Endoscopic Findings of Post-wedge Bronchoplastic Lobectomy

It is speculated that the advantage of wedge bronchoplastic lobectomy lies in the reduction in the incidence of major anastomotic complications. On the other hand, wedge bronchoscopic lobectomy can result in kinking at the anastomosis site. This study was performed to evaluate the operative outcomes and the postoperative endoscopic findings for wedge resection of the bronchus. From 2004 to 2012, nine patients underwent wedge bronchoplastic lobectomy for lung carcinoma. We evaluated the angles of the wedge and the distance of the preserved parts to the cut line of the bronchus (the so-called bronchial bridge). There were six right upper lobectomies, two middle and lower lobectomies, and one left lower lobectomy. Regarding bronchoscopic findings, five patients who underwent right upper lobectomy showed bulging into the bronchial lumen. There were no anastomotic strictures. Intraoperatively it was noted in these five patients that the bronchial bridge tended to be relatively long and/or the angle of the wedge resection tended to be relatively wide. To prevent bulging into the bronchial lumen after right upper wedge bronchoplastic lobectomy, bronchial wedge excisions should be shaped in order to reduce the length of the bronchial bridge

Long-term Survival of a Patient with Typical Lung Carcinoid Tumor and Supraclavicular Lymph Node Metastasis Treated by Surgical Resection

Herein we report on the long-term survival of a surgical case of typical carcinoid tumor and supraclavicular lymph node metastasis at initial diagnosis. The present study is a follow-up to a previously published case report. Initially, a 73-year-old man was admitted to hospital for evaluation of an enlarged lymph node in his right supraclavicular fossa. Serum progastrin-releasing peptide (ProGRP) concentrations were markedly elevated, and carcinoid was diagnosed by histopathological examination of the excised supraclavicular lymph node. The patient underwent right upper lobectomy and mediastinal lymph node dissection via median sternotomy. The final diagnosis was Stage IIIB (pT1aN3M0) typical carcinoid. Serum ProGRP concentrations decreased to within the normal range, and follow-up computed tomography, performed approximately 10 years after surgery, showed no recurrence. For this patient, radical resection of metastatic lymph nodes was an effective treatment for his typical lung carcinoid

Trastuzumab deruxtecan (T-DXd) in patients (pts) with HER2-overexpressing/amplified (HER2+) metastatic colorectal cancer (mCRC): Primary results from the multicenter, randomized, phase 2 DESTINY-CRC02 study.

Background: T-DXd (6.4 mg/kg, every 3 weeks [Q3W]) demonstrated antitumor activity in pts with HER2+ mCRC in DESTINY-CRC01 (Siena et al. Lancet Oncol. 2021). We present primary results of DESTINY-CRC02 (NCT04744831), which assessed the efficacy and safety of T-DXd (5.4 and 6.4 mg/ kg) in pts with HER2+ mCRC. Methods: This was a multicenter phase 2 study. Eligible pts had centrally confirmed HER2+ (immunohistochemistry [IHC] 3+ or IHC 2+/in situ hybridization [ISH]+) mCRC. Pts with RAS wild-type (wt) or mutant (m) mCRC were eligible. Pts had received prior standard therapy, unless contraindicated; prior anti-HER2 therapy was allowed. In stage 1, 80 pts were randomized 1:1 to 5.4 (n = 40) or 6.4 (n = 40) mg/kg T-DXd Q3W. In stage 2, an additional 42 pts received 5.4 mg/kg TDXd. Primary endpoint was confirmed objective response rate (cORR) by blinded independent central review (BICR). Secondary endpoints included duration of response (DoR), progression-free survival (PFS), overall survival (OS), and safety. Results: At data cutoff (Nov 1, 2022), most pts in the 5.4 and 6.4 mg/kg T-DXd arms had HER2 IHC 3+ (78.0% and 85.0%), RAS wt tumors (82.9% and 85.0%), and a median of 3 and 4 prior lines of therapy, respectively. cORR was 37.8% (95% CI, 27.3-49.2%) in the 5.4 mg/kg arm and 27.5% (95% CI, 14.6-43.9%) in the 6.4 mg/kg arm (all partial responses in both arms). Key efficacy data are shown in the Table: Grade $3 treatment-emergent adverse events (AEs) were observed in 41/83 pts (49.4%) and 23/39 pts (59.0%) in the 5.4 and 6.4 mg/kg T-DXd arms, respectively. Serious AEs were observed in 20/83 pts (24.1%) and 12/39 pts (30.8%) in the 5.4 and 6.4 mg/kg arms, respectively. Independently adjudicated drug-related interstitial lung disease occurred in 7/83 pts (8.4%) with 5.4 mg/kg T-DXd and 5/39 pts (12.8%) with 6.4 mg/kg T-DXd, and most events were grade 1/2 (1 grade 5 in the 6.4 mg/kg arm). Conclusions: T-DXd showed promising antitumor activity in pts with HER2+ mCRC at both 5.4 and 6.4 mg/kg doses. Antitumor efficacy was observed irrespective of RAS mutation status at 5.4 mg/kg T-DXd, and in those with prior anti-HER2 therapy. Overall, safety was consistent with the known safety profile of T-DXd and favored the 5.4 mg/kg dose. Clinical trial information: NCT0474483