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Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study Agreement between MDTMs for diagnosis in diffuse lung disease is acceptable and good for a diagnosis of IPF, as validated by the non-significant greater prognostic separation of an IPF diagnosis made by MDTMs than the separation of a diagnosis made by individual clinicians or radiologists. Furthermore, MDTMs made the diagnosis of IPF with higher confidence and more frequently than did clinicians or radiologists. This difference is of particular importance, because accurate and consistent diagnoses of IPF are needed if clinical outcomes are to be optimised. Inter-multidisciplinary team agreement for a diagnosis of hypersensitivity pneumonitis is low, highlighting an urgent need for standardised diagnostic guidelines for this disease.
An Update on Lymphocyte Subtypes in Asthma and Airway Disease Inflammation is a hallmark of many airway diseases. Improved understanding of the cellular and molecular mechanisms of airway disease will facilitate the transition in our understanding from phenotypes to endotypes, thereby improving our ability to target treatments based on pathophysiologic characteristics. For example, allergic asthma has long been considered to be driven by an allergen-specific T helper 2 response. However, clinical and mechanistic studies have begun to shed light on the role of other cell subsets in the pathogenesis and regulation of lung inflammation.
Comprehensive and Individualized Patient Care in Idiopathic Pulmonary Fibrosis: Refining Approaches to Diagnosis, Prognosis, and Treatment Implement multidisciplinary clinical and imaging approaches to achieve more timely and accurate diagnosis of IPF • Develop IPF treatment strategies based on key guideline recommendations and examine the supporting clinical trial data • Describe key elements of an individualized approach to IPF treatment that involves shared decision-making Standard immunosuppressive therapy is no longer indicated, whereas pirfenidone, nintedanib, and antacid therapy are all conditionally recommended for use. Individualizing treatment is important in light of potential improved adherence to both drug therapy and health behaviors. An early referral to an interstitial lung disease center offers the advantages of comprehensive diagnostic and disease-management expertise, potential enrollment in a clinical trial, and evaluation for transplantation.
The development of biomarker-driven targeted therapy has resulted in substantial benefits for patients with non–small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) mutations, and rearrangements involving the anaplastic lymphoma kinase (ALK) gene or the ROS1 gene. For patients with EGFR-mutant NSCLC EGFR tyrosine kinase inhibitors (eg, gefitinib, erlotinib, and afatinib) have a superior objective response rate and progression-free survival compared with chemotherapy in the first-line setting. For patients who have disease progression on EGFR tyrosine kinase inhibitor and with NSCLC with an EGFR T790M mutation osimertinib has demonstrated a superior response rate and progression-free survival compared with chemotherapy in the second-line setting.4 For patients with ALK rearrangements ALK tyrosine kinase inhibitors (eg, crizotinib, ceritinib) have a superior response rate and progression-free survival compared with chemotherapy in the first-line setting, and for patients who experience disease progression, ceritinib and alectinib have demonstrated clinically relevant response rates and progression-free survival..For patients with ROS1 rearrangements, targeted therapy, is associated with a higher response rate and longer progression-free survival than has been observed with chemotherapy. These molecular alterations are more common in NSCLC with adenocarcinoma histology and in the minority of patients with a light smoking or never smoking history. The success of these targeted therapies in molecularly defined subsets of NSCLC made the development of targeted therapies and identification of predictive biomarkers a focus of thoracic oncology research. Routine molecular testing is now the standard of care for patients with NSCLC with adenocarcinoma histology