Weekly Respiratory Research Analysis
This week’s respiratory literature highlights three high-impact areas: a phase‑3 randomized trial showing an overall‑survival benefit for amivantamab‑lazertinib versus osimertinib in previously untreated patients (with higher toxicity), a multicenter RCT demonstrating that ultrasound elastography–guided pleural biopsy substantially improves diagnostic sensitivity for malignant pleural effusion without added harm, and a large living systematic review/meta‑analysis confirming strong real‑world eff
Summary
This week’s respiratory literature highlights three high-impact areas: a phase‑3 randomized trial showing an overall‑survival benefit for amivantamab‑lazertinib versus osimertinib in previously untreated patients (with higher toxicity), a multicenter RCT demonstrating that ultrasound elastography–guided pleural biopsy substantially improves diagnostic sensitivity for malignant pleural effusion without added harm, and a large living systematic review/meta‑analysis confirming strong real‑world effectiveness and reassuring safety for RSV immunoprophylaxis (nirsevimab) and adult RSV vaccines. Together these reports influence first‑line oncology choices, diagnostic pathways for pleural disease, and public‑health vaccination/immunoprophylaxis strategies.
Selected Articles
1. Overall Survival with Amivantamab-Lazertinib in
In a phase‑3 randomized trial of previously untreated patients, amivantamab‑lazertinib produced a statistically significant overall survival benefit versus osimertinib (HR for death 0.75; P=0.005), with 3‑year OS 60% vs 51%. The combination resulted in higher rates of grade ≥3 adverse events (80% vs 52%), notably skin toxicity, venous thromboembolism, and infusion reactions.
Impact: Demonstrates an overall‑survival advantage for a novel bispecific/combination targeted regimen over the current comparator in first‑line disease — a finding with potential to change standard of care.
Clinical Implications: May alter first‑line therapy selection for molecularly matched patients; requires implementation of toxicity‑management protocols and preemptive monitoring for skin events, thromboembolism, and infusion reactions.
Key Findings
- Amivantamab‑lazertinib improved overall survival versus osimertinib (HR 0.75; 95% CI 0.61–0.92; P=0.005).
- Three‑year overall survival: 60% (amivantamab‑lazertinib) vs 51% (osimertinib).
- Grade ≥3 adverse events were more frequent with amivantamab‑lazertinib (80% vs 52%), including skin toxicity, venous thromboembolism, and infusion‑related events.
- At data cutoff, a higher proportion remained on assigned therapy in the amivantamab‑lazertinib arm (38% vs 28%).
2. Ultrasonic Elastography-guided Pleural Biopsy
A multicenter randomized trial (NCT05781659) found that ultrasonic elastography‑guided pleural biopsy (UEPB) significantly increased sensitivity for diagnosing malignant pleural effusion (85% sensitivity) compared with standard thoracic ultrasound‑guided pleural biopsy, with a comparable safety profile.
Impact: A randomized, multicenter diagnostic trial that operationalizes elastography targeting to increase tissue yield without added harm — immediately actionable for pleural workups in experienced centers.
Clinical Implications: Consider UEPB when malignancy is suspected or cytology is nondiagnostic; implement sonographer training and protocols to integrate elastography into pleural diagnostic pathways to reduce repeat procedures and expedite care.
Key Findings
- UEPB sensitivity for malignant pleural effusion was 85.0%, significantly higher than standard TUSPB.
- Safety profile of UEPB was similar to TUSPB (no increased adverse events reported).
- Multicenter randomized design supports generalizability to experienced centers.
3. Real-world effectiveness and safety of nirsevimab, RSV maternal vaccine and RSV vaccines for older adults: a living systematic review and meta-analysis.
A living systematic review and meta‑analysis incorporating ~50 studies (~7.6 million people) showed nirsevimab reduced RSV‑related ED visits and hospitalizations by ~81% and ICU admissions by ~76% in infants; older‑adult RSV vaccines reduced RSV‑related hospitalizations by ~80%. Severe safety signals were rare across studies; data for maternal RSV vaccination remain limited.
Impact: Large, up‑to‑date synthesis confirming high real‑world effectiveness and reassuring safety of RSV immunoprophylaxis — directly informs immunization policy and rollout decisions for infants and older adults.
Clinical Implications: Supports broad infant nirsevimab rollout prior to the first RSV season and continued deployment of older‑adult RSV vaccines with active pharmacovigilance; prioritize research to fill maternal vaccine effectiveness gaps.
Key Findings
- Nirsevimab effectiveness ~80.7% against ED visits and hospital admissions, ~75.6% against ICU admissions in infants (meta‑analytic estimates).
- Older‑adult RSV vaccines reduced RSV‑related hospital admissions by ~79.6%.
- No severe adverse events reported for nirsevimab in included studies; GBS events with adult vaccines were rare (<10 per million doses).
- Real‑world maternal RSV vaccine effectiveness data remain limited.