FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2767454329> ?p ?o ?g. }

• W2767454329 endingPage "S1702" @default.
• W2767454329 startingPage "S1701" @default.
• W2767454329 abstract "Despite fast growing information of tumor molecular biology, the increase in the therapeutic portfolio, and a significant improvement in diagnostic radiology, treatment of advanced NSCLC in 2017 remains palliative with still no curative perspective for the vast majority of patients. Therefore, the main treatment goals include the change from an acute into a chronic disease, extending survival times as well as improving or just maintaining quality of life. In order to assure an optimal palliation the majority of patients with advanced NSCLC – considering the high age and concomitant comorbidities - frequently may require modifications of the treatment standard. Furthermore, it can also not be ignored that recently approved novel agents and innovative diagnostic technology represent a growing burden of financial toxicity leading to regional differences in the availability of modern therapy and in the access to molecular testing and modern imaging. Nonetheless, treatment algorithms for advanced NSCLC have over the last decade gradually gained in complexity by incorporating a number of diagnostic and therapeutic achievements allowing personalization, individualization, and precision of therapy. Not only patient factors such as performance status (PS), comorbidity, and patients’ treatment expectation must lead to treatment differentiation and modification but also disease characteristics such as tumor stage, tumor load, histological type (squamous vs non–squamous) and the molecular profile of the tumor (mutant vs wild type) influence the process in reaching the goal of optimal sustainable palliation. Other critical elements in realizing personalized therapy and precision medicine within the process of optimal palliation consist in a rational selection of anti-cancer agents (predictive factors, mode of action, toxicity profile) and their appropriate application (single agent, concomitant combinations, drug sequencing) as well as other novel therapeutic actions such as interventional radiology, modern radio therapy, and minimal surgery. Optimal therapeutic management for sustainable palliation should definitely be based on clinically reliable evidence presented by frequently updated treatment recommendations: Today’s treatment algorithm for advanced NSCLC is challenged by a number of newer agents, such as tyrosine kinase inhibitors, monoclonal antibodies, checkpoint inhibitors (Table 1), and the incorporation of new treatment strategies such as continuation or switch maintenance therapy (Fig 1). For advanced NSCLC (Fig 2) it is generally accepted that platinum based doubled chemotherapy remains the backbone for the majority of our patients with good PS and this combination therapy should be modified according to feasibility and tolerability, comorbidity, patients’ age over 70 years, PS. For wild type non-squamous NSCLC there is pemetrexed which has been shown to be favorable over older cytotoxic agents if combined with platinum based components. In addition, pemetrexed has also sufficiently demonstrated that if it is continued in case non-progression under four cycles of standard platinum based doublet chemotherapy not containing pemetrexed (switch maintenance) or containing pemetrexed (continuation maintenance) prolongs survival. Another agent, the small molecule and EGFR-tyrosine kinase inhibitor erlotinib also prolongs survival if used in the switch maintenance setting but its benefit depends on the quality of response to the chemotherapy and is restricted to patients which have experienced disease stabilization only. The VEGFR-targeting antibody, bevacizumab, if added to platinum based doublet therapy, specifically to carboplatin/paclitaxel significantly improves response rate, duration of response, progression free survival, as well as overall survival in eligible patients. Human immune checkpoint inhibitor-antibodies inhibiting the PD-1 receptor or PD-1 ligand have recently been integrated into the treatment algorithms of wild type NSCLC. Pembrolizumab is currently the only checkpoint inhibitor approved and recommended for first line therapy in patients with a PD-L1 expression level ≥ 50 % and with negative or unknown EGFR/ALC/ROS1 testing. In wild type squamous NSCLC the given treatment options are still limited and platinum based therapy (no pemetrexed, no bevacizumab) remains the recommended treatment standard. Nonetheless, just recently the EGFR-targeting monoclonal antibody necitumumab has shown to significantly improve survival if combined with the standard doublet regimen cisplatin/gemcitabine in comparison to cisplatin/gemcitabine only and therefore, has just recently approved. Maintenance therapy in squamous tumors with docetaxel or erlotinib (switch) or gemcitabine (continuation) may be justified in some patients even here the statistical evidence is weak. For about 10-30% of NSCLC (in Europe < 15%) non-squamous tumors expressing specific molecular features first-line treatment by genotype has been established. Tumors with sensitizing EGFR mutations have been exposed by gefitinib, erlotinib, and afatinib and have shown to prolong progression free survival over standard platinum based doublet standard therapy. In tumors bearing ALK-/ROS1-gene-rearrangements crizotinib and ceritinib have also shown to prolong progression free survival if compared to platinum based / pemetrexed doublet chemotherapy. Therefore, EGFR-TKI therapy (erlotinib, gefitinib, afatinib) should be prescribed for patient with tumors bearing sensitizing EGFR-mutations and for patients with tumors bearing ALK-/ROS1-gene-rearrangements ALK-/ROS1-targeted therapy (crizotinib, ceritinib) should be prescribed. However, for these patients molecular testing is critical and should be used to select patients for EGFR/ALK/ROS1 targeted therapy. Patients with lung adenocarcinoma should not be excluded from testing on the basis of clinical characteristics (ethnicity, gender, smoking status). Last but not least, second-/subsequent-line therapy is another strong element contributing to sustainable palliation in patients with advanced NSCLC. For tumor without driver mutations agents available before 2014 include docetaxel, pemetrexed (for non-squamous cell tumors only) and erlotinib. In recent years the two antiangiogenic agents nintetanib and ramucirumab (both in combination with docetaxel) and three immune checkpoint inhibitors (nivolumab, pembrolizumab, azetolizumab) have been added to the armentarium to treat patients with advanced non-mutated NSCLC who have progressed on or after first-line therapy (Fig 2). In mutated NSCLC several therapeutic options for second-/subsequent line-therapies are recommended depending on the type of progression and the molecular profile of the tumor. Osimertinib has been just recently approved for EGFRm/790M expressing tumors. For ALK-positive tumors ceritinib, alectinib, and crizotinib can be prescribed. In general, selection of agents for second-/subsequent-line therapies is based on whether the drugs have been used earlier, or toxicity or patients view. References are available by the author." @default.
• W2767454329 created "2017-11-17" @default.
• W2767454329 creator A5007889470 @default.
• W2767454329 date "2017-11-01" @default.
• W2767454329 modified "2023-09-26" @default.
• W2767454329 title "MS 14.01 Elements to Reach the Treatment Goal of Palliation" @default.
• W2767454329 doi "https://doi.org/10.1016/j.jtho.2017.09.248" @default.
• W2767454329 hasPublicationYear "2017" @default.
• W2767454329 type Work @default.
• W2767454329 sameAs 2767454329 @default.
• W2767454329 citedByCount "0" @default.
• W2767454329 crossrefType "journal-article" @default.
• W2767454329 hasAuthorship W2767454329A5007889470 @default.
• W2767454329 hasConcept C121608353 @default.
• W2767454329 hasConcept C126322002 @default.
• W2767454329 hasConcept C142724271 @default.
• W2767454329 hasConcept C146357865 @default.
• W2767454329 hasConcept C151730666 @default.
• W2767454329 hasConcept C159110408 @default.
• W2767454329 hasConcept C163763905 @default.
• W2767454329 hasConcept C177713679 @default.
• W2767454329 hasConcept C2776907518 @default.
• W2767454329 hasConcept C2779134260 @default.
• W2767454329 hasConcept C2779159551 @default.
• W2767454329 hasConcept C2779384505 @default.
• W2767454329 hasConcept C2779951463 @default.
• W2767454329 hasConcept C2994186709 @default.
• W2767454329 hasConcept C32220436 @default.
• W2767454329 hasConcept C60644358 @default.
• W2767454329 hasConcept C71924100 @default.
• W2767454329 hasConcept C86803240 @default.
• W2767454329 hasConceptScore W2767454329C121608353 @default.
• W2767454329 hasConceptScore W2767454329C126322002 @default.
• W2767454329 hasConceptScore W2767454329C142724271 @default.
• W2767454329 hasConceptScore W2767454329C146357865 @default.
• W2767454329 hasConceptScore W2767454329C151730666 @default.
• W2767454329 hasConceptScore W2767454329C159110408 @default.
• W2767454329 hasConceptScore W2767454329C163763905 @default.
• W2767454329 hasConceptScore W2767454329C177713679 @default.
• W2767454329 hasConceptScore W2767454329C2776907518 @default.
• W2767454329 hasConceptScore W2767454329C2779134260 @default.
• W2767454329 hasConceptScore W2767454329C2779159551 @default.
• W2767454329 hasConceptScore W2767454329C2779384505 @default.
• W2767454329 hasConceptScore W2767454329C2779951463 @default.
• W2767454329 hasConceptScore W2767454329C2994186709 @default.
• W2767454329 hasConceptScore W2767454329C32220436 @default.
• W2767454329 hasConceptScore W2767454329C60644358 @default.
• W2767454329 hasConceptScore W2767454329C71924100 @default.
• W2767454329 hasConceptScore W2767454329C86803240 @default.
• W2767454329 hasIssue "11" @default.
• W2767454329 hasLocation W27674543291 @default.
• W2767454329 hasOpenAccess W2767454329 @default.
• W2767454329 hasPrimaryLocation W27674543291 @default.
• W2767454329 hasRelatedWork W173034263 @default.
• W2767454329 hasRelatedWork W1985041619 @default.
• W2767454329 hasRelatedWork W2126486098 @default.
• W2767454329 hasRelatedWork W2515655475 @default.
• W2767454329 hasRelatedWork W2554808068 @default.
• W2767454329 hasRelatedWork W2589770771 @default.
• W2767454329 hasRelatedWork W3029039537 @default.
• W2767454329 hasRelatedWork W3130963457 @default.
• W2767454329 hasRelatedWork W3161153624 @default.
• W2767454329 hasRelatedWork W4283728497 @default.
• W2767454329 hasVolume "12" @default.
• W2767454329 isParatext "false" @default.
• W2767454329 isRetracted "false" @default.
• W2767454329 magId "2767454329" @default.
• W2767454329 workType "article" @default.