Daily Respiratory Research Analysis
Analyzed 136 papers and selected 3 impactful papers.
Summary
Analyzed 136 papers and selected 3 impactful articles.
Selected Articles
1. Benmelstobart plus anlotinib versus pembrolizumab as first-line treatment for PD-L1-positive, advanced non-small-cell lung cancer (CAMPASS): a blinded, randomised, controlled, phase 3 trial.
In PD-L1–positive, driver-negative advanced NSCLC, benmelstobart plus anlotinib prolonged progression-free survival versus pembrolizumab (11.0 vs 7.1 months; HR 0.70; p=0.0057). Grade ≥3 treatment-related adverse events were more frequent with the combination (59% vs 29%), notably hypertension and haemoptysis, without unexpected safety signals.
Impact: This head-to-head phase 3 RCT suggests a potential new first-line option in PD-L1–positive NSCLC by improving PFS over a current standard (pembrolizumab). It may shift clinical practice pending overall survival and broader validation.
Clinical Implications: For PD-L1+ driver-negative advanced NSCLC, combining PD-L1 blockade with anti-angiogenic therapy may be considered where available, with careful monitoring for hypertension and haemoptysis. Patient selection and bleeding risk assessment are essential; OS results will inform guideline adoption.
Key Findings
- Median PFS improved to 11.0 months with benmelstobart+anlotinib versus 7.1 months with pembrolizumab (HR 0.70; p=0.0057).
- Grade ≥3 treatment-related adverse events were higher with the combination (59% vs 29%), with hypertension (26% vs 3%) and haemoptysis (3% vs 0%) notable.
- Serious treatment-related AEs occurred in 25% vs 21%; treatment-related deaths were 1% vs 2%; no unexpected safety signals reported.
Methodological Strengths
- Multicenter, randomized, blinded independent review of outcomes (RECIST v1.1).
- Stratified randomization with predefined subgroups and intention-to-treat analysis.
Limitations
- Open-label to investigators; potential assessment bias mitigated but not eliminated.
- Overall survival data immature; conducted exclusively in China which may affect generalizability; higher toxicity burden.
Future Directions: Await OS and quality-of-life analyses; explore biomarkers for benefit/toxicity, bleeding risk stratification, and global confirmatory trials to assess generalizability.
BACKGROUND: PD-1 and PD-L1 inhibitors have been shown to synergise with anti-angiogenic agents in non-small-cell lung cancer (NSCLC). We aimed to compare benmelstobart plus anlotinib with pembrolizumab in patients with previously untreated, driver gene-negative, PD-L1-positive, advanced NSCLC. METHODS: The blinded, randomised, controlled, phase 3 CAMPASS trial was conducted in 79 centres across China. Patients aged 18-75 years with stage IIIB-IV squamous or non-squamous NSCLC, no previous systemic treatment for advanced, recurrent or metastatic diseases, a PD-L1 tumour proportion score of 1% or greater, a life expectancy of 3 months or longer, at least one measurable lesion, and an Eastern
2. Heat waves and annual mortality among older adults (aged ≥65 years) in the USA.
In 73.8 million Medicare beneficiaries (2000–2018), each additional heat wave was associated with 8.83 more deaths per 10,000 person-years, including elevated respiratory mortality. Effects were larger among Black individuals and in high-poverty neighborhoods, whereas abundant green space was protective.
Impact: This national-scale analysis quantifies chronic mortality burdens of heat waves, identifies respiratory mortality impacts, and highlights inequities and potential environmental mitigations (green space). It informs clinical risk counseling and public health adaptation strategies.
Clinical Implications: Clinicians should incorporate heat risk counseling for older adults with chronic respiratory and cardiovascular disease, prioritize outreach to high-risk (Black, high-poverty) communities, and advocate for environmental interventions such as urban greening.
Key Findings
- An additional heat wave was associated with +8.83 deaths per 10,000 person-years (95% CI 5.99–11.68).
- Cause-specific mortality increases included cardiovascular, respiratory, and neurological deaths.
- Disparities: larger effects among Black individuals (+16.50) vs White (+5.85) and in high-poverty neighborhoods; green space was protective.
- Estimated 17,603 excess deaths from 8,307 observed heat waves; one additional heat wave per ZIP per decade projected ~56,815 premature deaths.
Methodological Strengths
- Massive national open cohort with 668 million person-years and ZIP-code level exposure assessment.
- Robust quasi-Poisson models adjusting for individual and neighborhood covariates; cause-specific analyses and subgroup effect modification.
Limitations
- Observational design with potential residual confounding and ecological bias.
- Heat wave definition may not capture indoor exposures or microclimates; lack of individual behavioral modifiers.
Future Directions: Link individual-level clinical data (e.g., COPD/asthma exacerbations, medication use) to refine vulnerability indices; evaluate targeted heat-health interventions and urban greening impacts on respiratory outcomes.
BACKGROUND: Heat waves are increasing in frequency and intensity due to climate change. While acute mortality effects are well documented, the impact on annual mortality and the modification of this association by race, poverty level, and amount of green space at a national level are less understood. We aimed to quantify the association of heat waves with annual all-cause and cause-specific mortality among older adults in the contiguous USA. METHODS: We conducted a cohort study using an
3. Randomised trial of delivering co-located, personalised stop-smoking support within lung cancer screening: the YESS study.
Among 1,003 participants receiving co-located cessation support within lung screening, validated 7-day abstinence was ~30–34% at 3 months and ~29% at 12 months regardless of study arm. Personalized imaging-based feedback did not improve quit rates overall, though a benefit was observed in women at 3 months.
Impact: Provides high-quality evidence on embedding cessation services into lung screening and cautions against assuming added value of personalized imaging feedback. Supports implementing co-located, opt-out cessation programs within screening pathways.
Clinical Implications: Offer co-located, opt-out cessation services during lung screening to achieve high quit rates. Personalized CT-based feedback need not be routine; consider targeted tailoring (e.g., women) while optimizing pharmacotherapy and behavioral support.
Key Findings
- Validated 7-day point prevalence abstinence at 3 months: 33.6% (personalized) vs 30.0% (standard); OR 1.17 (95% CI 0.90–1.54).
- At 12 months: 29.2% vs 28.6%; OR 1.03 (95% CI 0.78–1.36), indicating no overall added benefit.
- Women showed higher 3-month abstinence with personalization (33.9% vs 23.1%; OR 1.70, 95% CI 1.15–2.53); no benefit in men.
Methodological Strengths
- Randomized controlled design with biochemical validation of abstinence.
- Pragmatic integration within real-world lung screening workflow; large sample size.
Limitations
- Subgroup findings (sex differences) require replication; intervention fidelity and messaging salience may vary.
- Generalizability may depend on screening program structure and cessation resources.
Future Directions: Test tailored messaging strategies by sex and risk phenotype; evaluate digital adjuncts and longer-term maintenance approaches within screening programs.
INTRODUCTION: Lung cancer screening (LCS) with low-dose CT offers a teachable moment for smoking cessation (SC), but the optimal way to implement SC within LCS is unclear. The Yorkshire Enhanced Stop Smoking (YESS) study assessed the efficacy of a personalised stop-smoking intervention delivered alongside LCS. METHODS: Opt-out, co-located SC support, comprising nicotine replacement therapy/e-cigarettes/pharmacotherapy and behavioural support, was offered to all individuals who currently smoked attending for LCS. Four weeks later, participants were offered recruitment to a randomised controlled trial of continued standard best practice (SBP) versus a personalised SC support package, including a booklet containing CT images of participants' own heart and lungs, annotated where appropriate to highlight emphysema or coronary artery calcification and scripted communication delivered by a smoking cessation practitioner. RESULTS: 1003 people were recruited; 52.5% were allocated to the intervention group. Validated 7-day point prevalent (PP) abstinence rates were 33.6% and 30.0% in the intervention versus SBP groups, respectively (OR 1.17, 95% CI 0.90 to 1.54) at 3 months and 29.2% versus 28.6% (OR 1.03, 95% CI 0.78 to 1.36) at 12 months post-screening. Subgroup analyses indicated a significant increase in 7-day PP abstinence at 3 months with the intervention in women (33.9% intervention, 23.1% SBP, OR 1.70, 95% CI 1.15 to 2.53) but not in men (33.3% intervention, 37.8% SBP, OR 0.82, 95% CI 0.57 to 1.19). CONCLUSION: Around one-third of study participants were abstinent from smoking at 3 months post-screening irrespective of study arm, but adding the personalised intervention did not increase quit rates. Further research is needed exploring possible sex differences in efficacy of personalised SC support. The high overall quit rate reinforces the value of SC support delivered alongside LCS. TRIAL REGISTRATION NUMBER: ISRCRN 63825779 and NCT03750110.