BRCA2 mutation in advanced lung squamous cell carcinoma treated with Olaparib and a PD-1 inhibitor: a case report

[Molecular pathology in non-small-cell lung cancer: current and emerging biomarkers]

In the classification of lung cancer, the basic division into small cell and non-small cell carcinomas continues to apply. Despite the same histological subtyping, it is known that there are defined genetic changes in the tumor cells that significantly determine tumor growth as "drivers", so that their blockade can significantly influence the clinical course. Thus, in the last 10 years, the treatment of lung cancer has been increasingly supplemented by the establishment of tumor-specific targeted drugs and immunomodulatory approaches. This development has led to increasingly differentiated and individualized approaches to treatment. Pathology and especially molecular pathological diagnostics play a central role here, as an increasing number of biomarkers must be examined.

Reirradiation using helical tomotherapy-based hypofractionated stereotactic radiotherapy for 19 brain metastases after the second recurrence of distant brain failure: a case report and literature review

Background

A definitive optimal oncologic care regimen for recurrent multiple brain metastases (BMs) has yet to be established, and the accrual of high-quality evidence pertaining to helical tomotherapy-based stereotactic radiotherapy (HT-SRT) in patients with BMs is needed.

Case Description

We treated a 64-year-old male smoker initially diagnosed with non-small cell lung cancer (NSCLC) with BMs, and the initial schedule involved administering linear accelerator-based hypofractionated stereotactic radiotherapy (Linac-HSRT) targeting 6 intracranial lesions. Further chemotherapy was declined due to intolerance after one cycle of paclitaxel-albumin/carboplatin. Distant brain failure (DBF) and extracranial progression emerged 3 months subsequent to the initial SRT, and helical tomotherapy-based hypofractionated stereotactic radiotherapy (HT-HSRT) was replanned to 4 BMs, while helical tomotherapy-based intensity-modulated radiotherapy was employed for the extracranial lesions. Nevertheless, reirradiation with hippocampal-sparing HT-HSRT and simultaneous memantine approach were imminently delivered for confirmed DBF, as 19 newly identified intact intracranial lesions were observed at 5 months posttreatment. As assessed by the Hopkins Verbal Learning Test Revised Total Recall test, neither severe symptomatic radionecrosis (RN) nor neurocognitive dysfunction has manifested thus far, representing a survival period of 20.5 months. In the literature review, SRT delivery schedule to BMs, strategies for managing recurrent BMs and addressing RN, along with 6 summarized published studies of HT-SRT for BM were discussed.

Conclusions

We posit that the administration of repeated SRT for recurrent BMs in a short-term interval may be viable, yet randomized, robust analyses are imperative to ascertain the potential benefits of HT-SRT in preserving neurocognition and confirm the efficacy of memantine and hippocampal avoidance during SRT.

Clinical translation for targeting DNA damage repair in non-small cell lung cancer: a review

Despite significant advancements in screening, diagnosis, and treatment of non-small cell lung cancer (NSCLC), it remains the primary cause of cancer-related deaths globally. DNA damage is caused by the exposure to exogenous and endogenous factors and the correct functioning of DNA damage repair (DDR) is essential to maintain of normal cell circulation. The presence of genomic instability, which results from defective DDR, is a critical characteristic of cancer. The changes promote the accumulation of mutations, which are implicated in cancer cells, but these may be exploited for anti-cancer therapies. NSCLC has a distinct genomic profile compared to other tumors, making precision medicine essential for targeting actionable gene mutations. Although various treatment options for NSCLC exist including chemotherapy, targeted therapy, and immunotherapy, drug resistance inevitably arises. The identification of deleterious DDR mutations in 49.6% of NSCLC patients has led to the development of novel target therapies that have the potential to improve patient outcomes. Synthetic lethal treatment using poly (ADP-ribose) polymerase (PARP) inhibitors is a breakthrough in biomarker-driven therapy. Additionally, promising new compounds targeting DDR, such as ATR, CHK1, CHK2, DNA-PK, and WEE1, had demonstrated great potential for tumor selectivity. In this review, we provide an overview of DDR pathways and discuss the clinical translation of DDR inhibitors in NSCLC, including their application as single agents or in combination with chemotherapy, radiotherapy, and immunotherapy.