Skip to main content

Main menu

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • COVID-19 submission information
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

User menu

  • Log in
  • Subscribe
  • Contact Us
  • My Cart

Search

  • Advanced search
  • ERS Publications
    • European Respiratory Journal
    • ERJ Open Research
    • European Respiratory Review
    • Breathe
    • ERS Books
    • ERS publications home

Login

European Respiratory Society

Advanced Search

  • Home
  • Current issue
  • Early View
  • Archive
  • Authors/reviewers
    • Instructions for authors
    • Submit a manuscript
    • COVID-19 submission information
    • Institutional open access agreements
    • Peer reviewer login
  • Alerts
  • Subscriptions

New drugs in thoracic oncology: needs and knowledge – an online ERS Lung Cancer Assembly survey

Thierry Berghmans, Matthew Evison, Torsten Gerriet Blum, Nir Peled, Jacques Cadranel
ERJ Open Research 2018 4: 00040-2018; DOI: 10.1183/23120541.00040-2018
Thierry Berghmans
1Dept of Intensive Care, and Oncological Emergencies and Thoracic Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Matthew Evison
2Manchester Thoracic Oncology Centre, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Torsten Gerriet Blum
3Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Nir Peled
4Soroka Cancer Center, Ben-Gurion University, Beer Sheva, Israel
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jacques Cadranel
5Chest Dept and Thoracic Oncology Expert Center, AP-HP Hôpital Tenon and Medicine Sorbonne University, Paris, France
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • PDF
Loading

Abstract

In the last decade, systemic therapy for advanced lung cancer has become diverse, complex and personalised. These new therapies (monoclonal antibodies, tyrosine kinase inhibitors (TKIs) and immunotherapy) have a far different toxicity profile compared to chemotherapy. Furthermore, clinical indications and reimbursement criteria can vary across Europe. The aim of the present online survey was to assess the knowledge, views and challenges facing the European respiratory community in this rapidly changing field.

A 15-question web survey was sent to all European Respiratory Society members through the Society's monthly electronic communication.

A total of 315 questionnaires were completed. Most of the respondents were male (59.1%), were above 40 years of age (52.9%) and were working in university/academic hospitals (74.8%), the majority as pulmonologists (90%). Only 55% of the participants were aware of the legal processes for drug recognition. Except for epidermal growth factor receptor TKI, up to 38% did not know about the specific toxicities of anaplastic lymphoma kinase/ROS proto-oncogene 1 TKIs, monoclonal antibodies and immune checkpoint inhibitors. Of the respondents, 92% showed an interest in an online platform reporting new drugs' toxicities.

Despite a large amount of publicity and integration of new drugs into therapeutic algorithms and clinical guidelines, physicians taking care of lung cancer patients have a need for up-to-date information on systemic therapy toxicity management and legal constraints.

Abstract

Physicians have a need for up-to-date information on new drug toxicity management in thoracic oncology http://ow.ly/j3YA30kOtBz

Introduction

Until the turn of the 21st Century, tumour-specific treatment in lung cancer was based on the triplet surgery–radiotherapy–chemotherapy, either alone or in combination according to disease extent. A better knowledge of cancer biology including cell cycle control, metastatic process and immune cell–tumour interactions led to substantial modifications in the current therapeutic strategies, mainly for stage IV nonsmall cell lung cancer (NSCLC) [1]. Monoclonal antibodies targeting epidermal growth factor receptor (EGFR) [2] or vascular endothelial growth factor (VEGF) [3] demonstrated survival improvement when combined with first-line platinum-based chemotherapy, while a small oral drug with anti-angiogenic properties, nintedanib [4], had the same result in combination with docetaxel for salvage therapy in an adenocarcinoma sub-group. In addition to these encouraging data, more successes were noted in selected patients with oncogenic driver mutations, EGFR and proto-oncogene B-Raf (BRAF) mutations, or anaplastic lymphoma kinase (ALK) and ROS proto-oncogene 1 (ROS-1) translocations. Small oral tyrosine kinase inhibitors (TKIs) allowed significant improvement in progression-free survival duration with limited toxicity in comparison with conventional chemotherapy [5–16]. The last advances were recently noted with the introduction of immune checkpoint inhibitors targeting either the programmed cell death 1 (PD1)/programmed death ligand 1 (PDL1) or cytotoxic T-lymphocyte-associated protein 4 (CTLA4) axes [16–21]. The Food and Drug Administration (FDA) in North America and the European Medicines Agency (EMA) in Europe have currently approved three drugs (pembrolizumab, nivolumab and atezolizumab) and the diversification in the (pneumo)oncologist's armamentarium is set to continue as other targeted therapies, immunotherapies and combined regimens are under investigation.

These advances are leading to complexity in therapeutic decisions. Furthermore, all these new drugs are presenting with far different toxicity profiles compared to the well-known chemotherapeutic agents. (Pneumo)oncologists must now update their knowledge regarding the mechanisms of action and toxicities but should additionally be aware of the respective national legal prescription pathways and reimbursement criteria for these drugs. In order to obtain a picture of the current situation in Europe, the ERS Thoracic Oncology Assembly-driven Clinical Research Collaboration (CRC) RATIONALE designed an online survey focusing on any physicians involved in lung cancer diagnosis or treatment.

Methodology

An ERS grant was obtained in 2015 through a CRC application, with the main objective being the development of an online platform regarding toxicity of new drugs in thoracic oncology. Before developing this prospective registry, a survey was designed with the primary aim of providing a picture of physicians' current knowledge of the legal processes and toxicities of new systemic therapies available for lung cancer treatment.

After consensual agreement, 15 questions and one optional comment section constituted the survey (table 1). The survey was sent anonymously through the ERS monthly electronic communication to all ERS members, whatever their main specialty. A recall was done once and the data capture was finally closed on October 31, 2017.

View this table:
  • View inline
  • View popup
TABLE 1

Questionnaire summary

Results

The survey ran from May 2017 to November 2017 and 315 questionnaires were obtained. The main characteristics of the respondents are presented in table 2. There were a slight majority of males, above 40 years of age, working essentially in university and academic hospitals. Respondents were representative of most European countries with the following distribution: Spain (n=40), United Kingdom (n=25), Germany and Greece (both n=22), Portugal (n=21), France (n=20), Italy (n=14), the Netherlands (n=12), Austria (n=11), Belgium (n=9), Poland (n=8), Serbia (n=7), Romania (n=6), Finland and Switzerland (both n=5), Hungary, Bulgaria and the Czech Republic (n=4 each), Norway and Macedonia (both n=3), Croatia and Luxembourg (n=2 each). In addition people from Turkey (n=10), the Philippines (n=8), Australia and Israel (n=2 each) also answered the questionnaire.

View this table:
  • View inline
  • View popup
TABLE 2

General characteristics of the respondents

Six questions concerned legal constraints, indications and toxicities of new drugs in lung cancer, focusing on targeted therapies (EGFR, ALK and ROS-1 TKIs, monoclonal antibodies directed against EGFR or with anti-angiogenic activity and immunotherapy regarding either the PD1/PDL1 or CTLA4 axes). There is clearly a lack of knowledge of the legal processes for drug prescription in Europe (138 positive answers among 253 responses (54.5%)), while the EMA was recognised by 86.6% of the respondents (219 out of 253). Table 3 summarises this information in countries that have more than 10 respondents, while table 4 summarises the knowledge of the lung cancer community about indications and general toxicity of the new systemic therapies (showing the need for further information with the exception of EGFR TKI). In addition, a lot of physicians do not recognise potential toxicities related to these new drugs (table 5). Toxicity management is coordinated primarily by the chest physicians while medical oncologists were also frequently in charge. The role of the organ-specific specialist is infrequent, maybe reflecting the fact that toxicities were respiratory system centred (table 5).

View this table:
  • View inline
  • View popup
TABLE 3

Breakdown of the legal constraints knowledge in countries that have more than 10 respondents

View this table:
  • View inline
  • View popup
TABLE 4

Indication and toxicity knowledge of new systemic therapies

View this table:
  • View inline
  • View popup
TABLE 5

Pulmonary complications and toxicity management

The last four questions regarded the To“X”csin project, an online prospective registry coordinated through the ERS with the aim of reporting and describing toxicities related to new systemic therapies in lung cancer. Among 312 respondents, 235 would use the online platform while only 25 would abstain from it and 52 were unsure. Most of the participants (268 out of 309) estimated that the platform should focus on all types of toxicities while few (41 out of 309) considered only lung toxicities. In order to launch the online platform, the majority reported that needing regulatory board and ethics committee approval was either a certainty (147 out of 306) or a possibility (132 out of 306); however, for 27 respondents this seemed not to be mandatory in their national setting.

The proposals from the respondents for the platform's main functions can be summarised in five groups: 1) providing information and education, eventually on rare pathologies/events; 2) creating a network for information and data sharing/creation of a European database; 3) diffusion of information on unexpected/rare side effects; 4) allowing case discussions and contact with “specialists”; 5) connecting with competent authorities at the national and European levels.

Discussion

Lung cancer management has evolved from a simple “all-fit-in” strategy based on surgery, radiotherapy and conventional chemotherapy to a complex algorithm concerning specific biological entities (oncogenic driver mutations/inflammatory tumours) and new systemic therapies having specific mechanisms of action and toxicity profiles. This survey, the first milestone of the CRC RATIONALE masterplan, as an essential part of the ERS Thoracic Oncology Assembly, emphasised the need for providing information to lung cancer specialists about national and European legal processes of drug prescription and indications, as well as toxicity descriptions and management in three therapeutic fields: 1) targeted therapies; 2) monoclonal antibodies; and 3) immunotherapies.

Twenty years ago, lung cancer was separated into two distinct entities, small cell lung cancer (SCLC) and NSCLC, with dedicated therapeutic strategies. With the reporting of the first actionable oncogenic driver mutation in 2004 [22], a new era of targeted therapies was opened and other targets were rapidly discovered [23]. While advances were made they only concerned small groups of patients, moving from a common cancer to rare entities so that physicians have limited experience either for diagnosis, treatment or toxicity management. More recently, immunotherapy developments led to the introduction of anti-PD1/PDL1 antibodies into routine care for a very large group of NSCLC patients. However, physicians are now confronted by toxic autoimmune manifestations, an uncommon situation in lung cancer which justifies the assistance of organ-specialists who are in turn not aware of lung cancer specificities. Furthermore, at the difference of conventional chemotherapy and first/second generation EGFR TKI, there are not only very specific toxicities associated with new drugs (e.g. visual disturbances associated with ALK inhibitors) but also differences in the incidences of similar toxic events inside the same class of drugs (less skin reaction and diarrhoea for osimertinib compared to first/second generation EGFR TKIs (gefitinib, erlotinib and afatinib)) or therapeutic approaches (more immune adverse events with ipilimumab compared to anti-PD1). The present survey, mainly representing medical (pneumo)oncologists, underlines some deficits in knowledge amongst lung cancer clinicians in these different domains. The exception is EGFR mutation and TKI, probably because of less complexity than currently noted in the ALK translocated tumours and more than a decade of use in routine practice.

Respondents to this survey clearly supported the development of a user-friendly system providing updated information on toxicity prevalence and description of new systemic drugs in lung oncology. The CRC RATIONALE is building an industry-independent web platform (To“X”csin) where toxic events may be prospectively recorded. Their expectation is also to have the possibility of sharing experience with other specialists not only about lung toxicity but about any organ toxicity. We can question the current way of obtaining such information. There are numerous sources of data coming from the pharmaceutical industry but, without any value judgement in the present situation, these can be biased as was previously reported for psychiatric medications [24]. Furthermore, reporting adverse events to national and European medical agencies is a legal constraint; however, the response via information for the physicians sometimes seems limited or delayed, since regular updates on types and frequencies of adverse events are difficult to obtain and official modification of medical notices (often after substantial documentation of relevant adverse events) may take time due to bureaucratic processes. This emphasises the need for a new up-to-date and rapid communication platform, directed by and designed for the physicians, which will be ensured by the aspired to To“X”csin platform.

Two main questions arise for the survey. The first is regarding the number of participants, as the first call allowed us to obtain around 100 responses and with the second call we increased this number to more than 300. This appears to be a relatively low value according to the number of ERS members; however, it is evident that answers to surveys are generally low, especially amongst physicians of which only a minority are involved in lung cancer treatment and who receive many solicitations. The second question of importance is whether the respondents are representative of the European lung cancer community. Participants covered all the different parts of Europe and the slight male majority is also reflective of the current tendency in gender repartition. Age distribution shows that most respondents are active experienced physicians, although we observed some discrepancy regarding the site of activity with an excess of academics and universitarians. Despite this, the need for information remains important. Most of the respondents were pneumologists and very few were from other specialties. However, in most European countries, pneumologists are in charge of first-line lung cancer diagnosis and treatment.

Facing the evolving complexity in NSCLC management and the rapid introduction of new systemic therapies, the lung cancer community is requesting new information and communication modes for sharing experience with toxicities that are underlined by this online survey. Thus, the CRC RATIONALE within the ERS Thoracic Oncology Assembly has elaborated a website dedicated to this topic. We expect that To”X”csin will be available in 2018, provided that all legal constraints are reached.

Footnotes

  • Conflict of interest: J. Cadranel reports receiving grants and personal fees from Astra Zeneca, Novartis and Pfizer, personal fees from Boehringer Ingelheim, Roche, BMS and MSD, outside the submitted work.

  • Support statement: This survey is part of a European Respiratory Society Clinical Research Collaboration. Funding information for this article has been deposited with the Crossref Funder Registry.

  • Received March 8, 2018.
  • Accepted July 1, 2018.
  • Copyright ©ERS 2018

This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

References

  1. ↵
    1. Novello S,
    2. Barlesi F,
    3. Califano R, et al.
    Metastatic non-small-cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27: Suppl. 5, v1–27.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Pujol JL,
    2. Pirker R,
    3. Lynch TJ, et al.
    Meta-analysis of individual patient data from randomized trials of chemotherapy plus cetuximab as first-line treatment for advanced non-small cell lung cancer. Lung Cancer 2014; 83: 211–218.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Soria JC,
    2. Mauguen A,
    3. Reck M, et al.
    Systematic review and meta-analysis of randomised, phase II/III trials adding bevacizumab to platinum-based chemotherapy as first-line treatment in patients with advanced non-small-cell lung cancer. Ann Oncol 2013; 24: 20–30.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Reck M,
    2. Kaiser R,
    3. Mellemgaard A, et al.
    Docetaxel plus nintedanib versus docetaxel plus placebo in patients with previously treated non-small-cell lung cancer (LUME-Lung 1): a phase 3, double-blind, randomised controlled trial. Lancet Oncol 2014; 15: 143–155.
    OpenUrlCrossRefPubMed
  5. ↵
    1. Inoue A,
    2. Kobayashi K,
    3. Maemondo M, et al.
    Updated overall survival results from a randomized phase III trial comparing gefitinib with carboplatin-paclitaxel for chemo-naive non-small cell lung cancer with sensitive EGFR gene mutations (NEJ002). Ann Oncol 2013; 24: 54–59.
    OpenUrlCrossRefPubMed
    1. Mitsudomi T,
    2. Morita S,
    3. Yatabe Y, et al.
    Gefitinib versus cisplatin plus docetaxel in patients with non-small-cell lung cancer harbouring mutations of the epidermal growth factor receptor (WJTOG3405): an open label, randomised phase 3 trial. Lancet Oncol 2010; 11: 121–128.
    OpenUrlCrossRefPubMed
    1. Rosell R,
    2. Carcereny E,
    3. Gervais R, et al.
    Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multicentre, open-label, randomised phase 3 trial. Lancet Oncol 2012; 13: 239–246.
    OpenUrlCrossRefPubMed
    1. Wu Y-L,
    2. Zhou C,
    3. Liam C-K, et al.
    First-line erlotinib versus gemcitabine/cisplatin in patients with advanced EGFR mutation-positive non-small-cell lung cancer: analyses from the phase III, randomized, open-label, ENSURE study. Ann Oncol 2015; 26: 1883–1889.
    OpenUrlCrossRefPubMed
    1. Zhou C,
    2. Wu YL,
    3. Chen G, et al.
    Final overall survival results from a randomised, phase III study of erlotinib versus chemotherapy as first-line treatment of EGFR mutation-positive advanced non-small-cell lung cancer (OPTIMAL, CTONG-0802). Ann Oncol 2015; 26: 1877–1883.
    OpenUrlCrossRefPubMed
    1. Sequist LV,
    2. Yang JC,
    3. Yamamoto N, et al.
    Phase III study of afatinib or cisplatin plus pemetrexed in patients with metastatic lung adenocarcinoma with EGFR mutations. J Clin Oncol 2013; 31: 3327–3334.
    OpenUrlAbstract/FREE Full Text
    1. Wu YL,
    2. Zhou C,
    3. Hu CP, et al.
    Afatinib versus cisplatin plus gemcitabine for first-line treatment of Asian patients with advanced non-small-cell lung cancer harbouring EGFR mutations (LUX-Lung 6): an open-label, randomised phase 3 trial. Lancet Oncol 2014; 15: 213–222.
    OpenUrlCrossRefPubMed
    1. Shaw AT,
    2. Kim DW,
    3. Nakagawa K, et al.
    Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med 2013; 368: 2385–2394.
    OpenUrlCrossRefPubMed
    1. Shaw AT,
    2. Kim TM,
    3. Crinò L, et al.
    Ceritinib versus chemotherapy in patients with ALK-rearranged non-small-cell lung cancer previously given chemotherapy and crizotinib (ASCEND-5): a randomised, controlled, open-label, phase 3 trial. Lancet Oncol 2017; 18: 874–886.
    OpenUrl
    1. Solomon BJ,
    2. Mok T,
    3. Kim D-W, et al.
    First-line crizotinib versus chemotherapy in ALK-positive lung cancer. N Engl J Med 2014; 371: 2167–2177.
    OpenUrlCrossRefPubMed
    1. Soria J-C,
    2. Tan DSW,
    3. Chiari R, et al.
    First-line ceritinib versus platinum-based chemotherapy in advanced ALK-rearranged non-small-cell lung cancer (ASCEND-4): a randomised, open-label, phase 3 study. Lancet 2017; 389: 917–929.
    OpenUrlCrossRefPubMed
  6. ↵
    1. Reck M,
    2. Rodríguez-Abreu D,
    3. Robinson AG, et al.
    Pembrolizumab versus chemotherapy for PD-L1-positive non-small-cell lung cancer. N Engl J Med 2016; 375: 1823–1833.
    OpenUrlCrossRefPubMed
    1. Brahmer J,
    2. Reckamp KL,
    3. Baas P, et al.
    Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med 2015; 373: 123–135.
    OpenUrlCrossRefPubMed
    1. Borghaei H,
    2. Paz-Ares L,
    3. Horn L, et al.
    Nivolumab versus docetaxel in advanced nonsquamous non-small-cell lung cancer. N Engl J Med 2015; 373: 1627–1639.
    OpenUrlCrossRefPubMed
    1. Herbst RS,
    2. Baas P,
    3. Kim D-W, et al.
    Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer (KEYNOTE-010): a randomised controlled trial. Lancet 2016; 387: 1540–1550.
    OpenUrlCrossRefPubMed
    1. Rittmeyer A,
    2. Barlesi F,
    3. Waterkamp D, et al.
    Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer (OAK): a phase 3, open-label, multicentre randomised controlled trial. Lancet 2017; 389: 255–265.
    OpenUrlCrossRefPubMed
  7. ↵
    1. Reck M,
    2. Luft A,
    3. Szczesna A, et al.
    Phase III randomized trial of ipilimumab plus etoposide and platinum versus placebo plus etoposide and platinum in extensive-stage small-cell lung cancer. J Clin Oncol 2016; 34: 3740–3748.
    OpenUrl
  8. ↵
    1. Lynch TJ,
    2. Bell DW,
    3. Sordella R, et al.
    Activating mutations in the epidermal growth factor receptor underlying responsiveness of non-small-cell lung cancer to gefitinib. N Engl J Med 2004; 350: 2129–2139.
    OpenUrlCrossRefPubMed
  9. ↵
    1. Hirsch FR,
    2. Scagliotti GV,
    3. Mulshine JL, et al.
    Lung cancer: current therapies and new targeted treatments. Lancet 2017; 389: 299–311.
    OpenUrl
  10. ↵
    1. Turner EH,
    2. Matthews AM,
    3. Linardatos E, et al.
    Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008; 358: 252–260.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top
Vol 4 Issue 3 Table of Contents
ERJ Open Research: 4 (3)
  • Table of Contents
  • Index by author
Email

Thank you for your interest in spreading the word on European Respiratory Society .

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
New drugs in thoracic oncology: needs and knowledge – an online ERS Lung Cancer Assembly survey
(Your Name) has sent you a message from European Respiratory Society
(Your Name) thought you would like to see the European Respiratory Society web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Print
Citation Tools
New drugs in thoracic oncology: needs and knowledge – an online ERS Lung Cancer Assembly survey
Thierry Berghmans, Matthew Evison, Torsten Gerriet Blum, Nir Peled, Jacques Cadranel
ERJ Open Research Jul 2018, 4 (3) 00040-2018; DOI: 10.1183/23120541.00040-2018

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
New drugs in thoracic oncology: needs and knowledge – an online ERS Lung Cancer Assembly survey
Thierry Berghmans, Matthew Evison, Torsten Gerriet Blum, Nir Peled, Jacques Cadranel
ERJ Open Research Jul 2018, 4 (3) 00040-2018; DOI: 10.1183/23120541.00040-2018
del.icio.us logo Digg logo Reddit logo Technorati logo Twitter logo CiteULike logo Connotea logo Facebook logo Google logo Mendeley logo
Full Text (PDF)

Jump To

  • Article
    • Abstract
    • Abstract
    • Introduction
    • Methodology
    • Results
    • Discussion
    • Footnotes
    • References
  • Figures & Data
  • Info & Metrics
  • PDF

Subjects

  • Lung cancer
  • Tweet Widget
  • Facebook Like
  • Google Plus One

More in this TOC Section

Original articles

  • Endobronchial autologous BM-MSCs in IPF patients
  • Effect of β-blockers on the risk of COPD exacerbations
  • Recurrence of symptoms after childhood LRTI
Show more Original articles

Lung cancer

  • Gene expression profile of EMT in tumours of NSCLC patients
  • CT on lung cancer screening
  • Exosomes from EGFR-mutated adenocarcinoma induce a partial/hybrid EMT
Show more Lung cancer

Related Articles

Navigate

  • Home
  • Current issue
  • Archive

About ERJ Open Research

  • Editorial board
  • Journal information
  • Press
  • Permissions and reprints
  • Advertising

The European Respiratory Society

  • Society home
  • myERS
  • Privacy policy
  • Accessibility

ERS publications

  • European Respiratory Journal
  • ERJ Open Research
  • European Respiratory Review
  • Breathe
  • ERS books online
  • ERS Bookshop

Help

  • Feedback

For authors

  • Instructions for authors
  • Publication ethics and malpractice
  • Submit a manuscript

For readers

  • Alerts
  • Subjects
  • RSS

Subscriptions

  • Accessing the ERS publications

Contact us

European Respiratory Society
442 Glossop Road
Sheffield S10 2PX
United Kingdom
Tel: +44 114 2672860
Email: journals@ersnet.org

ISSN

Online ISSN: 2312-0541

Copyright © 2023 by the European Respiratory Society