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RESPIRATORY Medicine / Pulmonology Updates

RESPIRATORY Medicine / Pulmonology Updates

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频道帖子
[Comment] Amivantamab, lazertinib, and bevacizumab: a chemotherapy-free option for patients with advanced EGFR-mutant NSCLC with acquired resistance to a third-generation EGFR TKI https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00230-4/fulltext?rss=yes Acquired resistance to third-generation EGFR tyrosine-kinase inhibitors (TKIs) is an inevitable challenge in the management of EGFR-mutant advanced non-small-cell lung cancer (NSCLC). Multiple resistance mechanisms have been identified and various strategies have subsequently been developed, yet platinum-doublet chemotherapy has long remained the standard backbone of treatment.1 Currently, promising strategies include bispecific antibody-based regimens (amivantamab and ivonescimab) combined with platinum-based chemotherapy,2,3 and TROP2-targeted antibody–drug conjugates,4 but all still involve cytotoxic agents.

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[Articles] Combined amivantamab, lazertinib, and bevacizumab in patients with EGFR-mutant advanced non-small-cell lung cancer with acquired resistance to a third-generation EGFR tyrosine-kinase inhibitor (ETOP 18-21 AMAZE-lung): a prospective, international, multicentre, single-arm, phase 2 trial https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00203-1/fulltext?rss=yes Combined amivantamab, lazertinib, and bevacizumab showed durable anti-tumour activity, representing a promising chemotherapy-sparing alternative after progression on third-generation EGFR TKIs. Safety was consistent with known toxicity profiles.
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[Editorial] Preparedness for conflict in medical facilities https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00322-X/fulltext?rss=yes Global conflicts have made it essential for all countries to prepare their health-care facilities for the possibility of war. During a session at the 2026 European Respiratory Society (ERS) International Congress on war as a threat to respiratory care, we heard from the incredible doctors walking on the front line themselves. Dr Olha Konstantynovska (Kharkiv, Ukraine) is among those dedicating time to push for preparedness across borders. The session explored armed conflict as a systemic threat to respiratory health, aiming to highlight the need for preparedness measures that integrate clinical care, public health, planning, surveillance, and policy.
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[News] European Respiratory Society International Congress 2026 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00314-0/fulltext?rss=yes More than half of patients with chronic obstructive pulmonary disease (COPD) have exacerbations despite receiving standard-of-care (SOC) inhaled maintenance therapy. Biologics currently approved for inadequately controlled COPD are limited to use only in patients with raised blood eosinophil counts, leaving an unmet need in the wider COPD population. Frank C Sciurba (University of Pittsburgh, Pittsburgh, PA, USA) presented findings from two identical phase 3 trials (OBERON and TITANIA) of tozorakimab, a monoclonal antibody interleukin (IL)-33 inhibitor, versus placebo as add-on therapy to SOC for former or current smokers with COPD and a history of exacerbations in the previous year.
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[Comment] Survival is not the end(point): the second phase of ECPR care https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00280-8/fulltext?rss=yes A 54-year-old male has a cardiac arrest, witnessed by his coworkers who immediately perform cardiopulmonary resuscitation (CPR). Repeated defibrillations and high-quality resuscitation illicit no response, making survival increasingly unlikely. Nowadays, extracorporeal CPR (ECPR) can change that trajectory: circulation is restored, the patient survives and eventually returns home to his family with a favourable neurological outcome.1,2 This patient represents one of approximately 3000 annual ECPR cases in the Extracorporeal Life Support Organization live registry.
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[Correspondence] Identifying the residual unmet need in severe asthma https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00255-9/fulltext?rss=yes The biologic treatments approved for the management of severe asthma have transformed the outlook for patients over the past decade. Each novel therapy has offered the opportunity for oral steroid-free asthma control and, for many patients, the possibility of clinical remission. Although anti-IgE proved effective for some patients, the development of targeted therapies against eosinophils soon appeared to be the paradigm shift. These anti-IL5 (mepolizumab) and anti-IL5R (benralizumab) biologics were soon followed by equally effective approaches targeting other components of T2 inflammation, namely those mediated via the IL-4 receptor (targeted by dupilumab) and those downstream of the epithelial alarmin TSLP (inhibited by tezepelumab).
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[Articles] Symptom burden to characterise, predict, and prevent asthma attacks: a patient-level meta-analysis of randomised trials and translational prospective studies https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00150-5/fulltext?rss=yes In a large, individual patient-level meta-analysis of randomised controlled trials and translational prospective observational cohort studies, we observed little alignment of symptom burden with other clinical, physiological, or biological features of asthma and modest prognostic value for severe attacks. Conversely, type 2 biomarkers more reliably identified patients at high risk and those likely to respond to treatment. Symptoms might require contextual interpretation to guide anti-inflammatory escalation in asthma.
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[Spotlight] Edinburgh Festival Fringe: “Cancer isn't pretty—and neither is opera” https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00261-4/fulltext?rss=yes Cancer is often about numbers: the ups and downs of protein, hormone, or other tumour markers; the number of weeks of chemotherapy or radiotherapy that a patient must face; the number of months or years given as an estimated length of survival during a prognosis. Yet cancer is also about emotions: anger, fear, grief, and even hope. Katy Lees, a professional soprano, brought those emotions to life beautifully during Breathe: Five Arias That Saved My Life, her autobiographical one-woman debut show at the Edinburgh Festival Fringe, the world's biggest arts festival, which is taking place in Edinburgh, UK, on Aug 7–31.
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[Spotlight] A Pox on Fools: The Grifters and Cynics Who Want Us To Reject Vaccines https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00260-2/fulltext?rss=yes Midway through A Pox on Fools, Thomas Levenson concedes that “one of the biggest problems in writing this book is that the Trump administration-led war on vaccines is moving so quickly that each catastrophic statement or decision is so soon overtaken by something worse.” He makes a good point. In August, 2026, in an interview with CNN, the US Secretary of the Department of Health and Human Services (HHS) Robert F Kennedy Jr repeatedly suggested that there could be a link between vaccination and autism.
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🚀 UpdatesInMedicine.com is now live! For medical professionals: • Latest clinical guidelines • Important new research • Prac
🚀 UpdatesInMedicine.com is now live! For medical professionals: • Latest clinical guidelines • Important new research • Practical clinical reviews • Guidelines in Practice • Research in Practice • Conferences, webinars, CPD/CME & opportunities 🌐 UpdatesInMedicine.com From evidence to everyday practice.
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[Spotlight] Medical oxygen supply in Zambia: beyond COVID-19 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00294-8/fulltext?rss=yes In 2021, as the COVID-19 pandemic overwhelmed health systems worldwide, Zambia designated the Chongwe district hospital as a COVID-19 care centre, receiving critically ill patients from all over the country.
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[Comment] Tuberculosis preventive treatment in high-burden settings: inequality in benefit, evidence, and potential harms https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00278-X/fulltext?rss=yes The WHO End TB Strategy targets a 90% reduction in global incidence by 2035, with programmatic scale-up of tuberculosis preventive treatment (TPT) in high-burden countries a key priority;1 yet there is scarce evidence to support the effectiveness of this approach for incidence reduction. Guidelines recommend TPT for individuals at high risk of tuberculosis, including recent contacts without clinical evidence of disease and, where possible, with evidence of tuberculosis infection (a positive Mycobacterium tuberculosis immune-sensitisation test), given as 6–9 months of isoniazid or, more recently, 1–4 months of a rifamycin-based regimen.
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[Articles] Duration of effectiveness of tuberculosis preventive treatment across various tuberculosis burden settings: a systematic review and individual-participant meta-analysis https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00219-5/fulltext?rss=yes Among close contacts with evidence of M tuberculosis infection, we found that the initial protection from TPT eroded relatively quickly in high-burden settings, but was sustained long-term in medium-burden and low-burden settings. In medium-burden and low-burden settings, completing TPT provided greater initial protection, but TPT non-completers had similar long-term tuberculosis risk.
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[Articles] State-level burden of chronic respiratory diseases in the USA, 1990–2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023 https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00218-3/fulltext?rss=yes State-level policy environments, including fiscal and preventive health measures, might contribute to shaping respiratory health outcomes beyond individual risk factors. Integrating tobacco control measures, equitable vaccination programmes, and targeted health-system investments could help to address the uneven burden of chronic respiratory diseases across US states and the growing mortality gap despite stable prevalence, although further research is needed to clarify which specific policy determinants underlie these associations.
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[Comment] Understanding US state-level heterogeneity in chronic respiratory disease burden https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00226-2/fulltext?rss=yes Chronic respiratory diseases (CRDs) are a major contributor to global mortality. In 2023, they accounted for an estimated 4·2 million deaths and ranked fourth among the leading causes of death worldwide (fifth in the USA, with 221 000 deaths) according to the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023.1 Mortality alone, however, understates the total health loss attributable to these diseases. Disability-adjusted life-years (DALYs), a composite measure of premature deaths and years lived with disability, more fully captures the totality of disease burden.
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[News] AI data centres could worsen US air pollution https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00293-6/fulltext?rss=yes Artificial intelligence (AI) firms are exploiting loopholes and lax air pollution enforcement in a race to build new on-site fossil-fuel power plants for data centres across the USA. Concerns over air pollution, water use, secrecy, and noise have fomented a growing backlash against the construction boom just ahead of November's mid-term elections.
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[Comment] When spirometry is normal: can FeNO fill the gap in asthma diagnosis? https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00288-2/fulltext?rss=yes Asthma is one of the most prevalent chronic respiratory diseases, imposing a considerable individual and societal burden, yet objective diagnosis remains challenging. Diagnosis relies on several complementary tests, many of which are not routinely available in primary care. In their absence, the risk of both under-diagnosis and over-diagnosis is substantial, and treatment is sometimes initiated as a diagnostic trial—an approach rarely considered for other chronic diseases.
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[Articles] Accuracy of type 2 inflammatory biomarkers to diagnose asthma in adults and children: a meta-analysis of 30 studies with prospective validation in an adult primary care cohort https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00228-6/fulltext?rss=yes In adults and children with suspected asthma, FeNO predicted airway hyper-responsiveness and enabled clinically applicable rule-in and rule-out thresholds. BEC performed poorly alone and added no value to FeNO. Findings and thresholds were replicated in a prospective adult primary care cohort; a similar study in children is ongoing. FeNO-guided diagnostic algorithms using context-specific rule-in and rule-out thresholds, while accounting for recent inhaled corticosteroid exposure, warrant consideration.
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Is acetazolamide a 'REMedy for rapid eye movement-predominant obstructive sleep apnoea? http://thorax.bmj.com/cgi/content/short/81/10/933?rss=1 Pharmacotherapy for obstructive sleep apnoea (OSA) has entered a new phase in which the focus is shifting from broad, one-size-fits-all approaches to targeted treatments matched to specific physiological endotypes. While continuous positive airway pressure (CPAP) remains the standard of care, many individuals, particularly those with rapid eye movement (REM)-predominant OSA (REM-OSA), struggle with adherence.1 REM sleep is characterised by more frequent and prolonged obstructive events due to dips in ventilatory drive and greater upper-airway vulnerability,2 making this subgroup uniquely challenging to treat. Against this backdrop, interest has grown in the use of medications such as the carbonic anhydrase inhibitor acetazolamide, which modulates ventilatory drive and potentially offers targeted benefit where REM-related pathophysiology dominates. In this issue of Thorax, it is therefore with great interest that we read the recent study by Messineo et al3 which is the first trial to directly test the...
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Increase in second primary lung cancers in a nation-wide cohort study from Sweden http://thorax.bmj.com/cgi/content/short/81/10/981?rss=1 Background We describe the occurrence of second primary lung cancers (SPLCs) and their determinant in Sweden. Methods Nation-wide cancer registry from years 1961 to 2021 identified a total of 853 SPLCs. Results The incidence of SPLCs increased almost linearly from 1980 onwards, equally for women and men and approximately equally after the four main histological types. SPLC included adenocarcinoma 63.9%, squamous cell carcinoma (SCC) 19.4%, small cell carcinoma 9.6% and large cell carcinoma 9.1%. The female cumulative probability (CumP) of SPLC after first adenocarcinoma in 10 years reached 0.019, after SCC 0.015 and after small and large cell carcinoma 0.008. The respective CumP for men was 0.013, 0.012, 0.002 and 0.005. While adenocarcinoma was often followed by second adenocarcinoma, after first non-adenocarcinoma SPLCs presented in diverse histologies. Relative risk of SPLC compared with first lung cancer was overall 3.59, higher for women (4.16) than for men (2.99) and approximately equally high after adenocarcinoma and SCC. In patients diagnosed before age 55 years, the relative risk was 6.68 for all, but after female adenocarcinoma it was 9.95 compared with 6.77 for males. The highest relative risks, up to 20-fold, were found after early onset female adenocarcinoma diagnosed after defined T stages. Conclusions Although SPLCs are still rare, their number is increasing rapidly and the relative risks compared with first lung cancer are substantial, qualifying selected groups of high-risk patients, such as patients with early onset adenocarcinoma for early detection by CT screening when/if such tests become available.
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