brain. They are the famous faces of a disease that is the leading cause of cancer deaths. Five-year survival rates for lung cancer, the leading cause of cancer deaths, are very low. Please take a look at some of the ASCO 2014 lung cancer updates on my blog: http://norwalk.patch.com/groups/zeena-nackerdiens-blog/p/american-society-of-clinical-oncology-annual-meeting-2014-key-lung-cancer-abstracts.
Recently, a phase II clinical trial in hepatocellular carcinoma (HCC) has suggested that the combination of sorafenib and 5-fluorouracil (5-FU) is feasible and side effects are manageable. However, preclinical experimental data explaining the interaction mechanism(s) are lacking. Our objective is to investigate the anticancer efficacy and mechanism of combined sorafenib and 5-FU therapy in vitro in HCC cell lines MHCC97H and SMMC-7721.
This document summarizes information on lung cancer screening and diagnosis. It discusses findings from the National Lung Screening Trial which showed that low-dose CT screening reduced lung cancer mortality by 20% in high-risk patients aged 55-74 who were current or former heavy smokers. Risk factors for lung cancer are also reviewed, notably smoking which is responsible for over 90% of lung cancer deaths. The clinical presentation of lung cancer and methods for diagnosis including imaging, biopsy, histology, and molecular testing are described. The TNM staging system is explained along with descriptors for tumor size and lymph node involvement.
This document discusses advanced non-small cell lung cancer and targeted therapies. It provides an overview of lung cancer epidemiology and risk factors like smoking. It also reviews molecular targets in NSCLC like EGFR, KRAS, and EML4-ALK and associated targeted therapies. The document outlines NSCLC diagnosis, staging, and management approaches including surgery, chemotherapy, and newer targeted therapies based on molecular profiling.
This document summarizes differences between right-sided colon cancer (RCC) and left-sided colon cancer (LCC). It notes that RCC predominantly follows a microsatellite instability (MSI) pathway, while LCC follows a chromosomal instability (CIN) pathway. It discusses various risk factors, molecular pathways, and epidemiological differences between the two cancers. For example, RCC is more common in females and African Americans and often contains BRAF or CIMP mutations, while LCC contains more KRAS mutations. The document concludes that differences in environmental exposures and genetic/epigenetic alterations in the right vs. left colon can help explain differences in RCC and LCC.
This document outlines a research protocol to study neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) as predictors of systemic inflammation and chronic illness in pre-surgery patients. The study will retrospectively analyze data from 1000 patients who attended a preadmission clinic between January and April 2013. Medical history, exam findings, and blood test results will be collected to calculate NLR and PLR ratios and examine their relationship to inflammation and health conditions. The goal is to determine the prevalence of elevated ratios and their ability to predict surgical risk factors.
This document is the third edition of a book on lung cancer edited by Jack A. Roth, James D. Cox, and Waun Ki Hong. It contains chapters written by experts on various topics related to lung cancer, including smoking cessation, lung cancer genetics, detection and diagnosis of preneoplastic lung lesions, surgical and non-surgical treatments, targeted therapies, screening and prevention. The book provides a comprehensive overview of the current state of knowledge across the multidisciplinary field of lung cancer research and clinical management.
Thyroid Papillary Carcinoma and Noninvasive Follicular Thyroid Neoplasm with ...CrimsonPublishersGJEM
Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. A variant called follicular variant PTC (FVPTC) has been increasing in frequency and can show more aggressive behavior. A new classification of noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) has been proposed for less aggressive tumors previously called noninvasive encapsulated FVPTC. Further studies are needed to evaluate long-term outcomes of NIFTP and determine appropriate treatment and follow-up given its low risk of recurrence despite nuclear features resembling PTC.
Lung cancer: a 2014 update with information about immunotherapiesZeena Nackerdien
In 2006, Dana Reeve – actress, activist, and non-smoker – died of lung cancer. In 2009, Valerie Harper – actress and “Dancing with the Stars” contestant – was diagnosed with lung cancer that has since metastasized to the brain. They are the famous faces of a disease that is the leading cause of cancer deaths. Five-year survival rates for lung cancer, the leading cause of cancer deaths, are very low. Please take a look at some of the ASCO 2014 lung cancer updates on my blog: http://norwalk.patch.com/groups/zeena-nackerdiens-blog/p/american-society-of-clinical-oncology-annual-meeting-2014-key-lung-cancer-abstracts.
Recently, a phase II clinical trial in hepatocellular carcinoma (HCC) has suggested that the combination of sorafenib and 5-fluorouracil (5-FU) is feasible and side effects are manageable. However, preclinical experimental data explaining the interaction mechanism(s) are lacking. Our objective is to investigate the anticancer efficacy and mechanism of combined sorafenib and 5-FU therapy in vitro in HCC cell lines MHCC97H and SMMC-7721.
This document summarizes information on lung cancer screening and diagnosis. It discusses findings from the National Lung Screening Trial which showed that low-dose CT screening reduced lung cancer mortality by 20% in high-risk patients aged 55-74 who were current or former heavy smokers. Risk factors for lung cancer are also reviewed, notably smoking which is responsible for over 90% of lung cancer deaths. The clinical presentation of lung cancer and methods for diagnosis including imaging, biopsy, histology, and molecular testing are described. The TNM staging system is explained along with descriptors for tumor size and lymph node involvement.
This document discusses advanced non-small cell lung cancer and targeted therapies. It provides an overview of lung cancer epidemiology and risk factors like smoking. It also reviews molecular targets in NSCLC like EGFR, KRAS, and EML4-ALK and associated targeted therapies. The document outlines NSCLC diagnosis, staging, and management approaches including surgery, chemotherapy, and newer targeted therapies based on molecular profiling.
This document summarizes differences between right-sided colon cancer (RCC) and left-sided colon cancer (LCC). It notes that RCC predominantly follows a microsatellite instability (MSI) pathway, while LCC follows a chromosomal instability (CIN) pathway. It discusses various risk factors, molecular pathways, and epidemiological differences between the two cancers. For example, RCC is more common in females and African Americans and often contains BRAF or CIMP mutations, while LCC contains more KRAS mutations. The document concludes that differences in environmental exposures and genetic/epigenetic alterations in the right vs. left colon can help explain differences in RCC and LCC.
Dissertation topics on cellular basics of cancer and therapeutics - PubricaPubrica
• Researching cancer and its therapeutics is an important tool for cancer studies and medical writing services.
• The important topics to be covered while writing a thesis for cancer and its therapeutics are discussed in scientific medical writing.
• Pubrica is here to help with the easy scientific medical writingabout cancer research and its therapeutics.
Full Information: https://bit.ly/3llZgmV
Reference: https://pubrica.com/services/physician-writing-services/
Why Pubrica?
When you order our services, we promise you the following – Plagiarism free, always on Time, outstanding customer support, written to Standard, Unlimited Revisions support and High-quality Subject Matter Experts.
Contact us :
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
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The document discusses post-transplant malignancies in solid organ transplant recipients. It notes that recipients have a 3-5 fold higher risk of cancer than the general population due to prolonged immunosuppression. The most common post-transplant malignancies are non-melanoma skin cancer, post-transplant lymphoproliferative disorder (PTLD), and Kaposi's sarcoma. PTLD is often associated with Epstein-Barr virus infection and occurs more frequently after transplants of certain organs. Treatment involves reducing immunosuppression when possible and additional therapies depending on the malignancy type and individual case.
Mohammad Rahman is a senior research associate at Ohio State University studying cancer metastasis. He has a PhD in cancer biology from Shimane Medical University in Japan and has held several postdoctoral research positions. His research focuses on how exosomes secreted by cancer cells drive metastasis by inducing epithelial to mesenchymal transition in other cells. He recently discovered that lung cancer cell exosomes can induce EMT in recipient cells, which may be important for establishing the tumor microenvironment and cancer spread. The goal of his current research proposal is to investigate the mechanisms by which cancer-derived exosomal contents drive metastasis.
Mohammad Rahman is a senior research associate at Ohio State University studying cancer metastasis. He has a PhD in cancer biology from Shimane Medical University in Japan and has held several postdoctoral research positions. His research focuses on how exosomes secreted by cancer cells drive metastasis by inducing epithelial to mesenchymal transition in other cells. He recently discovered that lung cancer cell exosomes can induce EMT in recipient cells, which may be important for establishing the tumor microenvironment and cancer spread. The goal of his current research proposal is to investigate the mechanisms by which cancer-derived exosomal contents drive metastasis.
Kidney transplant recipients have a 2-3x higher risk of developing cancer compared to the general population due to factors related to CKD, immunosuppression, and viral infections. Specific cancers like non-Hodgkin lymphoma, skin cancers, and cancers of the kidney and urinary tract are more common. Immunosuppression drugs like calcineurin inhibitors and mTOR inhibitors can influence cancer risk. Screening for cancers in kidney transplant patients requires individualization based on life expectancy and risks. Managing cancer often involves modifying immunosuppression to balance cancer treatment and risk of organ rejection.
This document summarizes two recent studies on ovarian cancer published in PLoS Medicine. The first study found that biomarkers for ovarian cancer are more strongly associated with histological subtypes than disease stage, suggesting molecular profiling may be needed to properly classify and manage different subtypes. The second study identified an 86-gene expression profile from tumor samples that predicts survival outcomes in patients with advanced ovarian cancer. Validation in independent studies is still needed, but the findings provide encouraging progress in developing prognostic markers and molecular signatures to help guide personalized treatment of ovarian cancer.
Immunosuppressed allograft recipients have three to five folds increase in cancer risk as compared to age matched general population. The most common malignancies encountered are Non Melanotic Skin Cancer, Post Transplant Lymphoproliferative Disorder and Kaposi's Sarcoma. Duration of immunosuppressive therapy and/or type of immunosuppressive agents are important controllable factors which have an impact in the development of tumors. Oncogenic viruses have an important role in the development of these malignancies.
The Case for Lung Cancer Screening ASRT presentationKimberly Luse
The document discusses the case for lung cancer screening through low-dose CT scans. It provides background on lung cancer statistics, risk factors, and previous research studies that have established the effectiveness of CT screening in reducing lung cancer mortality compared to chest X-rays. Major points covered include the National Lung Screening Trial findings of a 20% reduction in lung cancer deaths from low-dose CT screening, and the 2015 Centers for Medicare and Medicaid Services decision to cover low-dose CT screening for certain high-risk patients between the ages of 55-77 with a smoking history.
Recent progressing approaches to improve the efficiency of CAR-T cell immunotherapy against solid tumors.
1. Promoting CAR-T cell trafficking and infiltration at tumor sites through approaches like engineering CAR-T cells to express the enzyme heparanase to degrade tumor extracellular matrix, or incorporating chemokine receptor genes into CAR-T cells to guide them to tumor locations.
2. Preventing tumor immune escape by blocking immune checkpoint molecules like PD-1 and CTLA-4 that inhibit CAR-T cells, or knocking out the adenosine 2A receptor to reduce CAR-T cell dysfunction.
3. Developing bi-specific CAR-T cells targeting two different tumor antigens to reduce immune escape, and
This document discusses lung cancer, including epidemiology, risk factors, types, staging, diagnosis, signs and symptoms, treatment protocols, and prognosis. It provides statistics on lung cancer rates in Palestine and the US. The main types of lung cancer covered are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Treatment approaches are discussed depending on cancer stage, including surgery, chemotherapy, and radiation therapy. Outcomes vary significantly depending on cancer type and stage, with localized disease having the best prognosis.
- Non-small cell lung cancer is the most common malignancy worldwide and a leading cause of cancer death. It accounts for the majority (70-80%) of lung cancers.
- Imaging techniques like CT scans are important for accurately assessing the primary tumor and detecting metastasis. Positron emission tomography (PET) CT is more sensitive than size-based criteria alone for detecting lymph node involvement.
- Staging involves classifying the size and extent of the primary tumor and determining if the cancer has spread to lymph nodes or distant organs. Higher stages indicate larger primary tumors or spread beyond the lungs.
This document provides an overview of non-small cell lung cancer (NSCLC). It discusses that lung cancer is the leading cause of cancer death. The majority of cases are late-stage at diagnosis and have a poor prognosis. Smoking is responsible for 90% of lung cancers. Advances in screening and targeted therapies have improved outcomes for some patients. Molecular testing is important to identify drivers and direct treatment, such as EGFR mutations that predict response to tyrosine kinase inhibitors.
Epidemiology./Biostatistics class on lung cancer screening including description of lung cancer, natural history and treatment, lung cancer statistics, lung cancer risk factors, NLST results, NLST follow-on, criteria for a good screening test, USPSTF and CMS lung cancer screening guidelines, and challenges to screening
The document discusses PD-L1 expression in gliomas and the potential for blocking the PD-1/PD-L1 pathway as a new treatment strategy. It summarizes that PD-L1 is expressed in glioma cell lines and tumor tissues in approximately 44% of cases based on various studies. Higher PD-L1 expression is correlated with higher glioma grade. Blocking the PD-1/PD-L1 pathway has shown encouraging results in other cancers and offers hope as a new immunotherapy for gliomas given the role of this pathway in glioma progression and limiting the immune response against the tumors.
Intervento della Dott.ssa Serena Merante, Haematology Consultant James Cook University Hospital
Middlesbrough, UK al Convegno dell'Associazione Italiana Pazienti Leucemia Mieloide Cronica del 20 Maggio 2017 presso Triuggio (Mb)
Lung cancer was rare prior to 1900 but became a leading cause of cancer death in the mid-20th century due to tobacco consumption. Tobacco smoking remains the primary cause of lung cancer worldwide, though 60% of new lung cancers in the US occur in former or never smokers. There are two main types of lung cancer - non-small cell lung cancer (NSCLC) which includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, and small cell lung cancer. Molecular profiling of mutations has identified subsets of NSCLC and helped develop targeted therapies, though transformation between cancer types can occur. Aberrant miRNA and methylation expression are also involved in lung cancer pathogenesis and have potential as biomarkers.
Lung cancer stigma: Causes, Prevalence, Impacts and Conceptual Model Andrea Borondy Kitts
Presentation summary of my MPH class paper on Lung Cancer Stigma: Causes, Prevalence, Impacts and Development of a Lung Cancer Stigma Model to Guide Public Health Interventions
Small cell lung cancer (SCLC) is an aggressive neuroendocrine tumor with rapid growth and early metastasis. SCLC is usually responsive to initial chemotherapy but often relapses within two years. The standard first-line treatment is platinum-based chemotherapy such as etoposide plus cisplatin or carboplatin. Adding thoracic radiotherapy to chemotherapy improves survival for limited-stage disease. Many clinical trials have evaluated additional agents or alternative regimens but no significant improvements in outcomes have been achieved compared to standard etoposide plus platinum chemotherapy.
This document summarizes molecular changes related to lung cancer and their clinical implications. It discusses:
1) Lung cancer accounts for many cancer deaths in the US and there is effort to improve screening and early detection. Molecular changes in lung cancer cells are being studied to develop new targeted therapies.
2) Genetic and epigenetic changes alter oncogenes and tumor suppressor genes in lung cancer, disrupting cell growth. Common changes include mutations in p53 and the p16-cyclin D1 pathway.
3) Understanding the molecular basis of lung carcinogenesis can help identify high-risk groups for screening and develop biologically-based prevention and treatment strategies. Translating discoveries about uncontrolled cell growth into
This document summarizes two recent studies on prognostic biomarkers for hepatocellular carcinoma (HCC). The first study found that high levels of C-reactive protein (CRP), an inflammatory marker, predicts poor long-term survival for patients with HCC undergoing nonsurgical treatments. The second study found that low levels of CD4+ cytotoxic T lymphocytes (CTLs), part of the immune system, predicts poor outcomes and high recurrence rates for HCC patients. Both inflammatory and immunological markers may provide prognostic information to supplement current clinical staging systems for HCC. However, more research is still needed to validate the prognostic value of these biomarkers.
Dissertation topics on cellular basics of cancer and therapeutics - PubricaPubrica
• Researching cancer and its therapeutics is an important tool for cancer studies and medical writing services.
• The important topics to be covered while writing a thesis for cancer and its therapeutics are discussed in scientific medical writing.
• Pubrica is here to help with the easy scientific medical writingabout cancer research and its therapeutics.
Full Information: https://bit.ly/3llZgmV
Reference: https://pubrica.com/services/physician-writing-services/
Why Pubrica?
When you order our services, we promise you the following – Plagiarism free, always on Time, outstanding customer support, written to Standard, Unlimited Revisions support and High-quality Subject Matter Experts.
Contact us :
Web: https://pubrica.com/
Blog: https://pubrica.com/academy/
Email: sales@pubrica.com
WhatsApp : +91 9884350006
United Kingdom: +44- 74248 10299
The document discusses post-transplant malignancies in solid organ transplant recipients. It notes that recipients have a 3-5 fold higher risk of cancer than the general population due to prolonged immunosuppression. The most common post-transplant malignancies are non-melanoma skin cancer, post-transplant lymphoproliferative disorder (PTLD), and Kaposi's sarcoma. PTLD is often associated with Epstein-Barr virus infection and occurs more frequently after transplants of certain organs. Treatment involves reducing immunosuppression when possible and additional therapies depending on the malignancy type and individual case.
Mohammad Rahman is a senior research associate at Ohio State University studying cancer metastasis. He has a PhD in cancer biology from Shimane Medical University in Japan and has held several postdoctoral research positions. His research focuses on how exosomes secreted by cancer cells drive metastasis by inducing epithelial to mesenchymal transition in other cells. He recently discovered that lung cancer cell exosomes can induce EMT in recipient cells, which may be important for establishing the tumor microenvironment and cancer spread. The goal of his current research proposal is to investigate the mechanisms by which cancer-derived exosomal contents drive metastasis.
Mohammad Rahman is a senior research associate at Ohio State University studying cancer metastasis. He has a PhD in cancer biology from Shimane Medical University in Japan and has held several postdoctoral research positions. His research focuses on how exosomes secreted by cancer cells drive metastasis by inducing epithelial to mesenchymal transition in other cells. He recently discovered that lung cancer cell exosomes can induce EMT in recipient cells, which may be important for establishing the tumor microenvironment and cancer spread. The goal of his current research proposal is to investigate the mechanisms by which cancer-derived exosomal contents drive metastasis.
Kidney transplant recipients have a 2-3x higher risk of developing cancer compared to the general population due to factors related to CKD, immunosuppression, and viral infections. Specific cancers like non-Hodgkin lymphoma, skin cancers, and cancers of the kidney and urinary tract are more common. Immunosuppression drugs like calcineurin inhibitors and mTOR inhibitors can influence cancer risk. Screening for cancers in kidney transplant patients requires individualization based on life expectancy and risks. Managing cancer often involves modifying immunosuppression to balance cancer treatment and risk of organ rejection.
This document summarizes two recent studies on ovarian cancer published in PLoS Medicine. The first study found that biomarkers for ovarian cancer are more strongly associated with histological subtypes than disease stage, suggesting molecular profiling may be needed to properly classify and manage different subtypes. The second study identified an 86-gene expression profile from tumor samples that predicts survival outcomes in patients with advanced ovarian cancer. Validation in independent studies is still needed, but the findings provide encouraging progress in developing prognostic markers and molecular signatures to help guide personalized treatment of ovarian cancer.
Immunosuppressed allograft recipients have three to five folds increase in cancer risk as compared to age matched general population. The most common malignancies encountered are Non Melanotic Skin Cancer, Post Transplant Lymphoproliferative Disorder and Kaposi's Sarcoma. Duration of immunosuppressive therapy and/or type of immunosuppressive agents are important controllable factors which have an impact in the development of tumors. Oncogenic viruses have an important role in the development of these malignancies.
The Case for Lung Cancer Screening ASRT presentationKimberly Luse
The document discusses the case for lung cancer screening through low-dose CT scans. It provides background on lung cancer statistics, risk factors, and previous research studies that have established the effectiveness of CT screening in reducing lung cancer mortality compared to chest X-rays. Major points covered include the National Lung Screening Trial findings of a 20% reduction in lung cancer deaths from low-dose CT screening, and the 2015 Centers for Medicare and Medicaid Services decision to cover low-dose CT screening for certain high-risk patients between the ages of 55-77 with a smoking history.
Recent progressing approaches to improve the efficiency of CAR-T cell immunotherapy against solid tumors.
1. Promoting CAR-T cell trafficking and infiltration at tumor sites through approaches like engineering CAR-T cells to express the enzyme heparanase to degrade tumor extracellular matrix, or incorporating chemokine receptor genes into CAR-T cells to guide them to tumor locations.
2. Preventing tumor immune escape by blocking immune checkpoint molecules like PD-1 and CTLA-4 that inhibit CAR-T cells, or knocking out the adenosine 2A receptor to reduce CAR-T cell dysfunction.
3. Developing bi-specific CAR-T cells targeting two different tumor antigens to reduce immune escape, and
This document discusses lung cancer, including epidemiology, risk factors, types, staging, diagnosis, signs and symptoms, treatment protocols, and prognosis. It provides statistics on lung cancer rates in Palestine and the US. The main types of lung cancer covered are non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). Treatment approaches are discussed depending on cancer stage, including surgery, chemotherapy, and radiation therapy. Outcomes vary significantly depending on cancer type and stage, with localized disease having the best prognosis.
- Non-small cell lung cancer is the most common malignancy worldwide and a leading cause of cancer death. It accounts for the majority (70-80%) of lung cancers.
- Imaging techniques like CT scans are important for accurately assessing the primary tumor and detecting metastasis. Positron emission tomography (PET) CT is more sensitive than size-based criteria alone for detecting lymph node involvement.
- Staging involves classifying the size and extent of the primary tumor and determining if the cancer has spread to lymph nodes or distant organs. Higher stages indicate larger primary tumors or spread beyond the lungs.
This document provides an overview of non-small cell lung cancer (NSCLC). It discusses that lung cancer is the leading cause of cancer death. The majority of cases are late-stage at diagnosis and have a poor prognosis. Smoking is responsible for 90% of lung cancers. Advances in screening and targeted therapies have improved outcomes for some patients. Molecular testing is important to identify drivers and direct treatment, such as EGFR mutations that predict response to tyrosine kinase inhibitors.
Epidemiology./Biostatistics class on lung cancer screening including description of lung cancer, natural history and treatment, lung cancer statistics, lung cancer risk factors, NLST results, NLST follow-on, criteria for a good screening test, USPSTF and CMS lung cancer screening guidelines, and challenges to screening
The document discusses PD-L1 expression in gliomas and the potential for blocking the PD-1/PD-L1 pathway as a new treatment strategy. It summarizes that PD-L1 is expressed in glioma cell lines and tumor tissues in approximately 44% of cases based on various studies. Higher PD-L1 expression is correlated with higher glioma grade. Blocking the PD-1/PD-L1 pathway has shown encouraging results in other cancers and offers hope as a new immunotherapy for gliomas given the role of this pathway in glioma progression and limiting the immune response against the tumors.
Intervento della Dott.ssa Serena Merante, Haematology Consultant James Cook University Hospital
Middlesbrough, UK al Convegno dell'Associazione Italiana Pazienti Leucemia Mieloide Cronica del 20 Maggio 2017 presso Triuggio (Mb)
Lung cancer was rare prior to 1900 but became a leading cause of cancer death in the mid-20th century due to tobacco consumption. Tobacco smoking remains the primary cause of lung cancer worldwide, though 60% of new lung cancers in the US occur in former or never smokers. There are two main types of lung cancer - non-small cell lung cancer (NSCLC) which includes adenocarcinoma, squamous cell carcinoma, and large cell carcinoma, and small cell lung cancer. Molecular profiling of mutations has identified subsets of NSCLC and helped develop targeted therapies, though transformation between cancer types can occur. Aberrant miRNA and methylation expression are also involved in lung cancer pathogenesis and have potential as biomarkers.
Lung cancer stigma: Causes, Prevalence, Impacts and Conceptual Model Andrea Borondy Kitts
Presentation summary of my MPH class paper on Lung Cancer Stigma: Causes, Prevalence, Impacts and Development of a Lung Cancer Stigma Model to Guide Public Health Interventions
Small cell lung cancer (SCLC) is an aggressive neuroendocrine tumor with rapid growth and early metastasis. SCLC is usually responsive to initial chemotherapy but often relapses within two years. The standard first-line treatment is platinum-based chemotherapy such as etoposide plus cisplatin or carboplatin. Adding thoracic radiotherapy to chemotherapy improves survival for limited-stage disease. Many clinical trials have evaluated additional agents or alternative regimens but no significant improvements in outcomes have been achieved compared to standard etoposide plus platinum chemotherapy.
This document summarizes molecular changes related to lung cancer and their clinical implications. It discusses:
1) Lung cancer accounts for many cancer deaths in the US and there is effort to improve screening and early detection. Molecular changes in lung cancer cells are being studied to develop new targeted therapies.
2) Genetic and epigenetic changes alter oncogenes and tumor suppressor genes in lung cancer, disrupting cell growth. Common changes include mutations in p53 and the p16-cyclin D1 pathway.
3) Understanding the molecular basis of lung carcinogenesis can help identify high-risk groups for screening and develop biologically-based prevention and treatment strategies. Translating discoveries about uncontrolled cell growth into
This document summarizes two recent studies on prognostic biomarkers for hepatocellular carcinoma (HCC). The first study found that high levels of C-reactive protein (CRP), an inflammatory marker, predicts poor long-term survival for patients with HCC undergoing nonsurgical treatments. The second study found that low levels of CD4+ cytotoxic T lymphocytes (CTLs), part of the immune system, predicts poor outcomes and high recurrence rates for HCC patients. Both inflammatory and immunological markers may provide prognostic information to supplement current clinical staging systems for HCC. However, more research is still needed to validate the prognostic value of these biomarkers.
This document provides clinical practice guidelines for the diagnosis, treatment and follow-up of metastatic non-small cell lung cancer (NSCLC) from the ESMO Guidelines Working Group. It discusses the incidence, epidemiology and risk factors for NSCLC. It recommends obtaining adequate tissue for histological diagnosis and molecular testing to guide individual treatment decisions. It also recommends testing for EGFR mutations and ALK rearrangements to identify patients eligible for targeted therapies. It provides guidance on staging workup, including imaging and laboratory tests, and staging NSCLC according to the AJCC/UICC system to determine treatment approaches.
This document summarizes the current immunotherapy and targeted therapy options for endometrial cancer. It discusses the biological and genetic background of endometrial cancer and its classification into types. The main immunotherapeutic options available include anti-cancer vaccines, immune checkpoint inhibitors that target molecules like PD-1 and PD-L1, and adoptive cell therapies. Several clinical trials of these therapies for endometrial cancer are ongoing based on their success in other cancer types. Identification of genetic alterations in endometrial cancer is leading to new targeted therapy options.
Sophisticated genomics-based tools will transform cancer care in the coming decade. This paper investigates what will drive this transformation in oncology. Next-generation sequencing (NGS) will play a key role by providing a deeper understanding of cancer's molecular complexity through genomic techniques. NGS allows researchers to sequence entire genomes, exomes, and RNA to identify biomarkers and explore features like single nucleotide variations, translocations, and copy number variations. While NGS provides powerful approaches, its application requires an understanding of each platform's capabilities and limitations to obtain reliable results.
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...JohnJulie1
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...EditorSara
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...EditorSara
This study aimed to investigate the correlation between the expression of P4HB and GRP78 proteins and their prognostic value in gastric cancer. The study found that P4HB protein expression was positively correlated with GRP78 protein expression in gastric cancer tissue samples. High expression of either P4HB or GRP78 alone, or co-expression of both, was associated with poorer overall survival in patients. When considering postoperative adjuvant chemotherapy, high co-expression of P4HB and GRP78 only represented an unfavorable prognosis in patients who received chemotherapy. A prognostic nomogram incorporating P4HB and GRP78 expression and other factors was developed and found to have better predictive performance than the TNM staging system.
Clinic Correlation and Prognostic Value of P4HB and GRP78 Expression in Gastr...NainaAnon
Prolyl 4-hydroxylase, beta polypeptide (P4HB) and Glucose‑regulated protein 78 (GRP78) represent for poor prognosis of various cancers, while rare research investigate correlation of them. This study aimed to explore correlation and prognostic value of them in gastric cancer (GC).
Lung cancer is the most common cancer in males and second most common in females after breast cancer.
it is the third most commonly diagnosed and leading cause of cancer death in Pakistan, with an estimated 6,800 (4.6%) new cases and 6,013 (5.9%) deaths occurring in 2012
We have compared our data with the international statistics to see where do we stand.
In Pakistan, we do not have a valid central cancer registry at present which can provide a true picture of lung cancer. This calls for an urgent need to formulate a valid central cancer registry in the country in association with the local bodies.
How patient subpopulations are changing the commercialization of oncology pro...IMSHealthRWES
An excerpt from the latest issue of AccessPoint, looking at how genomic profiling data is transforming our understanding of patient subpopulations - a key to targeting treatments with greater precision
The study describes the design and baseline characteristics of a prospective cohort study evaluating the Lung Cancer Risk Test (LCRT), a 15-gene test measured in normal bronchial epithelial cells. Over two years, 403 current and former heavy smokers aged 50-90 were enrolled across 12 sites. Baseline data found the average age was 62.9 years with 50.4 pack-years of smoking and 34% were current smokers. Bronchoscopy with bronchial brushing to obtain epithelial cells was found to be safe. An established biospecimen repository contains epithelial and blood samples to enable further lung cancer risk research.
Sex-Based Difference in Gene Alterations and Biomarkers in Anal Squamous Cell...semualkaira
anal squamous cell carcinoma (ASCC) is a relatively rare malignancy ac-counting for about 2-3% of all the gastrointestinal tumors. The standard of treatment for localized disease is chemoradiotherapy
Sex-Based Difference in Gene Alterations and Biomarkers in Anal Squamous Cell...semualkaira
anal squamous cell carcinoma (ASCC) is a relatively rare malignancy ac-counting for about 2-3% of all the gastrointestinal tumors. The standard of treatment for localized disease is chemoradiotherapy. Several studies reported a sex disparity
in ASCC prognosis showing a better survival for female compared
to men. Methods: we examined 1,380 patients with ASCC who received comprehensive genomic profiling as part of routine clinical
care and present key
This document provides personal and professional information about Dr. Teh-Ying Chou. It summarizes her educational background, current positions, work experience, research interests and topics. Her research focuses on the pathobiology of lung diseases, including studies on EGFR mutations in lung cancer patients treated with gefitinib, genetic profiling of in situ and invasive lung adenocarcinomas, and the role of Clusterin in epithelial-mesenchymal transitions and metastasis of lung cancer cells. She has published papers on biomarkers for acute respiratory distress syndrome outcomes and the predictive value of EGFR mutations for gefitinib treatment responses in lung cancer.
Recent developments in p53 and nano oncologytazib rahaman
Recent research into the tumor suppressor gene TP53 and its role in cancer prognosis and treatment:
1) The largest study to date of TP53 mutations in over 10,000 cancer patients across 32 cancer types found correlations between mutation types and patient survival rates, and identified 4 genes whose expression levels are associated with prognosis.
2) Additional research suggests that the PBRM1 gene, which is often mutated in kidney cancer, interacts with TP53, indicating TP53 may play a more important role in kidney cancer than previously believed.
3) A research team received $1.8 million in funding to develop new ovarian cancer therapies targeting TP53 by reactivating its function and investigating its role in cancer development
This document provides an overview of molecular diagnostic methods for liver cancer. It discusses detecting cancer-related genes, genes of related viruses like HBV and HCV, and markers of liver cancer. Common markers are alpha-fetoprotein, GGT, and CA125. Detection methods include PCR, gene chips, radioimmunoassay, ELISA, and chemiluminescent, fluorescent, and electrochemiluminescent immunoassay systems. The document concludes that combining detection of multiple markers is more effective than single markers and will improve early diagnosis as methods advance.
Integrative Cancer - New theories and Advances in Treatment From Hippocrates ...Sheldon Stein
Professor Serge Jurasunsas' recent paper on Integrative Cancer, From Hippocrates to the Human Genome - posted on his behalf. Discusses testing, protocols and case discussion.
Deadenylase Expression in Small Cell Lung Cancer Related To Clinical Characte...JohnJulie1
Lung cancer is the second common malignancy and the most aggressive cancer worldwide with late diagnosis and poor prognosis. The search for biomarkers that promote early diagnosis and improve therapeutic strategies focuses to the understanding of the mechanisms underlying cancer development and progression. The deregulation of gene expression is one of the cancer hallmarks reflected to the stability...
Deadenylase Expression in Small Cell Lung Cancer Related To Clinical Characte...AnonIshanvi
Lung cancer is the second common malignancy and the most aggressive cancer worldwide with late diagnosis and poor prognosis. The search for biomarkers that promote early diagnosis and improve therapeutic strategies focuses to the understanding of the mechanisms underlying cancer development and progression
Similar to Dignosis&mangment of lung cancer (20)
ESA/ACT Science Coffee: Diego Blas - Gravitational wave detection with orbita...Advanced-Concepts-Team
Presentation in the Science Coffee of the Advanced Concepts Team of the European Space Agency on the 07.06.2024.
Speaker: Diego Blas (IFAE/ICREA)
Title: Gravitational wave detection with orbital motion of Moon and artificial
Abstract:
In this talk I will describe some recent ideas to find gravitational waves from supermassive black holes or of primordial origin by studying their secular effect on the orbital motion of the Moon or satellites that are laser ranged.
The binding of cosmological structures by massless topological defectsSérgio Sacani
Assuming spherical symmetry and weak field, it is shown that if one solves the Poisson equation or the Einstein field
equations sourced by a topological defect, i.e. a singularity of a very specific form, the result is a localized gravitational
field capable of driving flat rotation (i.e. Keplerian circular orbits at a constant speed for all radii) of test masses on a thin
spherical shell without any underlying mass. Moreover, a large-scale structure which exploits this solution by assembling
concentrically a number of such topological defects can establish a flat stellar or galactic rotation curve, and can also deflect
light in the same manner as an equipotential (isothermal) sphere. Thus, the need for dark matter or modified gravity theory is
mitigated, at least in part.
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfSelcen Ozturkcan
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EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
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photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
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massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
Describing and Interpreting an Immersive Learning Case with the Immersion Cub...Leonel Morgado
Current descriptions of immersive learning cases are often difficult or impossible to compare. This is due to a myriad of different options on what details to include, which aspects are relevant, and on the descriptive approaches employed. Also, these aspects often combine very specific details with more general guidelines or indicate intents and rationales without clarifying their implementation. In this paper we provide a method to describe immersive learning cases that is structured to enable comparisons, yet flexible enough to allow researchers and practitioners to decide which aspects to include. This method leverages a taxonomy that classifies educational aspects at three levels (uses, practices, and strategies) and then utilizes two frameworks, the Immersive Learning Brain and the Immersion Cube, to enable a structured description and interpretation of immersive learning cases. The method is then demonstrated on a published immersive learning case on training for wind turbine maintenance using virtual reality. Applying the method results in a structured artifact, the Immersive Learning Case Sheet, that tags the case with its proximal uses, practices, and strategies, and refines the free text case description to ensure that matching details are included. This contribution is thus a case description method in support of future comparative research of immersive learning cases. We then discuss how the resulting description and interpretation can be leveraged to change immersion learning cases, by enriching them (considering low-effort changes or additions) or innovating (exploring more challenging avenues of transformation). The method holds significant promise to support better-grounded research in immersive learning.
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Thematic analysis in qualitative research is a time-consuming and systematic task, typically done using teams. Team members must ground their activities on common understandings of the major concepts underlying the thematic analysis, and define criteria for its development. However, conceptual misunderstandings, equivocations, and lack of adherence to criteria are challenges to the quality and speed of this process. Given the distributed and uncertain nature of this process, we wondered if the tasks in thematic analysis could be supported by readily available artificial intelligence chatbots. Our early efforts point to potential benefits: not just saving time in the coding process but better adherence to criteria and grounding, by increasing triangulation between humans and artificial intelligence. This tutorial will provide a description and demonstration of the process we followed, as two academic researchers, to develop a custom ChatGPT to assist with qualitative coding in the thematic data analysis process of immersive learning accounts in a survey of the academic literature: QUAL-E Immersive Learning Thematic Analysis Helper. In the hands-on time, participants will try out QUAL-E and develop their ideas for their own qualitative coding ChatGPT. Participants that have the paid ChatGPT Plus subscription can create a draft of their assistants. The organizers will provide course materials and slide deck that participants will be able to utilize to continue development of their custom GPT. The paid subscription to ChatGPT Plus is not required to participate in this workshop, just for trying out personal GPTs during it.
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Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...Sérgio Sacani
Context. The observation of several L-band emission sources in the S cluster has led to a rich discussion of their nature. However, a definitive answer to the classification of the dusty objects requires an explanation for the detection of compact Doppler-shifted Brγ emission. The ionized hydrogen in combination with the observation of mid-infrared L-band continuum emission suggests that most of these sources are embedded in a dusty envelope. These embedded sources are part of the S-cluster, and their relationship to the S-stars is still under debate. To date, the question of the origin of these two populations has been vague, although all explanations favor migration processes for the individual cluster members. Aims. This work revisits the S-cluster and its dusty members orbiting the supermassive black hole SgrA* on bound Keplerian orbits from a kinematic perspective. The aim is to explore the Keplerian parameters for patterns that might imply a nonrandom distribution of the sample. Additionally, various analytical aspects are considered to address the nature of the dusty sources. Methods. Based on the photometric analysis, we estimated the individual H−K and K−L colors for the source sample and compared the results to known cluster members. The classification revealed a noticeable contrast between the S-stars and the dusty sources. To fit the flux-density distribution, we utilized the radiative transfer code HYPERION and implemented a young stellar object Class I model. We obtained the position angle from the Keplerian fit results; additionally, we analyzed the distribution of the inclinations and the longitudes of the ascending node. Results. The colors of the dusty sources suggest a stellar nature consistent with the spectral energy distribution in the near and midinfrared domains. Furthermore, the evaporation timescales of dusty and gaseous clumps in the vicinity of SgrA* are much shorter ( 2yr) than the epochs covered by the observations (≈15yr). In addition to the strong evidence for the stellar classification of the D-sources, we also find a clear disk-like pattern following the arrangements of S-stars proposed in the literature. Furthermore, we find a global intrinsic inclination for all dusty sources of 60 ± 20◦, implying a common formation process. Conclusions. The pattern of the dusty sources manifested in the distribution of the position angles, inclinations, and longitudes of the ascending node strongly suggests two different scenarios: the main-sequence stars and the dusty stellar S-cluster sources share a common formation history or migrated with a similar formation channel in the vicinity of SgrA*. Alternatively, the gravitational influence of SgrA* in combination with a massive perturber, such as a putative intermediate mass black hole in the IRS 13 cluster, forces the dusty objects and S-stars to follow a particular orbital arrangement. Key words. stars: black holes– stars: formation– Galaxy: center– galaxies: star formation
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Targeting Hsp90 and its pathogen Orthologs with Tethered Inhibitors as a Diagnostic and Therapeutic Strategy for cancer and infectious diseases with Dr. Timothy Haystead.
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Dignosis&mangment of lung cancer
1. e30S
CHEST Supplement
DIAGNOSIS AND MANAGEMENT OF LUNG CANCER, 3RD ED: ACCP GUIDELINES
Molecular Biology of Lung Cancer
Lung cancer is the leading cause of cancer death in
the United States, with 157,000 deaths annually,
and in the world, with 1,375,000 deaths annually.2
The overall 5-year survival for lung cancer remains
at 16%, which is significantly lower than the mortality
rate for other common cancers, including colon, breast,
and prostate cancer. The discrepancy in the mortality
rate of lung cancer compared with other cancers has
several explanations. First, lung cancers are typically
detected at an advanced stage. The anticipated imple-
mentation of population-based screening for lung can-
cer is expected to decrease mortality. Second, compared
with the other common cancers that share adenocar-
cinoma as the histology, lung cancer is heterogenous
histologically and biologically. Until recently, lung can-
cer was treated as a homogenous disease with all non-
small cell lung cancers (NSCLCs) treated identically,
solely on the basis of clinical stage. Based on bench
and clinical research, the treatment of lung cancer
has been refined, with treatments allocated accord-
ing to histology and specific molecular features. For
example, targeting mutations such as epidermal growth
factor receptor (EGFR) with tyrosine kinase inhibi-
tors (TKIs) has been particularly successful as a treat-
ment modality, demonstrating response rates in patients
with EGFR-mutated adenocarcinoma that are signif-
icantly higher than those for conventional chemo-
therapy. However, the development of new targeted
therapies is, in part, highly dependent on an improved
understanding of the molecular underpinnings of
tumor initiation and progression, knowledge of the
role of molecular aberrations in disease progression,
Based on recent bench and clinical research, the treatment of lung cancer has been refined, with
treatments allocated according to histology and specific molecular features. For example, target-
ing mutations such as epidermal growth factor receptor (EGFR) with tyrosine kinase inhibitors
has been particularly successful as a treatment modality, demonstrating response rates in selected
patients with adenocarcinoma tumors harboring EGFR mutations that are significantly higher
than those for conventional chemotherapy. However, the development of new targeted ther-
apies is, in part, highly dependent on an improved understanding of the molecular underpin-
nings of tumor initiation and progression, knowledge of the role of molecular aberrations in
disease progression, and the development of highly reproducible platforms for high-throughput
biomarker discovery and testing. In this article, we review clinically relevant research directed
toward understanding the biology of lung cancer. The clinical purposes of this research are (1) to
identify susceptibility variants and field molecular alterations that will promote the early detec-
tion of tumors and (2) to identify tumor molecular alterations that serve as therapeutic targets,
prognostic biomarkers, or predictors of tumor response. We focus on research developments in
the understanding of lung cancer somatic DNA mutations, chromosomal aberrations, epigenetics,
and the tumor microenvironment, and how they can advance diagnostics and therapeutics.
CHEST 2013; 143(5)(Suppl):e30S–e39S
Abbreviations: ALK5anaplastic lymphoma kinase; EGFR5epidermal growth factor receptor; EML45echinoderm
microtubule-associated protein like-4; FDA5US Food and Drug Administration; FGFR5fibroblast growth factor receptor;
FISH5fluorescent in situ hybridization; miRNA5microRNA; NSCLC5non-small cell lung cancer; PCR5polymerase
chain reaction; SCC5squamous cell carcinoma; TKI5tyrosine kinase inhibitor
Molecular Biology of Lung Cancer
Diagnosis and Management of Lung Cancer,
3rd ed: American College of Chest Physicians
Evidence-Based Clinical Practice Guidelines
Serge Patrick Nana-Sinkam, MD, FCCP; and Charles A. Powell, MD, FCCP
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3. e32S Molecular Biology of Lung Cancer
to the approval of pemetrexed in the first-line, second-
line, and maintenance settings. The results demonstrated
clear-cut and very significant treatment-by-histology
interactions with regard to both progression-free and
overall survival, thus confirming the superior effi-
cacy of pemetrexed in patients with nonsquamous
NSCLC.25 In addition, mutations of EGFR and K-ras
and translocations of EML4/ALK are largely confined
to adenocarcinoma.26 These findings have prompted
a major shift toward targeted therapy in lung can-
cer management, as detailed by Socinski et al27 in the
article, “Treatment of Stage IV Non-small Cell Lung
Cancer,” in the American College of Chest Physicians
Lung Cancer Guidelines, thus mandating that diag-
nostic specimens be acquired and processed in a fashion
that permits the histologic subtyping of NSCLC.28 In
studies using immunostains to subtype NSCLC in
cytologic specimens, Loo et al29 and Nicholson et al30
showed that thyroid transcription factor-1 and mucin
vs p63 stains are the best stains for detecting ade-
nocarcinoma vs SCC, respectively. However, none
of the antibodies used in immunohistochemistry is
100% specific and sensitive for this differential diag-
nosis. Further details on clinical immunophenotyping
of lung cancer are found in the article by Schwartz
and Rezaei,31 “Diagnostic Surgical Pathology in Lung
Cancer,” in the American College of Chest Physicians
Lung Cancer Guidelines.
Identification of putative progenitor cells and stem
cells of lung cancer is an active area of investigation.
The objective is to target these cells to prevent can-
cer development and to treat established lung cancer.
To date, no cell that strictly exemplifies the hallmarks
of a stem cell has been confirmed as a lung cancer
stem cell. Putative stem and progenitor cells include
basal cells expressing p63 and cytokeratins 5 and 14,32
epithelial cells expressing the five-transmembrane
glycoprotein CD133,33 isolated cancer cells with high
activity of aldehyde dehydrogenase1,34 and bronchi-
oloalveolar stem cells identified at the bronchioloalve-
olar duct junction in a murine model of lung cancer.35
1.3 DNA Copy Number Alterations and Gene
Rearrangements
Chromosomal abnormalities including amplifica-
tions, deletions, and rearrangements have been inves-
tigated extensively in lung cancer. One commonly
used assay, fluorescent in situ hybridization (FISH),
relies on fluorescent labeled DNA segments to detect
regions with chromosomal aberrations. Early studies
demonstrated that FISH could identify chromosomal
aneuploidy in established lung cancer samples rang-
ing from primary tumors, to effusions, to bronchial
washings.36 Sokolova et al37 showed that FISH carried
a sensitivity of 84% and a specificity of 82% in the
correlation of mutations. Su et al12 described two assays
termed SNaPshot and polymerase chain reaction
(PCR)-based sizing assays that may also be used to
detect select somatic mutations in genes commonly
implicated in cancer. High-resolution melting repre-
sents another PCR-based platform for initial mutation
screening that holds some promise.13,14 In the future,
it is likely that exon-specific or whole-genome-based
sequencing will supplant existing technologies for
screening tumor genome alterations.
1.2 Lung Developmental and Differentiation
Pathways
Current paradigms suggest that lung carcinomas
arise from pluripotent stem and progenitor cells capa-
ble of differentiation into one or several histologic
cell types. These paradigms suggest that lung tumor
cell ontology is determined by the consequences
of gene transcriptional activation and/or repression
events that recapitulate embryonic lung develop-
ment.15-17 The hypothesis that lung cancer arises from
the aberrant expression of genes involved in lung
development is supported by gene expression studies
demonstrating similarities between signatures obtained
from human lung tumors and signatures characteristic
of normal lung development.18,19 Genes associated with
early lung development are more often expressed by
small cell lung carcinoma and by other aggressive tumors
with poor prognosis.20,21 Taken together, these obser-
vations suggest that poor differentiation is linked to the
molecular parameters of early development represent-
ing lung stem and progenitor cell programs, and that
the gene signatures of these phenotypes are important
for lung cancer progression and clinical outcome.
The importance of identifying the NSCLC histo-
logic subtype has increased recently because of the
demonstrated success of histology-specific chemo-
therapeutic regimens. Until recently, all patients
with NSCLC were treated without regard for his-
tologic subtype. The first data suggesting the impor-
tance of histologic dependence were shown in the
phase I-II trials of the vascular endothelial growth
factor antibody bevacizumab.22 These results indi-
cated that the drug was effective, but that toxicity was
increased in patients with squamous histology. Sub-
sequent trials (eg, Eastern Cooperative Oncology
Group 4599) were restricted to patients with non-
squamous histology,23 and current US Food and Drug
Administration (FDA) approval is applicable to these
patients only.
More recent clinical studies have shown a major
treatment-by-histology interaction in the responsive-
ness of advanced stage IV NSCLC to pemetrexed.
Scagliotti and colleagues24 performed an interaction
analysis of the three pivotal phase 3 studies leading
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4. journal.publications.chestnet.org CHEST / 143 / 5 / MAY 2013 SUPPLEMENT e33S
suppress both metastases and growth. Interestingly,
elevated SOX2 may correlate with a favorable prog-
nosis in SCC 58 but an unfavorable prognosis in stage 1
adenocarcinoma.59
Fibroblast growth factor receptor (FGFR)1 is selec-
tively amplified in SCC (22%). Reports from in vivo
and in vitro studies indicate that FGFR1 amplifica-
tion signifies sensitivity to treatment of SCC with
FGFR inhibitors.60 Additional studies suggest that
metastatic SCC may be particularly susceptible to anti-
FGFR agents.61 TKIs including ponatinib (AP24534),
which have potent anti-FGFR properties, are currently
being investigated in lung cancer in phase 1 trials.62
2.0 Epigenetics
2.1 Methylation
Over the past several years, investigators have deter-
mined that epigenetic changes within the human
genome at the level of chromatin remodeling, histone
modifications, and DNA methylation can alter the
expression patterns of critical tumor suppressors and
oncogenes to influence malignant transformation.
Aberrant hyper- and hypomethylation of CpG islands
represent the most common finding, ranging from 15%
to 80% of lung cancers.63 Several genes that have been
identified, including CDKN2A, FHIT, APC, p16, and
RASSF1A, appear to be commonly methylated.64-67
Methylated genes may be detected using several
techniques. The majority of early studies used tech-
nologies such as methylation-specific PCR and restric-
tion landmark genomic scanning, which are targeted
to specific genomic regions and candidates. These
techniques have proven successful in identifying pat-
terns of methylation that distinguish tumor from nor-
mal tissues and also in identifying clinical subgroups.68
High-throughput profiling allows for global epigenetic
analysis for candidate genes within promoter CpG
islands; 39 untranslated regions; and noncoding regions
of the genome, including miRNA, long noncoding
RNAs, and ultraconserved regions.69
Both global and gene-specific epigenetic changes
are being tested as noninvasive biomarkers for early
detection and prognosis of lung cancer.70,71 System-
atic examination of the “methylome” can be used to
further subclassify molecular and clinically distinct
subgroups of lung cancer and to potentially guide
therapeutic decisions. Brock et al72 examined the prog-
nostic value of methylation patterns for seven genes
(p16, MGMT, DAPK, RASSF1A, CDH13, ASC, and
APC) in the setting of resected stage 1 NSCLC. The
authors demonstrated that pairs of gene combina-
tions of p16, CDH13, APC, and RASSF1A served as
risk factors for recurrence. Methylation analysis for
specific genes is now being applied to biomarker
detection of lung cancer in bronchial washings. The
results from several studies suggest that FISH could
complement the diagnostic accuracy of cytology. For
example, Nakamura et al38 compared FISH with con-
ventional cytology and determined that FISH had a
specificity of 100% and a sensitivity of 87%. Halling
et al39 detected a sensitivity of FISH of 71% in bron-
chial brushing specimens and 49% in bronchial wash-
ing specimens. Select FISH probes have been used as
a diagnostic assay for the detection of lung cancer.39-41
For example, in a cohort of patients with lung can-
cer and a control group with nonneoplastic disease,
FISH for MYC (8q24), EGFR (7p12), and chromo-
somes 5 and 6 in bronchial brushings showed increased
sensitivity compared with conventional cytology.42
Varella-Garcia et al43 recently showed that chromo-
somal aneusomy in sputum as detected by FISH may
be useful in the early detection of lung cancer.
An emerging application for FISH technology has
been to determine EGFR status and, thus, TKI sen-
sitivity. Mutational analysis for EGFR is increasingly
becoming standard in the assessment of adenocarci-
nomas, given the significant response rates to EGFR/
TKI inhibitors among patients harboring mutations.44,45
The role of the EGFR copy number in determining
therapy or response remains unclear. Some studies
suggest that the EGFR copy number correlates with
mutational status and, to a lesser extent, with drug
responsiveness.46 Another study confirmed that muta-
tional status is the most valuable predictor of respon-
siveness, independent of copy number or protein
expression.47 Several phase 2 and 3 trials have been
conducted to answer this question, but the results have
been inconsistent.48,49 Two meta-analyses confirmed
that EGFR mutational analysis, not FISH, is the assay
of choice to predict response to TKI therapy.50,51
The EML4/ALK protein represents a fusion between
ALK and EML4 that is present in approximately 4%
of NSCLC.52,53 The rearrangement is associated with
response to the targeted ALK inhibitor crizotinib. A
comparison of different methodologies for dysregu-
lated ALK detection concluded that ALK break-apart
FISH could accurately detect rearrangements.54 Thus,
the break-apart assay is now FDA approved to deter-
mine treatment with crizotinib. However, studies are
ongoing to determine if a complementary set of assays,
including immunohistochemistry, FISH, and reverse
transcription-PCR, may be helpful in clinical decision
making.
SOX2, located at chromosome 3q26.33, is a tran-
scription factor gene involved in foregut development
and pluripotency that has been shown to be amplified
in SCCs, including lung.55,56 In fact, SOX2 carries a
specificity of 95% in distinguishing SCC from adeno-
carcinoma.57 Several studies have shown that SOX2
has oncogenic properties and that direct targeting can
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5. e34S Molecular Biology of Lung Cancer
histologies.84-86 The role of miRNA in the clinical set-
ting remains unclear, awaiting large, prospective pro-
filing studies that demonstrate reproducibility.
3.0 Tumor Microenvironment
The past few decades have seen a new appreciation
for the role of the tumor stroma in cancer initiation
and progression.87 Signaling between the stroma and
epithelium, via direct contact and secreted mediators,
is essential for tumor initiation, growth, differentia-
tion, progression, and metastasis.88 The tumor stroma
is a complex system composed of fibroblasts (cancer-
associated fibroblasts), macrophages (tumor-associated
macrophages), other immune cells, vasculature, and
extracellular matrix.89 Cancer cells modulate the stromal
microenvironment via secretion of a variety of growth
factors, including transforming growth factor-b,90
platelet-derived growth factor, vascular endothelial
growth factor, and basic fibroblast growth factor. In
turn, the stroma can produce antiangiogenic factors
and recruit an antitumor immune response. Alterna-
tively, the stromal response can facilitate tumor pro-
gression via the release of growth factors that feed
back to tumor cells, participate in new vessel growth,
and promote tumor growth and invasion.87 The stroma
can have powerful tumor-promoting effects. For
example, culturing cancer-associated fibroblasts with
initiated prostatic epithelial cells enhances tumor
growth and invasion,91 and in a murine model, loss of
TbRII in fibroblasts can promote tumor initiation in the
adjacent epithelium.92 In addition to its roles in lung
tumor initiation and progression, the stroma, in coop-
eration with tumor cells, can establish a niche within
the lung that is conducive to the establishment and
growth of metastatic foci from other primary tumors.93,94
Several researchers have directed research toward
understanding the prognostic significance of immune
cell composition within and surrounding the lung
tumor. Various immune cell compartments have been
examined, including macrophages (M1 vs M2), T-helper
(CD4 and CD8) cells, cytotoxic T cells, T-regulatory
cells, B cells, natural killer cells, neutrophils, and
myeloid-derived suppressor cells.95 To date, there is
no validated immune cell biomarker of prognosis.
The fields of cancer immunology and immunotherapy
are evolving; thus, it is possible that further research
will provide clinically important biomarkers of prog-
nosis and predictors of response to immunotherapy.
4.0 Oncogene Addiction: EGFR,
K-ras, EML4/ALK Alterations
The oncogene addiction hypothesis states that pre-
cise targeting of discrete fundamental genetic alter-
ations in tumors will kill tumor cells and result in
discovery efforts using noninvasive specimens. Belinsky
et al73 demonstrated in sputum that the analysis of
methylation patterns in a panel of predetermined
genes had predictive value for the eventual develop-
ment of lung cancer among high-risk smokers. An
independent study concluded that methylation pat-
terns within sputum correlated much better with pri-
mary tumor than did methylation within serum.74
Epigenetics analysis is being integrated into clin-
ical trials. De Fraipont et al75 examined tumor sam-
ples for methylation of RASSF1a and DAPK1 within
the French Intergroup (IFCT-0002) phase 3 trial of
neoadjuvant treatment of stage I to II NSCLC and
determined that methylation of both genes showed
prognostic efficacy.
2.2 microRNA
During the past 2 decades, investigators have deter-
mined that large noncoding portions of the human
genome may harbor functional capacity. These regions
of noncoding RNA are now known to have gene regu-
latory function. miRNAs (or miRs) represent perhaps
the best studied of this group of noncoding RNAs.76,77
Currently, there are .1,200 human miRNAs. Based
on in silico analysis, miRNAs may regulate up to two-
thirds of the human genome.78 miRNAs have been
implicated in all the fundamental hallmarks of cancer
initiation and progression. Profiling studies have dem-
onstrated global differences in miRNA expression
between lung tumor and noninvolved adjacent lung
tissues.79 These initial observations have led to research
focused on functional in vitro and in vivo validation of
single-miRNA single-target relationships and on link-
ing patterns of miRNA expression to clinical parame-
ters such as prognosis and therapeutic response.
Several studies have examined miRNAs as prognos-
tic biomarkers in lung cancer. The earliest studies in
stage 1 adenocarcinomas demonstrated that increased
miR-155 and decreased Let-7a2 correlated with poor
survival.79 Landi et al80 identified a 5-miRNA signa-
ture that correlated with survival. Saito et al81 deter-
mined that miR-21 consistently correlated with poor
outcomes among early lung stage cancers from three
independent cohorts. Another study suggested that
patterns of plasma miRNA may be used for risk strati-
fication in lung cancer screening programs.82 Other
studies have been unsuccessful in correlating miRNA
to outcome. A study among patients undergoing sur-
gical resection and adjuvant chemotherapy found
no association between select miRNAs and survival
or response to therapy.83 A few select miRNAs have
emerged as having the capacity to distinguish histo-
logic subtypes. Several studies have determined that
miR-205, which is overexpressed in SCC compared
with adenocarcinoma, can be used to distinguish the
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6. journal.publications.chestnet.org CHEST / 143 / 5 / MAY 2013 SUPPLEMENT e35S
(PF-02341066) in patients with ALK-translocated,
advanced lung carcinoma. In 82 patients with FISH-
testing-confirmed translocations, crizotinib at a dose
of 250 mg po bid led to a dramatic 57% response rate
and a 6-month progression-free survival of 72%. Sub-
sequently, based on data from this phase 1 trial, crizotinib
has been approved by the FDA for the treatment of
patients with NSCLC tumors that harbor the ALK
translocation as detected by an FDA-approved FISH
test. In line with recommendations from the American
Society of Clinical Oncology, we recommend testing
for molecular alterations in EGFR, K-ras, or ALK in
advanced-stage lung adenocarcinoma (see the article
by Socinski et al27 “Treatment of Stage IV Non-small
Cell Lung Cancer,” in the American College of Chest
Physicians Lung Cancer Guidelines). Sequential test-
ing for EGFR, K-ras, and ALK is reasonable, begin-
ning with either K-ras or EGFR analysis, with ALK
analysis reserved for K-ras- and EGFR-negative spec-
imens. Concomitant testing is not necessary unless
sequential testing causes a delay in treatment.
Despite the high frequency of clinical response seen
in patients treated with TKIs for EGFR mutant lung
tumors and with crizotinib for tumors that are posi-
tive for ALK, drug resistance and relapse invariably
develop.97 Research directed toward understanding
the biology of acquired resistance in these tumors
indicates that tumors can evade inhibition through a
variety of complex mechanisms. For example, Katayama
and colleagues107 examined tumor biopsy specimens
from 18 patients with crizotinib resistance and deter-
mined that resistance was attributable to acquired
ALK somatic mutations in five cases and to alterna-
tive mechanisms of resistance, including activation
of other tyrosine kinase receptors such as EGFR and
KIT, in others. Sequist and colleagues108 examined
tumor biopsy specimens from 37 patients with EGFR-
mutation-positive tumors with acquired resistance
to TKIs. Interestingly, five resistant tumors developed
a morphology that was consistent with small cell car-
cinoma and were sensitive to small cell therapies.
Importantly, three patients showed resolution of the
resistance alteration in the absence of EGFR inhibi-
tors and were, thus, sensitive to the resumption of
therapy. These studies indicate that biopsies of resis-
tant tumors may provide important information that
can guide subsequent therapy.
5.0 Molecular Profiling in
Early-Stage Lung Cancer
To discriminate a poor prognosis from a good prog-
nosis in early-stage lung cancers, a multitude of gene-
profiling studies have been conducted on early-stage
NSCLC, each proposing a signature of prognostic
genomic information that correlates with patient
clinical response.96 The successful application of this
principle has been demonstrated in lung adenocarci-
noma using agents targeted toward EGFR and ALK.97
EGFR is a 170-kDa tyrosine kinase receptor that is
overexpressed in 40% to 80% of NSCLC.98 It can be
targeted with small-molecule TKIs, such as erlotinib
and gefitinib, which bind to the ATP-binding pocket
of the receptor. The sequencing of tumor samples
from responding patients in clinical trials of TKIs led
to the discovery of somatic mutations in the EGFR
tyrosine kinase domain.44,45 The activating and onco-
genic mutations reported to date are in exons 18 to 21,
affecting the tyrosine kinase portion of EGFR. The
majority of mutations are either small deletions of
exon 19 affecting a 3-amino acid sequence or a point
mutation L858R on exon 21. Mutations affecting
exon 20, such as small insertions in T790M, account
for 3% to 5% of all EGFR mutations, and although
they are activating, they are also associated with resis-
tance to EGFR TKIs. The prevalence of EGFR muta-
tions varies by ethnicity, from 5% to 20% in whites, to
20% to 40% in the Asian population; the mutations
are less common in black patients.99,100 Clinical trials
from Japan from Maemondo and colleagues101 and
from the West Japan Oncology Group,102 and from
the OPTIMAL study in China,103 have shown that
TKI therapy in EGFR mutant adenocarcinoma results
in response rates of .70% and longer progression-free
survival when compared with conventional chemo-
therapy in advanced lung adenocarcinoma. Together,
these studies strongly support the role of molecular
testing in lung adenocarcinoma for identification of
EGFR mutant cancers104 and suggest that TKI treat-
ment is the preferred first-line therapy for advanced
EGFR mutant tumors. The American Cancer Society
has issued a provisional clinical opinion that patients
with NSCLC who are being considered for first-line
therapy with an EGFR TKI should have their tumor
tested for EGFR mutations.105
Because key lung cancer mutations are mutually
exclusive, an alternative to EGFR mutation testing is
K-ras mutation testing. K-ras mutations are present
in approximately 30% of lung adenocarcinomas and
are confined to three codons, which lowers the cost and
complexity of mutation sequencing. K-ras-mutation-
positive tumors are resistant to TKI therapy; thus,
a positive test obviates the need for EGFR mutation
testing. Adenocarcinomas that are negative for EGFR
and K-ras mutations can be screened by FISH for the
presence of chromosomal translocation of the ALK
gene. ALK gene translocations, mainly EML4/ALK,
were recently identified as an oncogenic mechanism in
NSCLC, present in 3% to 5% of tumors, predominantly
adenocarcinoma.52 Kwak and colleagues106 published
the first human experience with ALK inhibition through
the use of the dual ALK/MET inhibitor crizotinib
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7. e36S Molecular Biology of Lung Cancer
the manuscripts and recommendations. Further details on the
Conflict of Interest Policy are available online at http://chestnet.org.
Endorsements: This guideline is endorsed by the European
Society of Thoracic Surgeons, Oncology Nursing Society, American
Association for Bronchology and Interventional Pulmonology, and
the Society of Thoracic Surgeons.
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6.0 Conclusion
Despite the small improvements in lung cancer
5-year survival over the past 3 decades, there is cause
to be optimistic for a future with fewer lung cancer
deaths. This future will deploy molecular techniques
to diagnose lung cancer earlier and will continue to
translate laboratory-based investigations of lung can-
cer into diagnostics and novel therapeutics that will
have a significant impact on improving lung cancer
survival. Recent technologic developments117 prom-
ise a preponderance of high-throughput data and
novel disease insights that will continue to propel diag-
nostics and therapeutics toward a future with reduced
lung cancer morbidity and mortality.
Acknowledgments
Author contributions: Dr Powell had full access to all of the
data in the study and takes responsibility for the integrity of the
data and the accuracy of the data analysis.
Dr Nana-Sinkam: contributed to the literature search and draft-
ing and revision of the manuscript.
Dr Powell: contributed to the literature search and drafting and
revision of the manuscript.
Financial/nonfinancial disclosures: The authors have reported
to CHEST that no potential conflicts of interest exist with any
companies/organizations whose products or services may be dis-
cussed in this article.
Role of Sponsors: The American College of Chest Physicians
was solely responsible for the development of these guidelines.
The remaining supporters played no role in the development
process. External supporting organizations cannot recommend
panelists or topics, nor are they allowed prepublication access to
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