Background The selection of patients with non-small cell lung cancer (NSCLC) for immune checkpoint inhibitor (ICI) treatment remains challenging. This real-world study aimed to compare the overall survival (OS) before and after the implementation of ICIs, to identify OS prognostic factors, and to assess treatment data in first-line (1L) ICI-treated patients without epidermal growth factor receptor mutation or anaplastic lymphoma kinase translocation. Methods Data from the Danish NSCLC population initiated with 1L palliative antineoplastic treatment from 1 January 2013 to 1 October 2018, were extracted from the Danish Lung Cancer Registry (DLCR). Long-term survival and median OS pre- and post-approval of 1L ICI were compared. From electronic health records, additional clinical and treatment data were obtained for ICI-treated patients from 1 March 2017 to 1 October 2018. Results The OS was significantly improved in the DLCR post-approval cohort (n = 2055) compared to the pre-approval cohort (n = 1658). The 3-year OS rates were 18% (95% CI 15.6–20.0) and 6% (95% CI 5.1–7.4), respectively. On multivariable Cox regression, bone (HR = 1.63) and liver metastases (HR = 1.47), performance status (PS) 1 (HR = 1.86), and PS ≥ 2 (HR = 2.19) were significantly associated with poor OS in ICI-treated patients. Conclusion OS significantly improved in patients with advanced NSCLC after ICI implementation in Denmark. In ICI-treated patients, PS ≥ 1, and bone and liver metastases were associated with a worse prognosis.

Standard treatment of localized muscle-invasive bladder cancer (MIBC) is neoadjuvant chemotherapy (NAC) followed by radical cystectomy (RC), but ∼50% of patients relapse within 2 years. Adjuvant immunotherapy is currently administered based on pathology and clinical assessment in high-risk patients only, potentially resulting in under- and overtreatment. TOMBOLA is a Danish, multicenter, open-label, single-arm phase II trial evaluating serial circulating tumor DNA (ctDNA) testing to guide postoperative immunotherapy. Low- and high-risk patients with MIBC (cT2-4aN0-1M0) treated with NAC and RC were monitored postoperatively with tumor-informed ctDNA assays. ctDNA-positive patients initiated atezolizumab for up to 1 year, irrespective of imaging; ctDNA-negative patients received immunotherapy only upon radiographic detection of metastases. The primary endpoint was molecular and radiographic complete response. Key secondary endpoints included recurrence-free survival and overall survival. In total 192 patients were enrolled, and among 178 assessable patients in the intention-to-treat population (median follow-up 34 months), 104 (58%) were ctDNA-positive within 2 years after RC, 63% within 4 months. The median lead time from ctDNA detection to imaging-confirmed recurrence was 90 days (range -61 to 961 days). Of the ctDNA-positive patients, 84 completed atezolizumab and had scanning and ctDNA analyses available for primary endpoint assessment. Some 60% (50/84) of patients achieved the primary endpoint of complete response. One-year recurrence-free survival was 97% in ctDNA-negative patients and 76% in ctDNA-positive patients. Prespecified biomarker analyses showed that ctDNA status and levels, risk stratification, and immune-related gene expression signatures were associated with both recurrence risk and response to immunotherapy. Treatment was well tolerated with no new safety concerns. Tumor-informed ctDNA testing after NAC and RC predicts recurrence risk and enables personalized postoperative management in MIBC. TOMBOLA demonstrates that ctDNA-positive, low-risk patients may benefit from early immunotherapy, while ctDNA-negative high-risk patients may safely avoid adjuvant treatment without compromising outcomes.

Chronic inflammation has been recognized to foster tumour development. Whether chemotherapy can be used to neutralize chronic inflammation is unclear.

Malignant pleural effusion (MPE) is common in individuals with cancer and typically reflects advanced disease. Most cases are symptomatic, with dyspnea and pain having a severe effect on the patient's quality of life (QOL). The management of MPE aims to relieve symptoms, improve QOL, prevent repeated pleural interventions, and minimize hospital admissions. Common treatments for MPE that provide symptomatic relief include thoracentesis, chemical (talc) pleurodesis, or indwelling pleural catheters (IPCs). Talc pleurodesis and IPCs are the mainstay of treatment but represent very different treatment strategies: talc pleurodesis is an inpatient procedure, whereas IPCs are an ambulatory strategy. Given their similar efficacy, treatment decisions in MPE are often determined by other factors, such as the patient's clinical characteristics, individual treatment goals, and preferences for hospital-based or home-based care. We provide a summary of the evidence for different interventions for treating MPE and compare recommendations from the major American, European, British, and Spanish guidelines regarding when to consider each treatment. We highlight specific challenging treatment scenarios and key clinical considerations that may influence treatment decisions for different patients. There are barriers to accessing and receiving evidence-based care. Patients with symptomatic MPE would benefit from early referral from oncology teams to pleural services. We provide best practice recommendations for optimal referral and coordination of care to ensure that patients receive maximum benefits from their interventions.