Patterns of Extrathoracic Metastasis in Lung Cancer Patients

Site-Specific Response and Resistance Patterns in Patients with Advanced Non-Small-Cell Lung Cancer Treated with First-Line Systemic Therapy

Patients with advanced NSCLC have heterogenous responses to immune checkpoint inhibitors (ICIs) with or without chemotherapy. In NSCLC, the impact of the distribution of metastatic sites and the response to systemic therapy combinations remain poorly understood. In a retrospective cohort study of patients with unresectable stage III/IV NSCLC who received first-line systemic therapy, we sought to assess the association between the site of metastases with patterns of response and progression. Data regarding demographics, tumour characteristics (including site, size, and volume of metastases), treatment, and outcomes were examined at two cancer care centres. The endpoints included organ site-specific response rate, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). Two-hundred and eighty-five patients were included in the analysis. In a multivariate analysis, patients with bone metastases had a reduced ORR, PFS, and OS. Primary resistance was also more likely in patients with bone metastases. Patients with bone or liver metastases had a shorter OS when receiving ICIs with or without chemotherapy, but not with chemotherapy alone, suggesting an immunological basis for therapeutic resistance. A directed assessment of the tumour microenvironment in these locations and a deeper understanding of the drivers of organ-specific resistance to immunotherapy are critical to optimise novel combination therapies and sequencing in these patients.

A Peculiar Case of Rapidly Recurring Metastasis of Malignant Non-small Cell Primary Lung Carcinoma to the Heart

We report the case of a 64-year-old adult male with a rapidly recurring metastatic lung carcinoma in the right atrium of the heart. Advanced-stage lung carcinomas can metastasize to other organs such as the heart, bones, brain, liver, adrenal glands, and lymphatic system, although actual rates of metastasis to the heart are relatively quite low. This patient was diagnosed with a right atrial mass that was determined through pathology to be a result of an existing non-small cell lung carcinoma. This mass, despite resection, reappeared two weeks later at the same location and with a similar size to the previous metastatic tumor. This case highlights the importance of closely monitoring sites of resected tumors for potential regrowth and complications.

Therapeutic strategy using novel RET/YES1 dual-target inhibitor in lung cancer

Lung cancer represents a significant global health concern and stands as the leading cause of cancer-related mortality worldwide. The identification of specific genomic alterations such as EGFR and KRAS in lung cancer has paved the way for the development of targeted therapies. While targeted therapies for lung cancer exhibiting EGFR, MET and ALK mutations have been well-established, the options for RET mutations remain limited. Importantly, RET mutations have been found to be mutually exclusive from other genomic mutations and to be related with high incidences of brain metastasis. Given these facts, it is imperative to explore the development of RET-targeting therapies and to elucidate the mechanisms underlying metastasis in RET-expressing lung cancer cells. In this study, we investigated PLM-101, a novel dual-target inhibitor of RET/YES1, which exhibits notable anti-cancer activities against CCDC6-RET-positive cancer cells and anti-metastatic effects against YES1-positive cancer cells. Our findings shed light on the significance of the YES1-Cortactin-actin remodeling pathway in the metastasis of lung cancer cells, establishing YES1 as a promising target for suppression of metastasis. This paper unveils a novel inhibitor that effectively targets both RET and YES1, thereby demonstrating its potential to impede the growth and metastasis of RET rearrangement lung cancer.

The Metastasis Pattern of Renal Cell Carcinoma Is Influenced by Histologic Subtype, Grade, and Sarcomatoid Differentiation

Background and Objectives: Metastasis is a major cause of death in renal cell carcinoma (RCC) patients; therefore, a better understanding of the metastatic process and the ability to predict metastasis in advance is important for treating patients with RCC. This study aimed to investigate whether histological subtypes of RCC and other factors, such as nuclear grade and sarcomatoid differentiation, could predict the probability and location of metastases in patients with RCC. Materials and Methods: Cases of clear-cell, papillary, chromophobe, and sarcomatoid RCC were retrieved and analyzed from the Surveillance, Epidemiology, and End Results databases. Results: When comparing the metastatic patterns among the three histologic subtypes, patients with clear-cell RCC were significantly more likely to have brain and lung metastases. Moreover, patients with papillary RCC were significantly less likely to develop bone metastases and more likely to develop lymph node metastases. Patients with chromophobe RCC are significantly more likely to develop liver metastases. As the nuclear grade increased, there was also a significantly increased tendency for clear-cell RCC to metastasize to the lungs. Patients with sarcomatoid RCC had a higher rate of metastasis, with a significantly higher probability of metastasis to the bone and lungs, than those with all three histological subtypes did. Conclusions: Histological subtype, nuclear grade, and sarcomatoid differentiation were significant predictors of metastasis in patients with RCC.

Do Histology and Primary Tumor Location Influence Metastatic Patterns in Bladder Cancer?

Metastasis is the leading cause of death in patients with bladder cancer. This study utilized a statistical analysis of patient data from the Surveillance, Epidemiology, and End Results database to examine the influence of histological type and primary site on the metastatic behavior of bladder cancer. Significantly different metastatic patterns were observed among bladder cancer patients depending on their histological type. Patients with squamous cell carcinoma showed a significantly (p < 0.001) lower bone metastasis rate (27.2%) than patients with urothelial carcinoma (UC) (38.3%). Patients with neuroendocrine carcinoma showed a significantly (p < 0.001) higher liver metastasis rate (52.1%) and a significantly (p = 0.001) lower lung metastasis rate (25.7%) than patients with UC (22.6% and 33.5%, respectively). UC patients also demonstrated differences in metastatic behavior according to histological subtype. The sarcomatoid subtype showed a significantly (p < 0.001) higher lung metastasis rate (51.6%) and a significantly lower (p = 0.002) lymph node metastasis rate (22.6%) than the micropapillary subtype (12.1% and 54.1%, respectively). Significant differences in metastatic behavior were also observed among patients with conventional UCs originating from the bladder, ureter, and renal pelvis. This study highlights the impact of histological characteristics and primary site on metastatic tendencies in bladder cancer, highlighting the importance of tailoring treatment and surveillance strategies.

Advances in the Molecular Landscape of Lung Cancer Brain Metastasis

Lung cancer is one of the most frequent tumors that metastasize to the brain. Brain metastasis (BM) is common in advanced cases, being the major cause of patient morbidity and mortality. BMs are thought to arise via the seeding of circulating tumor cells into the brain microvasculature. In brain tissue, the interaction with immune cells promotes a microenvironment favorable to the growth of cancer cells. Despite multimodal treatments and advances in systemic therapies, lung cancer patients still have poor prognoses. Therefore, there is an urgent need to identify the molecular drivers of BM and clinically applicable biomarkers in order to improve disease outcomes and patient survival. The goal of this review is to summarize the current state of knowledge on the mechanisms of the metastatic spread of lung cancer to the brain and how the metastatic spread is influenced by the brain microenvironment, and to elucidate the molecular determinants of brain metastasis regarding the role of genomic and transcriptomic changes, including coding and non-coding RNAs. We also present an overview of the current therapeutics and novel treatment strategies for patients diagnosed with BM from NSCLC.