RESILIENT Part 2: A Randomized, Open-Label Phase III Study of Liposomal Irinotecan Versus Topotecan in Adults With Relapsed Small Cell Lung Cancer

PURPOSE

The phase III RESILIENT trial compared second-line liposomal irinotecan with topotecan in patients with small cell lung cancer (SCLC).

PATIENTS AND METHODS

Patients with SCLC and progression on or after first-line platinum-based chemotherapy were randomly assigned (1:1) to intravenous (IV) liposomal irinotecan (70 mg/m2 every 2 weeks in a 6-week cycle) or IV topotecan (1.5 mg/m2 daily for 5 consecutive days, every 3 weeks in a 6-week cycle). The primary end point was overall survival (OS). Key secondary end points included progression-free survival (PFS) and objective response rate (ORR).

RESULTS

Among 461 randomly assigned patients, 229 received liposomal irinotecan and 232 received topotecan. The median follow-up was 18.4 months. The median OS was 7.9 months with liposomal irinotecan versus 8.3 months with topotecan (hazard ratio [HR], 1.11 [95% CI, 0.90 to 1.37]; P = .31). The median PFS per blinded independent central review (BICR) was 4.0 months with liposomal irinotecan and 3.3 months with topotecan (HR, 0.96 [95% CI, 0.77 to 1.20]; nominal P = .71); ORR per BICR was 44.1% (95% CI, 37.6 to 50.8) and 21.6% (16.4 to 27.4), respectively. Overall, 42.0% and 83.4% of patients receiving liposomal irinotecan and topotecan, respectively, experienced grade ≥3 related treatment-emergent adverse events (TEAEs). The most common grade ≥3 related TEAEs were diarrhea (13.7%), neutropenia (8.0%), and decreased neutrophil count (4.4%) with liposomal irinotecan and neutropenia (51.6%), anemia (30.9%), and leukopenia (29.1%) with topotecan.

CONCLUSION

Liposomal irinotecan and topotecan demonstrated similar median OS and PFS in patients with relapsed SCLC. Although the primary end point of OS was not met, liposomal irinotecan demonstrated a higher ORR than topotecan. The safety profile of liposomal irinotecan was consistent with its known safety profile; no new safety concerns emerged.

Avelumab in Combination With Cetuximab and Chemotherapy as First-Line Treatment for Patients With Advanced Squamous NSCLC

Introduction

We present the results of a phase 2a trial of first-line avelumab (anti-programmed death-ligand 1 antibody) plus cetuximab (anti-EGFR antibody) in patients with advanced squamous NSCLC.

Methods

Patients with recurrent or metastatic squamous NSCLC received avelumab 800 mg (d 1 and 8), cetuximab 250 mg/m² (d 1) and 500 mg/m² (d 8), cisplatin 75 mg/m² (d 1), and gemcitabine 1250 mg/m² (d 1 and 8) for four 3-week cycles, followed by avelumab 800 mg and cetuximab 500 mg/m² every 2 weeks. The primary end point was the best overall response; the secondary end points were progression-free survival, duration of response, overall survival, and safety. Efficacy analyses were reported from an updated data cutoff.

Results

A total of 43 patients were enrolled. The median follow-up was 6.6 months for the primary analyses and 9.2 months for the efficacy analyses. In the efficacy analyses, 15 patients had a confirmed partial response (objective response rate, 34.9% [95% confidence interval: 21.0%-50.9%]), and the median duration of response was 7.1 months (95% confidence interval: 4.2-12.5 mo). The median progression-free survival and overall survival were 6.1 months and 10.0 months, respectively. In the safety analyses (primary analysis), 38 patients (88.4%) had a treatment-related adverse event, of whom 24 (55.8%) had a grade 3 or higher treatment-related adverse event.

Conclusions

The combination of avelumab + cetuximab and chemotherapy showed antitumor activity and tolerable safety; however, the ORR was not improved compared with those reported for current standards of care (NCT03717155).

Pharmacological Effects of Secondary Bile Acid Microparticles in Diabetic Murine Model

AIM

Examine bile acids effects in Type 2 diabetes.

BACKGROUND

In recent studies, the bile acid ursodeoxycholic acid (UDCA) has shown potent antiinflammatory effects in obese patients while in type 2 diabetics (T2D) levels of the pro-inflammatory bile acid lithocholic acid were increased, and levels of the anti-inflammatory bile acid chenodeoxycholic acid were decreased, in plasma.

OBJECTIVE

Hence, this study aimed to examine applications of novel UDCA microparticles in diabetes.

METHODS

Diabetic balb/c adult mice were divided into three equal groups and gavaged daily with either empty microcapsules, free UDCA, or microencapsulated UDCA over two weeks. Their blood, tissues, urine, and faeces were collected for blood glucose, inflammation, and bile acid analyses. UDCA resulted in modulatory effects on bile acids profile without antidiabetic effects suggesting that bile acid modulation was not directly linked to diabetes treatment.

RESULTS

UDCA resulted in modulatory effects on bile acids profile without antidiabetic effects suggesting that bile acid modulation was not directly linked to diabetes treatment.

CONCLUSION

Bile acids modulated the bile profile without affecting blood glucose levels.

FEM Analysis of Various Multilayer Structures for CMOS Compatible Wearable Acousto-Optic Devices

Lately, wearable applications featuring photonic on-chip sensors are on the rise. Among many ways of controlling and/or modulating, the acousto-optic technique is seen to be a popular technique. This paper undertakes the study of different multilayer structures that can be fabricated for realizing an acousto-optic device, the objective being to obtain a high acousto-optic figure of merit (AOFM). By varying the thicknesses of the layers of these materials, several properties are discussed. The study shows that the multilayer thin film structure-based devices can give a high value of electromechanical coupling coefficient (k2) and a high AOFM as compared to the bulk piezoelectric/optical materials. The study is conducted to find the optimal normalised thickness of the multilayer structures with a material possessing the best optical and piezoelectric properties for fabricating acousto-optic devices. Based on simulations and studies of SAW propagation characteristics such as the electromechanical coupling coefficient (k2) and phase velocity (v), the acousto-optic figure of merit is calculated. The maximum value of the acousto-optic figure of merit achieved is higher than the AOFM of all the individual materials used in these layer structures. The suggested SAW device has potential application in wearable and small footprint acousto-optic devices and gives better results than those made with bulk piezoelectric materials.

Relationship Between Socio-Demographic Characteristics, Reproductive Health Behaviors, and Health Literacy of Women in Serbia

Introduction: Health literacy of women can significantly affect different aspects of reproductive health. The aim of this study was the assessment of relationship of health literacy, socio-demographic characteristics and reproductive health behaviors of women in Serbia.

Methodology: This was a cross-sectional study on a random sample of women aged 18 and over from the territories of three Serbian regions, stratified according to age groups, region and type of settlement. A standardized version of the European Health Literacy Survey Questionnaire (HLS-EU-Q47) was used in assessing health literacy of women.

Results: Based on the calculated index of health literacy, 9.6% of respondents had inadequate health literacy. Inadequate levels of health literacy were more common in women living in rural areas (OR = 1.111) and the poorer classes (OR = 5.122). Employed women (OP = 1.249), with good health (OR = 1.512) with a degree (OR = 1.535) had bigger odds to have adequate health literacy. Multivariate regression analysis showed the following significant predictors: commitment to the chosen gynecologist (OR = 1.530), contraceptive use (OR = 1.020), knowledge of the damages that could be caused by the human papillomavirus (HPV) (OR = 1.578), awareness of vaccine availability against HPV infection (OR = 1.217) and following the health-related topics (OR = 2.350).

Conclusion: Limited levels of health literacy were significantly higher among middle-aged women, among those living in rural areas, among women who rated their health as poor or very poor, and who exhibited more negative patterns of reproductive health behavior, indicating the need for implementation of prevention programs and strategies with the aim of increasing the level of health literacy.

Viscosity and mixing properties of artificial saliva and four different mouthwashes

BACKGROUND

Numerous functions of saliva depend on its biophysical properties. Mouth rinses react with saliva and change both their own properties and properties of saliva.

OBJECTIVE

The aim of this study was to define the level of mixing of artificial saliva and mouth rinses, and define their viscosity and its changes at room and body temperature.

METHODS

Artificial saliva, fluoride solutions, chlorhexidine, zinc-hydroxyapatite solution and casein phosphopeptide amorphous calcium phosphate were used. To simulate their mixing, Y-channel PVC chips were used, in two different microfluidics systems. The experiments were recorded with a microscope, then the proportion of mixing was calculated using Matlab. For viscosity measurements rotational viscometer was used.

RESULTS

The results show partial mixing of all solutions with artificial saliva. Measurements with a viscometer indicate different viscosities of all used solutions. Viscosity of a mixture of solution and artificial saliva is always in the range of viscosity of the artificial saliva and the solution separately. Moreover, viscosity of all solutions, as well as mixture with artificial saliva, significantly decreases at higher temperature.

CONCLUSION

Intraoral administration of mouth rinses results in change of biophysical properties of both saliva and mouth rinses. Those changes can affect preventive and therapeutic effect, and therefore oral health.

Alginate-based drug oral targeting using bio-micro/nano encapsulation technologies

INTRODUCTION

Oral delivery is the most common administrated drug delivery path. However, oral administration of lipophilic drugs has some limitations: they have poor dose-response due to low and varied dissolution kinetics and oral bioavailability with sub-optimal dissolution within the aqueous gastrointestinal microenvironment. Therefore, there is a need for robust formulating methods that protect the drug until it reaches to its optimum absorption site, allowing its optimum pharmacological effects via increasing its intestinal permeation and bioavailability.

AREA COVERED

Herein, we provide insights on orally administered lipophilic drug delivery systems. The detailed description of the obstacles associated with the oral bioavailability of lipophilic drugs are also discussed. Following this, techniques to overcome these obstacles with much emphasis on optimal safety and efficacy are addressed. Newly designed ionic vibrational jet flow encapsulation technology has enormous growth in lipophilic drug delivery systems, which is discussed thereafter.

EXPERT OPINION

Researchers have shown interest in drug's encapsulation. A combination of drug-bile acid and microencapsulation methods can be one promising strategy to improve the oral delivery of lipophilic drugs. However, the most critical aspect of this approach is the selection of bile acids, polymer, and encapsulation technology.

Pharmacological and Advanced Cell Respiration Effects, Enhanced by Toxic Human-Bile Nano-Pharmaceuticals of Probucol Cell-Targeting Formulations

Bile acids have recently been studied for potential applications as formulation excipients and enhancers for drug release; however, some bile acids are not suitable for this application. Unconjugated lithocholic acid (ULCA) has recently shown drug formulation-stabilizing and anti-inflammatory effects. Lipophilic drugs have poor gut absorption after an oral dose, which necessitates the administration of high doses and causes subsequent side effects. Probucol (PB) is a highly lipophilic drug with poor oral absorption that resulted in restrictions on its clinical prescribing. Hence, this study aimed to design new delivery systems for PB using ULCA-based matrices and to test drug formulation, release, temperature, and biological effects. ULCA-based matrices were formulated for PB oral delivery by applying the jet-flow microencapsulation technique using sodium alginate as a polymer. ULCA addition to new PB matrices improved the microcapsule’s stability, drug release in vitro (formulation study), and showed a promising effect in ex vivo study (p < 0.05), suggesting that ULCA can optimize the oral delivery of PB and support its potential application in diabetes treatment.

Bio Micro-Nano Technologies of Antioxidants Optimised Their Pharmacological and Cellular Effects, ex vivo, in Pancreatic β-Cells

Introduction

Recent formulation and microencapsulation studies of probucol (PB) using the polymer sodium alginate (SA) and bile acids have shown promising results but PB stability, and pharmacology profiles remain suboptimal. This study aimed to investigate novel polymers for the nano and micro encapsulation of PB, with the anti-inflammatory bile acid ursodeoxycholic acid (UDCA).

Material and methods

Six formulations using three types of polymers were investigated with and without UDCA. The polymers were NM30D, RL30D, and RS30D and they were mixed with SA and PB at set ratios and microencapsulated using oscillating-voltage-mediated nozzle technology coupled with ionic gelation. The microcapsules were examined for physical and biological effects using pancreatic β-cells.

Results and discussion

UDCA addition did not adversely affect the morphology and physical features of the microcapsules. Despite thermal stability remaining unchanged, bile acid incorporation did enhance the electrokinetic stability of the formulation system for NM30D and RL30D polymers. Mechanical stability remained similar in all groups. Enhanced uptake of PB from the microcapsule by pancreatic β-cells was only seen with NM30D-UDCA-intercalated microcapsules and this effect was sustained at both glucose levels of 5.5 and 35.5 mM.

Conclusion

UDCA addition enhanced PB delivery and biological effects in a formulation-dependent manner.

A second-generation micro/nano capsules of an endogenous primary un-metabolised bile acid, stabilized by Eudragit-alginate complex with antioxidant compounds

Bile acids (BAs) are amphiphilic compounds and of recently have demonstrated wide range of formulation stabilizing effects. A recent study showed that primary un-metabolised bile acids (PUBAs) have β-cell protective effects, and synergistic antidiabetic effects when combined with antioxidant and anti-inflammatory drugs, such as probucol (PB). Thus, this study aimed to design and test microcapsules containing a PUBA incorporated with PB and an alginate-Eudragit matrix.

Six types of microcapsules were developed without (control) or with (test) PUBA, and tested for internal and external features and β-cell protective effects.

The incorporation of PB-alginate-Eudragit with PUBA produced stable microcapsules but did not exert consistent positive effects on cell viability in the hyperglycaemic state, which suggests that PUBA in alginate-Eudragit matrices did not exhibit synergistic effects with PB nor exerted antidiabetic effects.

Bile acid-polymer-probucol microparticles: protective effect on pancreatic β-cells and decrease in type 1 diabetes development in a murine model

Studies in our laboratory have shown potential applications of the anti-atherosclerotic drug probucol (PB) in diabetes due to anti-inflammatory and β-cell protective effects. The anti-inflammatory effects were optimized by incorporation of the anti-inflammatory bile acid, ursodeoxycholic acid (UDCA). This study aimed to test PB absorption, tissue accumulation profiles, effects on inflammation and type 1 diabetes prevention when combined with UDCA. Balb/c mice were divided into three equal groups and gavaged daily PB powder, PB microcapsules or PB-UDCA microcapsules for one week, at a constant dose. Mice were injected with a single dose of intraperitoneal/subcutaneous alloxan to induce type-1 diabetes and once diabetes was confirmed, treatments were continued for 3 days. Mice were euthanized and blood and tissues collected for analysis of PB and cytokine levels. The PB-UDCA group showed the highest PB concentrations in blood, gut, liver, spleen, brain, and white adipose tissues, with no significant increase in pancreas, heart, skeletal muscles, kidneys, urine or feces. Interferon gamma in plasma was significantly reduced by PB-UDCA suggesting potent anti-inflammatory effects. Blood glucose levels remained similar after treatments, while survival was highest among the PB-UDCA group. Our findings suggest that PB-UDCA resulted in best PB blood and tissue absorption and reduced inflammation.

Evaluation of Sealant Penetration in Relation to Fissure Morphology, Enamel Surface Preparation Protocol and Sealing Material

PURPOSE

The objective was to assess the effect of fissure depth and enamel surface preparation protocols on penetration of resin-based, giomer and glass-ionomer fissure sealants.

MATERIALS AND METHODS

Ninety extracted third molars were assigned into three groups according to the material used. All three groups were subsequently divided depending on tooth preparation: no pretreatment or surface preparation with 10% polyacrylic acid, 37% phosphoric acid, or self-etching adhesive. In addition, Er,Cr:YSGG laser or air abrasion were employed in all subgroups. The penetration was evaluated using scanning electron microscopy.

RESULTS

The groups that were pretreated with an appropriate acid resulted in superior penetration of glass-ionomer and resin-based sealants when compared with other surface preparation protocols (p < 0.05). The exception was teeth treated with both air abrasion and acid etching. Both preparation protocol and fissure depth significantly affected the sealant penetration (p < 0.05), but fissure depth had a greater impact on fissure penetration than did enamel surface pretreatment.

CONCLUSION

All investigated materials exhibit similar properties regarding sealant penetration. Penetration of a fissure sealant is significantly influenced by the fissure depth. In regard to enamel surface preparation protocol, a pretreatment with phosphoric acid in resin-based and polyacrylic acid in glass-ionomers appears to be essential in obtaining the adequate penetration of a sealing material.

Test Anxiety in Pre-Exam Period and Success of Nursing Students

The aim of this study was to examine the presence of preexam anxiety in nursing students and establish relationship of pre-exam anxiety intensity in relation to the category variables (gender, age, place of birth, current place of residence, with whom they live, whether they are employed, the average family income, year of study), objective success (i.e., pass rate at exams, the average score at the end of year, possible renewal of the year of study) and the subjective perception of academic success (i.e., self-satisfaction as a student as well as the importance of ratings obtained at the exam). The sample was random and consisted of the students of High Medical College of Professional Studies in Belgrade at the Department of vocational nurse. 209 students were tested, evenly distributed on the second and third year of study. Pre-examination anxiety among students was examined using a questionnaire The Test Anxiety Inventory – TAI (Test Anxiety Inventory), which includes subscales: Test Anxiety Inventory-Total (TAI-T), Test Anxiety Inventory-Worry (TAI-W) and Test Anxiety Inventory-Emotionality (TAI-E). From the obtained results we can conclude that nursing students showed a statistically significant pre-exam anxiety on all subscales. Preexam anxiety symptoms compared to candidates’ sex showed statistically significant differences in all scores, and average values are always higher in female students compared to male. There is also a statistically significant difference between students of the second year in relation to the third year students. It can be concluded that there is a significant number of nursing students with the pre-exam anxiety problems that need professional help and support in the form of expanding and strengthening personal competencies.

Association of the consumption of common food groups and beverages with mortality from cancer, ischaemic heart disease and diabetes mellitus in Serbia, 1991-2010: an ecological study

OBJECTIVES

This paper reports association between mortality rates from cancer, ischaemic heart disease and diabetes mellitus and the consumption of common food groups and beverages in Serbia.

DESIGN

In this ecological study, data on both mortality and the average annual consumption of common food groups and beverages per household's member were obtained from official data-collection sources. The multivariate linear regression analysis was used to determine the strength of the associations between consumption of common food groups and beverages and mortality rates.

RESULTS

Markedly increasing trends of cancer, ischaemic heart disease and diabetes mellitus mortality rates were observed in Serbia in the period 1991-2010. Mortality rates from cancer were negatively associated with consumption of vegetable oil (p=0.005) and grains (p=0.001), and same was found for ischaemic heart disease (p=0.002 and 0.021, respectively), while consumption of other dairy products showed a significant positive association (p<0.001 and p=0.032, respectively). In men and women, mortality rates from diabetes mellitus showed a significant positive association with consumption of poultry (p=0.014 and 0.004, respectively). Consumption of beef and grains showed a significant negative association with cancer mortality rates in both genders (p=0.002 and p<0.001 in men, and p<0.001 and p=0.014 in women, respectively), while consumption of cheese was negatively associated only in men (p<0.001). Mortality from diabetes mellitus showed a significant positive association with consumption of animal fat and other dairy products only in women (p=0.003 and 0.046, respectively).

CONCLUSIONS

Association between unfavourable mortality trends from cancer, ischaemic heart disease and diabetes mellitus, and common food groups and beverages consumption was observed and should be assessed in future analytical epidemiological studies. Promotion of healthy diet is sorely needed in Serbia.

Radial Endobronchial Ultrasound (EBUS) Guided Suction Catheter-Biopsy in Histological Diagnosis of Peripheral Pulmonary Lesions

BACKGROUND

EBUS guided trans-bronchial biopsy became routine in diagnosis of peripheral pulmonary lesions (PPL). Suction catheter-biopsy is a technique for obtaining a tissue sample from peripheral lung parenchyma. Aim of this study was to evaluate diagnostic efficiency, feasibility and safety of EBUS guided suction catheter-biopsy (SCB) in comparison to trans-bronchial biopsy (TBB) in diagnosis of PPL. The main intention was to demonstrate non-inferiority of the technique over trans-bronchial biopsy, especially when used under navigation of the EBUS.

METHODS

Radial EBUS probe (UM-3R, Olympus Co, Japan.) without guiding sheath was used to navigate suction catheter and TBB forceps to the PPL. The catheter was connected to the collection canister via vacuum pump. The SCB specimens were fixed with 10% buffered formalin.

RESULTS

There were 168 patients enrolled in this study; 69.9% males and 30.1% females. Main lesion diameter was 4.1±1.9 cm. Majority of patients, 131(77.9%) were diagnosed with lung cancer. Per-biopsy calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for EBUS-SCB were 92.4%, 100%, 100% and 67.7%, respectively. Corresponding values for EBUS-TBB were 92.3%, 100%, 100% and 69.7%. Only the size of the lesion significantly influenced (p=0.005) diagnostic performance. Complications occurred in 2 patients; one pneumothorax and one excessive bleeding.

CONCLUSION

EBUS guided SCB is efficient, feasible and safe in diagnosis of peripheral lung cancer. The technique is complementary to trans-bronchial biopsy.

Advanced bronchoscopic techniques in diagnosis and staging of lung cancer

The role of advanced brochoscopic diagnostic techniques in detection and staging of lung cancer has steeply increased in recent years. Bronchoscopic imaging techniques became widely available and easy to use. Technical improvement led to merging in technologies making autofluorescence or narrow band imaging incorporated into one bronchoscope. New tools, such as autofluorescence imagining (AFI), narrow band imaging (NBI) or fuji intelligent chromo endoscopy (FICE), found their place in respiratory endoscopy suites. Development of endobronchial ultrasound (EBUS) improved minimally invasive mediastinal staging and diagnosis of peripheral lung lesions. Linear EBUS proven to be complementary to mediastinoscopy. This technique is now available in almost all high volume centers performing bronchoscopy. Radial EBUS with mini-probes and guiding sheaths provides accurate diagnosis of peripheral pulmonary lesions. Combining EBUS guided procedures with rapid on site cytology (ROSE) increases diagnostic yield even more. Electromagnetic navigation technology (EMN) is also widely used for diagnosis of peripheral lesions. Future development will certainly lead to new improvements in technology and creation of new sophisticated tools for research in respiratory endoscopy. Broncho-microscopy, alveoloscopy, optical coherence tomography are some of the new research techniques emerging for rapid technological development.

Narrow band imaging videobronchoscopy improves assessment of lung cancer extension and influences therapeutic strategy

OBJECTIVE

Narrow band imaging (NBI) videobronchoscopy is a new technique aimed at lung cancer detection. This study investigated its sensitivity and specificity for evaluation of lung cancer extension and its possible influence on therapeutic decision, compared with white light videobronchoscopy.

METHODS

In this prospective study, we evaluated 106 patients with suspected lung cancer. All patients were examined using EVIS LUCERA videoendoscopy system. In every patient, at least three biopsies were taken from places visualized as pathologic, surrounding primary tumor, and three biopsies from places that appeared normal. The overall number of biopsies performed in 106 patients was 636.

RESULTS

The specificity and sensitivity of NBI in revealing greater lung cancer extension were 85.6% and 95%, respectively; positive and negative predictive values were 84% and 95.6%, respectively. Specificity and sensitivity were significantly better when compared with white light bronchoscopy alone (P < 0.01). NBI led to the change in therapeutic decision in 14 patients. There was statistically significant correlation between NBI assessment of tumor extension and change in therapeutic decision (P < 0.000).

CONCLUSIONS

NBI showed significantly better specificity and sensitivity in the assessment of lung cancer extension. NBI proved that it might have potential influence on therapeutic decision, making it more accurate. The procedure is safe and easily deployed in everyday practice.

Autofluorescence videobronchoscopy (AFI) for the assessment of tumor extension in lung cancer

The major objective of our study was to determine the specificity and sensitivity of AFI videobronchoscopy vs. white light videobronchoscopy, in the assessment of lung cancer extent. Secondary objective was to investigate whether or not AFI can reveal greater extension of the tumor, and can it influence therapy making decision. Autofluorescence videobronchoscopy systems are new technology for visualization of bronchial mucosa, and the proper indications for such systems will be determined in the near future. In this prospective trial we have enrolled 27 patients with suspected lung cancer in whom we performed 108 diagnostic biopsies and 54 control biopsies. All patients underwent WL videobronchoscopy followed by Auto Fluorescence Imaging (AFI) examination of tracheobronchial tree. We were using videobronchoscope BF-F260 and EVIS LUCERA SPECTRUM processor unit. Overall specificity for AFI in the diagnostics of lung cancer was found to be 85%, sensitivity was 90%, positive predictive value (PPV) 78%, and negative predictive value (NPV) 94%. Specificity, sensitivity, PPV, and NPV for WL videobronchoscopy in lung cancer diagnostics were 54%, 64%, 51%, and 69%, respectively. Relative sensitivity ratio of AFI over WL videobronchoscopy, which is calculated to be 1.41, confirmed superiority of AFI in lung cancer diagnostics. We confirmed significant correlation between the greater extension of the tumor (assessed with AFI) and the therapeutical decision in lung cancer treatment (p = 0.01). Influence of AFI on therapeutical decision was significant (p = 0.034). AFI videobronchoscopy system yields significantly higher sensitivity and specificity for the assessment of lung cancer extent than WLB videobronchoscopy alone. It had shown to be able to influence therapeutic option for lung cancer treatment. Further studies are needed to evaluate and validate these results.