Epidemiology of active tuberculosis in lung cancer patients: a systematic review.

Clin Respir J. 2013 Dec 18;

Authors: Christopoulos A, Saif MW, Sarris EG, Syrigos KN

Abstract
OBJECTIVES: The aim of this review article is to evaluate the available literature concerning the prevalence of active tuberculosis in lung cancer patients.
DATA SOURCE: MEDLINE, PubMed, EMBASE and Medscape databases were searched for studies with quantitative data on the interaction between TB and lung cancer, published since 1952. We used the Medical Subject Headings' term "tuberculosis" and the text-word terms "TB" and "Mycobacterium infection", and also, the Medical Subject Headings' terms "neoplasm" and "lung neoplasm" or the text-word term "lung cancer".
DATA SELECTION: We selected studies with cases verified by bacteriological examinations and biopsies that contained enough data to estimate tuberculosis prevalence. We did not exclude any study on the basis of language.
RESULTS: The prevalence of active tuberculosis among lung cancer patients varies depending on spatial and regional factors. Lung cancer patients that are more prone to developing tuberculosis are Asian and Caucasian males, with an average age of sixty years old. The prevalence of tuberculosis is higher in patients with chest X-ray evidence of old tuberculosis and/or history of tuberculosis, chronic obstructive pulmonary disease, heavy cigarette smoking, increased alcohol consumption and/or diabetes mellitus. A high mortality rate due to tuberculosis in lung cancer patients was also estimated.
CONCLUSION: Active tuberculosis complicating lung cancer is a significant clinical issue in countries with high prevalence of tuberculosis. However, as the there is a lack of reports from developed countries over the last twenty years, the significance of this interaction in countries with low tuberculosis burden remains controversial.

PMID: 24345074 [PubMed - as supplied by publisher]

A systematic review of symptomatic diagnosis of lung cancer.

Fam Pract. 2013 Dec 17;

Authors: Shim J, Brindle L, Simon M, George S

Abstract
BACKGROUND: Lung cancer (LC) is often diagnosed late when curative intervention is no longer viable. However, current referral guidelines (e.g. UK National Institute for Health and Care Excellence guidelines) for suspected LC are based on a weak evidence base.Aim.The purpose of this systematic review is to identify symptoms that are independently associated with LC and to identify the key methodological issues relating to symptomatic diagnosis research in LC.
METHODS: Medline, Ovid and Cumulative Index to Nursing and Allied Health Literature were searched for the period between 1946 and 2012 using the MeSH terms 'lung cancer' and 'symptom*'. Quality of each paper was assessed using Scottish Intercollegiate Guidelines Network and Consolidated Criteria for Reporting Qualitative Research Checklists and checked by a second and third reviewer.
RESULTS: Evidence regarding the diagnostic values of most symptoms was inconclusive; haemoptysis was the only symptom consistently indicated as a predictor of LC. Generally, evidence was weakened by methodological issues such as the lack of standardized data collection (recording bias) and the lack of comparability of findings across the different studies that extend beyond the spectrum of disease. Qualitative studies indicated that patients with LC experienced symptoms months before diagnosis but did not interpret them as serious enough to seek health care. Therefore, early LC symptoms might be under-represented in primary care clinical notes.
CONCLUSION: Current evidence is insufficient to suggest a symptom profile for LC across the disease stages, nor can it be concluded that classical LC symptoms are predictors of LC apart from, perhaps, haemoptysis. Prospective studies are now needed that systematically record symptoms and explore their predictive values for LC diagnosis.

PMID: 24347594 [PubMed - as supplied by publisher]

Biopsy and Mutation Detection Strategies in Non-Small Cell Lung Cancer.

Tuberc Respir Dis (Seoul). 2013 Nov;75(5):181-187

Authors: Jung CY

Abstract
The emergence of new therapeutic agents for non-small cell lung cancer (NSCLC) implies that histologic subtyping and molecular predictive testing are now essential for therapeutic decisions. Histologic subtype predicts the efficacy and toxicity of some treatment agents, as do genetic alterations, which can be important predictive factors in treatment selection. Molecular markers, such as epidermal growth factor receptor (EGFR) mutation and anaplastic lymphoma kinase (ALK) rearrangement, are the best predictors of response to specific tyrosine kinase inhibitor treatment agents. As the majority of patients with NSCLC present with unresectable disease, it is therefore crucial to optimize the use of tissue samples for diagnostic and predictive examinations, particularly for small biopsy and cytology specimens. Therefore, each institution needs to develop a diagnostic approach requiring close communication between the pulmonologist, radiologist, pathologist, and oncologist in order to preserve sufficient biopsy materials for molecular analysis as well as to ensure rapid diagnosis. Currently, personalized medicine in NSCLC is based on the histologic subtype and molecular status. This review summarizes strategies for tissue acquisition, histologic subtyping and molecular analysis for predictive testing in NSCLC.

PMID: 24348665 [PubMed - as supplied by publisher]

Molecular Basis of Drug Resistance: Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors and Anaplastic Lymphoma Kinase Inhibitors.

Tuberc Respir Dis (Seoul). 2013 Nov;75(5):188-198

Authors: Yang SH

Abstract
Over the past decade, several kinase inhibitors have been approved based on their clinical benefit in cancer patients. Unfortunately, in many cases, patients develop resistance to these agents via secondary mutations and alternative mechanisms. To date, several major mechanisms of acquired resistance, such as secondary mutation of the epidermal growth factor receptor (EGFR) gene, amplification of the MET gene and overexpression of hepatocyte growth factor, have been reported. This review describes the recent findings on the mechanisms of primary and acquired resistance to EGFR tyrosine kinase inhibitors and acquired resistance to anaplastic lymphoma kinase inhibitors, primarily focusing on non-small cell lung carcinoma.

PMID: 24348666 [PubMed - as supplied by publisher]