A 70-year-old woman presented with hemoptysis due to a right upper lobe mass. Bronchial artery embolization (BAE) using gelatin sponge was successful in controlling bleeding. Two weeks later, chest computed tomography (CT) revealed that the solid tumour had been replaced by a 5.6 cm thin-walled cavity without fluorodeoxyglucose uptake on positron emission tomography-computed tomography, although fluorodeoxyglucose accumulation was observed in the right hilar lymph node. Right upper lobectomy confirmed adenocarcinoma. The patient, confirmed with a pathological stage of IIIA, received adjuvant chemotherapy and has remained recurrence-free for more than 5 years. This case suggests that BAE induced tumour necrosis and cavitation; however, viable tumour tissue remained. Further accumulation of similar cases is needed to clarify the therapeutic significance of BAE in lung cancer.

Immune checkpoint inhibitors (ICIs) have markedly improved survival in advanced non–small cell lung cancer (NSCLC), potentially modifying the prognostic impact of comorbid chronic obstructive pulmonary disease (COPD). We conducted a multicenter retrospective cohort study across four Japanese institutions including patients with spirometry-confirmed COPD and advanced or recurrent NSCLC, including stage IV disease, postoperative recurrence, recurrence after definitive concurrent chemoradiotherapy, or other advanced/recurrent status documented in the clinical records, treated between January 2007 and December 2020, excluding those with sensitizing EGFR variants or ALK fusions. COPD was diagnosed based on smoking history and airflow limitation, defined as a forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) ratio of less than 70%, in accordance with the Japanese Respiratory Society guidelines and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. COPD treatment was defined as regular use of inhaled bronchodilators and/or inhaled corticosteroids initiated before or at the start of first-line therapy. Overall survival (OS) was measured from treatment initiation to death from any cause. Among 455 eligible patients with spirometry-confirmed COPD, 144 received regular inhaled COPD therapy and 311 did not. Median OS was longer in the COPD-treated group than in the untreated group (23.3 vs. 16.7 months; hazard ratio [HR] 0.73, 95% confidence interval [CI] 0.57–0.93; P = 0.0105). However, patients receiving COPD treatment were more likely to receive ICIs during the disease course than untreated patients (109/144, 75.7% vs. 138/311, 44.4%), and ICI therapy remained a strong independent predictor of OS in conventional multivariable analysis. In an additional time-dependent Cox analysis accounting for the timing of ICI initiation, COPD treatment showed a modest association with longer OS, whereas ICI exposure showed a nonsignificant trend toward improved OS. When patients were stratified by ICI exposure, COPD-treated patients had longer OS than untreated patients in the non-ICI subgroup, whereas OS did not differ meaningfully by COPD treatment status among patients who received ICIs. These findings indicate that the survival association between COPD treatment and OS should be interpreted with careful consideration of the timing and line of ICI exposure in the ICI era.

Background Chemoradiotherapy is the standard treatment for unresectable, locally advanced lung cancer. With the commencement of durvalumab as an adjuvant therapy, increased number of long-term survivors is anticipated. However, the prognosis of long-term survivors and appropriate follow-up remains largely unknown. Using real-world long-term data before durvalumab, this study aimed to evaluate the prognosis and incidence of metachronous cancer among patients with non-small cell lung cancer (NSCLC) who survived for longer than 5 years after chemoradiotherapy at our institution. Methods We retrospectively analyzed the data of patients with stage III (Union for International Cancer Control 6th) NSCLC who underwent chemoradiotherapy for curative intent at our institution from 2003 to 2017. Survival and cumulative incidence were estimated using the Kaplan–Meier method. Results In total, 147 patients were included in this study. Among them, 40 survived for longer than 5 years. The estimated 5-year survival rate was 31.2% (95% confidence interval [CI]: 23.7–39.2%), and 25 patients were then recurrence-free. The median survival period for patients who survived for longer than 5 years was 5.32 years (95% CI 3.91–6.21 years). Among these patients, 10 died of primary lung cancer and nine from metachronous cancers, particularly esophageal (n=3) and lung (n=4) cancers. Conclusion The prognosis of long-term survivors after curative chemoradiotherapy extends beyond 5 years. However, follow-up, focusing attention on the occurrence of metachronous cancer, is necessary. Routine surveillance, including chest computed tomography and upper endoscopy, may aid in the early detection of metachronous cancers

ABSTRACT A 39‐year‐old man presented with fever and dyspnoea for 1 week. Imaging suggested bacterial pneumonia with infiltrates in the right lung. However, the symptoms persisted despite antibiotics. Bronchoscopy revealed coagulation necrosis, and enhanced computed tomography identified a large thrombus in the right pulmonary artery, leading to a diagnosis of pulmonary infarction. The patient was treated with direct oral anticoagulants. Two years later, new nodular lesions with cavities were observed in the upper lobe of the right lung. Bronchoscopy revealed a Mycobacterium avium infection. We hypothesise that nontuberculous mycobacterial (NTM) pulmonary disease may complicate chronic pulmonary embolism.

A 69-year-old man with a history of thymoma resection was diagnosed with COVID-19 pneumonia. Initially, the patient responded well to molnupiravir, but he experienced a relapse. Subsequent steroids for COVID-19-related organizing pneumonia (OP) led to temporary improvement, but his condition deteriorated when the steroids were tapered off. Further investigation revealed hypogammaglobulinemia, and Good's syndrome (GS) was diagnosed. Immunoglobulin replacement therapy was administered, significantly improving the pulmonary shadows, and no subsequent relapse occurred. GS is an immunodeficiency condition associated with thymoma. If COVID-19 recurs or is refractory despite steroid therapy for OP, COVID-19 itself may not be resolved due to immunodeficiency.

BACKGROUND:We conducted a randomize phase II study to evaluate the efficacy and safety of topoisomerase II inhibitor amrubicin plus topoisomerase I inhibitor irinotecan (AI) compared with cisplatin plus irinotecan (PI) as first-line therapy in patients with extensive-disease (ED) small-cell lung cancer (SCLC). PATIENTS AND METHODS:Chemo-naïve patients with pathologically proven ED-SCLC (including limited disease (LD) SCLC with malignant effusion) were enrolled. Patients were randomized 1:1 to receive either AI (amrubicin 90mg/m2 on day 1 and irinotecan 50mg/m2 on days 1 and 8 of a 21-day cycle) or PI (cisplatin 60mg/m2 on day 1 and irinotecan 60mg/m2 on days 1, 8 and 15 of a 28-day cycle). The primary endpoint was overall survival proportion at 1 year. RESULTS:A total of 100 patients were randomly assigned to AI (n = 50) or to PI (n = 50). The 1-year overall survival proportions were 68.0% (95% confidence interval (CI): 56.2-82.2%) for AI and 59.2% (46.9-74.7%) for PI (1-sided P = .18). Median survival time was 14.8 months for AI and 13.5 months for PI with a hazard ratio (HR) of 0.618 (0.398-0.961, stratified log-rank test P = .031). Median progression-free survival time was 4.8 months for AI and 5.4 months for PI (stratified log-rank test, P = .54). Objective response rate was 70.0% (55.4-82.1%) for AI and 55.1% (40.2-69.3%) for PI (Fisher exact test, P = .15). There was no significant difference in hematological toxicity, whereas rates of vomiting, loss of appetite, diarrhea, and elevated serum creatinine are more frequent in PI. Interstitial lung disease (Grade 2 or 3) developed in 5 patients in AI and in 1 patient in PI. There was no treatment-related death. CONCLUSION:Although the study did not meet its primary endpoint, AI showed promising efficacy and good tolerability in chemo-naïve patients with ED-SCLC.

An 83-year-old woman was suspected to have lung cancer in the right lung. However, diffuse opacities only appeared in the left lung, and she was urgently hospitalized due to severe respiratory failure. The opacities in the left lung deteriorated, and she died despite treatments including antibiotics and steroids. An autopsy revealed pleomorphic carcinoma in the right upper lobe, stenosis of the right pulmonary artery due to compression of the right hilar lymph nodes, and diffuse alveolar damage (DAD) throughout the left lobes. Acute respiratory distress syndrome (ARDS), of which a histological feature is DAD, consists of bilateral opacities in the lungs according to the definition. Unilateral ARDS is extremely rare and has reportedly developed in patients with unilateral pulmonary artery agenesis. The unilateral absence of pulmonary perfusion might be involved in the pathogenesis of unilateral ARDS. In patients with lung cancer, compression of the pulmonary artery may result in unilateral ARDS.

An 80-year-old man who received a diagnosis of lung squamous cell carcinoma of the right upper lobe with chest wall invasion underwent conventional radiation therapy. The patient completed the radiation therapy but was debilitated by bacterial pneumonia during radiation therapy and radiation pneumonitis. Computed tomography after radiation therapy revealed improvement in the tumor, pathologic fractures of the right ribs, and residual chest wall invasion (Fig. 1A).

Zoledronic acid (ZA) reduces the incidence of skeletal-related events (SREs) in patients with bone metastases from solid tumors. However, its optimal dosing interval for patients with lung cancer is uncertain.

Recognizing physiologic 18F-fluorodeoxyglucose (FDG) uptake in severe COPD is crucial to avoid mistaking it for lung cancer metastasis. Correlating 18F-FDG avid lesions with co-registered computed tomography is essential for accurate lung cancer staging and preventing unnecessary interventions.

Mesenchymal epithelial transition factor receptor (MET) tyrosine kinase inhibitors (MET-TKIs) have been approved for the treatment of non-small cell lung cancers with MET exon 14 skipping mutations. Transient asymptomatic pulmonary opacities (TAPOs) associated with epidermal growth factor receptor (EGFR)-TKIs have been reported. Here, we report a case wherein ground-glass opacities (GGOs) appeared during the course of treatment with tepotinib, a MET-TKI, but spontaneously resolved with drug withdrawal, after which treatment was resumed with a reduced dose. Although there have been no reports of TAPOs with MET-TKIs, the clinical and imaging findings of this case were consistent with TAPOs. For TAPOs occurring because of MET-TKI, the drug can be continued under careful observation even if GGOs appear.

Background: Zoledronic acid (ZA) reduces the incidence of skeletal-related events (SREs) in patients with bone metastases from solid tumors. However, the optimal dosing interval of ZA for patients with lung cancer is uncertain. Methods: We conducted a randomized, open-label, feasibility phase 2 trial at eight Japanese hospitals. Patients with bone metastases from lung cancer were randomly assigned to receive either 4 mg of ZA every four weeks (4wk-ZA) or every eight weeks (8wk-ZA). The primary endpoint was the time to the first SRE and the rate and types of SREs after one year. SREs were defined as pathologic bone fracture, bone radiation therapy or surgery, and spinal cord compression. Secondary endpoints were the SRE incidence at six months, pain assessment, changes in analgesic consumption, serum N-telopeptide, toxicity, and overall survival. Results: Between November 2012 and October 2018, 109 patients were randomly assigned to the 4wk-ZA group (54 patients) and the 8wk-ZA group (55 patients). The number of patients who received chemotherapy or molecular-targeted agents was 30 and 23 and 18 and 16 in the 4wk-ZA and 8wk-ZA groups, respectively. The median time to the first SRE could not be calculated because of a low SRE. The time to the first SRE of all patients did not differ between the groups (P = 0.715, HR = 1.18, 95% CI = 0.48, 2.9). The SRE rate of all patients after 12 months was 17.6% (95% CI = 8.4, 30.9%) in the 4wk-ZA and 23.3% (95% CI = 11.8, 38.6%) in the 8wk-ZA group, without significant differences between the groups. There was no difference in any secondary endpoint between groups, and these endpoints did not differ among treatment modalities. Conclusions: An eight-week ZA interval does not increase the SRE risk for patients with bone metastasis from lung cancer and could be considered clinically.

Patients with cancer are at an increased risk of developing coronavirus disease 2019 (COVID-19) infection. Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate (ADC) against epidermal growth factor receptor 2 (HER2)-positive cancer, known to cause drug-induced interstitial lung disease (DILD), including drug-induced pneumonitis. A 60-year-old woman with breast cancer developed a fever during treatment with T-DXd and was diagnosed with COVID-19. The fever persisted for approximately 3 weeks, and chest computed tomography showed multiple consolidations with bilateral peripheral predominance. Since the clinical course was atypical for COVID-19 due to the long duration of the fever and the CT pattern was frequently seen in T-DXd-induced ILD, the patient was diagnosed with T-DXd-induced ILD, following which, prednisolone was started, leading to improvement in the symptoms and fading of shadows. Even in patients suspected of COVID-19 pneumonia, physicians should consider the possibility of DILD, particularly in patients undergoing cancer treatment.

Abstract Background Gefitinib (G) is a recommended molecular‐targeted agent for elderly patients with epidermal growth factor receptor (EGFR)‐mutant non‐small cell lung cancer (NSCLC). Docetaxel (Doc) and pemetrexed (Pem) have similar efficacies, and either is often used as the sole agent during treatment. The efficacy of continuing G after progressive disease (PD) develops has been reported. It remains unclear whether the continuation of G in combination with a single cytotoxic agent beyond PD is beneficial for elderly patients. Here, we conducted a randomized phase II study to assess the efficacy and safety of cytotoxic chemotherapy with G for elderly patients with progressive EGFR‐mutant NSCLC. Methods Elderly patients with EGFR‐mutant NSCLC with PD previously treated with G were enrolled. Patients received Pem 500 mg/m or Doc 60 mg/m every 21 days and were randomly assigned to receive chemotherapy with 250 mg G (G+ Doc/Pem arm) or without G (Doc/Pem arm) until further disease progression or unacceptable toxicity. Results This trial was terminated early owing to slow accrual. A group of 22 patients underwent analysis. The primary endpoint, progression‐free survival (PFS), was significantly longer in the G + Doc/Pem arm (median: 1.6 months vs. 5.6 months, hazard ratio = 0.40, 95% CI: 0.16–0.99, p = 0.0391). Adverse events ≥ grade 3 were more frequent in the G + Doc/Pem arm (45.5% vs. 90.9%, p = 0.032). Conclusions Patients on G and Pem or Doc beyond PD showed a longer PFS than those on single‐agent chemotherapy; however, it was associated with increased toxicity.

ABSTRACT Background The effectiveness of the domiciliary use of high-flow nasal cannula oxygen therapy (HFNC) in patients with chronic hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD) remains controversial. Objectives To investigate the efficacy and safety of domiciliary HFNC use in stable hypercapnic COPD patients. Methods This multicenter, open-label, randomized controlled trial enrolled patients with stable hypercapnic COPD. Over 52 weeks, we compared long-term oxygen therapy (LTOT) alone versus domiciliary HFNC plus LTOT (HFNC/LTOT). The primary endpoint was the frequency of moderate/severe COPD exacerbations. We also compared changes from baseline levels in arterial blood gas, SpO 2 , pulmonary function, health-related quality of life (HRQOL), and a six-minute walk test. Results We enrolled 104 patients in total; from these, we removed mismatching patients and then assigned 49 and 50 patients to HFNC/LTOT and LTOT groups, respectively, for safety analysis; 47 and 46 patients for HFNC/LTOT and LTOT groups, respectively, for efficacy analysis. Thirty-seven (79%) and 41 patients (89%) in HFNC/LTOT and LTOT, respectively, completed the final evaluation. HFNC significantly reduced the frequency of COPD exacerbations and prolonged the duration without moderate or severe COPD exacerbations over the 52-week study period ( p = 0.002, p = 0.032, respectively). The adjusted odds ratios (95% confidence intervals [CIs]) of the frequency of COPD exacerbations in LTOT against HFNC/LTOT was 2.85 (1.48, 5.47). The median survival time (95% CI) to the first COPD exacerbation with moderate or severe for the LTOT group was 25 weeks (14.1, 47.4); however, the HFNC/LTOT group did not reach the median survival time. HFNC also caused statistically significant differences ( p < 0.05) in the SpO 2 , FVC (%FVC), and FEV1 (%FEV1); however, these improvements were transient. There were no other improvements in arterial blood gas, pulmonary function, HRQOL, or six-minute walk test parameters. In addition, no safety concerns were identified for HFNC. Conclusions HFNC may be a reasonable therapeutic choice in stable hypercapnic COPD patients with a history of exacerbations. Trial registration number : UMIN000028581, NCT03282019 ( http://www.umin/ac.jp , https://clinicaltrials.gov/ )