Safety and effectiveness of CIMAvax-EGF administered in community polyclinics

In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated...

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Published in:	Frontiers in oncology Vol. 13; p. 1287902
Main Authors:	Ortiz Carrodeguas, Ramón A, Lorenzo Monteagudo, Geidy, Guerra Chaviano, Pedro P, Álvarez Montané, Irene, Salomón Saldívar, Eva E, Lobaina Lambert, Leonardo, Camacho Sosa, Kirenia, Bermúdez Pino, Raúl, Blanco Mustelier, Poncio, Valdés Rodríguez, Elba, González Piloto, Shairis, Guerra de la Vega, Arelys, Valdés Sánchez, Lizet, Montes De Santis, Arasay, Parra Zabala, Jenelly, Viada González, Carmen, Calvo Aguilera, Nadia, Saavedra Hernández, Danay, Santos Morales, Orestes, Crombet Ramos, Tania
Format:	Journal Article
Language:	English
Published:	Switzerland Frontiers Media S.A 18-01-2024
Subjects:	CIMAvax-EGF community polyclinics NSCLC Oncology primary health care institutions realworld-data (RWD) CIMAvax-EGF realworld-data (RWD) NSCLC primary health care institutions community polyclinics
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Abstract	In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients' burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition. https://rpcec.sld.cu/trials/RPCEC00000205-En, identifier RPCEC00000205.
AbstractList	In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients’ burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition. In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients' burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition.In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients' burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition.https://rpcec.sld.cu/trials/RPCEC00000205-En, identifier RPCEC00000205.Clinical trial registrationhttps://rpcec.sld.cu/trials/RPCEC00000205-En, identifier RPCEC00000205. In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients' burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition. https://rpcec.sld.cu/trials/RPCEC00000205-En, identifier RPCEC00000205. In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients’ burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition.Clinical trial registrationhttps://rpcec.sld.cu/trials/RPCEC00000205-En, identifier RPCEC00000205. In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth factor receptor is an established target for non-small cell lung cancer (NSCLC), and its overactivation by the ligands can induce accelerated proliferation, angiogenesis, and metastasis as well as proinflammatory or immunosuppressive signals. CIMAvax-EGF is an epidermal growth factor (EGF)-depleting immunotherapy that is approved for the treatment of NSCLC patients in Cuba. The study was designed as a phase IV trial to characterize the safety and effectiveness of CIMAvax-EGF in advanced NSCLC patients treated in 119 community polyclinics and 24 hospitals. CIMAvax-EGF treatment consisted of four bi-weekly doses followed by monthly boosters. Overall, 741 NSCLC patients ineligible for further cancer-specific treatment were enrolled. CIMAvax-EGF was safe, and the most common adverse events consisted of mild-to-moderate injection site reactions, fever, chills, tremors, and headache. For patients completing the loading doses, the median survival was 9.9 months. For individuals achieving at least stable disease to the frontline and completing vaccination induction, the median survival was 12 months. Most of the functional activities and symptoms evaluated through the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire improved over time. In conclusion, this real-world trial demonstrated that CIMAvax-EGF was safe and effective in patients who were vaccinated in the maintenance scenario. A larger effect was seen in subjects with poor prognosis like those with squamous tumors and high EGF levels. Remarkably, this community-based intervention was very important because it demonstrated the feasibility of treating advanced lung cancer patients with active immunotherapy in primary care institutions. In addition to CIMAvax-EGF, patients received supportive care at the community clinic. Vaccine administration by the family doctors at the polyclinics reduced the patients’ burden on the medical oncology services that continued providing chemotherapy and other complex therapies. We conclude that community polyclinics constitute the optimal scenario for administering those cancer vaccines that are safe and require prolonged maintenance in patients with advanced cancer, despite the continuous deterioration of their general condition. Clinical trial registration https://rpcec.sld.cu/trials/RPCEC00000205-En , identifier RPCEC00000205.
Author	Camacho Sosa, Kirenia Crombet Ramos, Tania Álvarez Montané, Irene Parra Zabala, Jenelly Lobaina Lambert, Leonardo Ortiz Carrodeguas, Ramón A González Piloto, Shairis Viada González, Carmen Calvo Aguilera, Nadia Montes De Santis, Arasay Santos Morales, Orestes Lorenzo Monteagudo, Geidy Valdés Rodríguez, Elba Blanco Mustelier, Poncio Saavedra Hernández, Danay Salomón Saldívar, Eva E Valdés Sánchez, Lizet Guerra de la Vega, Arelys Guerra Chaviano, Pedro P Bermúdez Pino, Raúl
AuthorAffiliation	7 “Faustino Pérez” Hospital, Medical Oncology Department , Matanzas , Cuba 10 “Octavio de la Concepción y la Pedraja” Polyclinic, Family Medicine Department. Santa Clara , Villa Clara , Cuba 1 “Celestino Hernández Robau” Hospital, Medical Oncology Department. Santa Clara , Villa Clara , Cuba 8 “Mario Gutiérrez Ardaya” Polyclinic, Family Medicine Department , Holguín , Cuba 9 “José Luis Dubrocq” Polyclinic, Family Medicine Department , Matanzas , Cuba 6 “Saturnino Lora” Hospital, Medical Oncology Department , Santiago de Cuba , Cuba 11 “Camilo Cienfuegos” Polyclinic, Family Medicine Department , Artemisa , Cuba 2 Center of Molecular Immunology, Clinical Research Direction , Havana , Cuba 5 “Joaquín Albarrán” Hospital, Medical Oncology Department , Havana , Cuba 12 “Previsora” Polyclinic, Family Medicine Department , Camagüey , Cuba 3 National Coordinating Center for Clinical Trials, Clinical Research Department , Havana , Cuba 4 “María Curie” Hospital, Medical Oncology Department , Camagüey , Cuba
AuthorAffiliation_xml	– name: 12 “Previsora” Polyclinic, Family Medicine Department , Camagüey , Cuba – name: 5 “Joaquín Albarrán” Hospital, Medical Oncology Department , Havana , Cuba – name: 1 “Celestino Hernández Robau” Hospital, Medical Oncology Department. Santa Clara , Villa Clara , Cuba – name: 6 “Saturnino Lora” Hospital, Medical Oncology Department , Santiago de Cuba , Cuba – name: 9 “José Luis Dubrocq” Polyclinic, Family Medicine Department , Matanzas , Cuba – name: 3 National Coordinating Center for Clinical Trials, Clinical Research Department , Havana , Cuba – name: 7 “Faustino Pérez” Hospital, Medical Oncology Department , Matanzas , Cuba – name: 10 “Octavio de la Concepción y la Pedraja” Polyclinic, Family Medicine Department. Santa Clara , Villa Clara , Cuba – name: 2 Center of Molecular Immunology, Clinical Research Direction , Havana , Cuba – name: 4 “María Curie” Hospital, Medical Oncology Department , Camagüey , Cuba – name: 8 “Mario Gutiérrez Ardaya” Polyclinic, Family Medicine Department , Holguín , Cuba – name: 11 “Camilo Cienfuegos” Polyclinic, Family Medicine Department , Artemisa , Cuba
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/38304035$$D View this record in MEDLINE/PubMed
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Copyright	Copyright © 2024 Ortiz Carrodeguas, Lorenzo Monteagudo, Guerra Chaviano, Álvarez Montané, Salomón Saldívar, Lobaina Lambert, Camacho Sosa, Bermúdez Pino, Blanco Mustelier, Valdés Rodríguez, González Piloto, Guerra de la Vega, Valdés Sánchez, Montes De Santis, Parra Zabala, Viada González, Calvo Aguilera, Saavedra Hernández, Santos Morales and Crombet Ramos. Copyright © 2024 Ortiz Carrodeguas, Lorenzo Monteagudo, Guerra Chaviano, Álvarez Montané, Salomón Saldívar, Lobaina Lambert, Camacho Sosa, Bermúdez Pino, Blanco Mustelier, Valdés Rodríguez, González Piloto, Guerra de la Vega, Valdés Sánchez, Montes De Santis, Parra Zabala, Viada González, Calvo Aguilera, Saavedra Hernández, Santos Morales and Crombet Ramos 2024 Ortiz Carrodeguas, Lorenzo Monteagudo, Guerra Chaviano, Álvarez Montané, Salomón Saldívar, Lobaina Lambert, Camacho Sosa, Bermúdez Pino, Blanco Mustelier, Valdés Rodríguez, González Piloto, Guerra de la Vega, Valdés Sánchez, Montes De Santis, Parra Zabala, Viada González, Calvo Aguilera, Saavedra Hernández, Santos Morales and Crombet Ramos
Copyright_xml	– notice: Copyright © 2024 Ortiz Carrodeguas, Lorenzo Monteagudo, Guerra Chaviano, Álvarez Montané, Salomón Saldívar, Lobaina Lambert, Camacho Sosa, Bermúdez Pino, Blanco Mustelier, Valdés Rodríguez, González Piloto, Guerra de la Vega, Valdés Sánchez, Montes De Santis, Parra Zabala, Viada González, Calvo Aguilera, Saavedra Hernández, Santos Morales and Crombet Ramos. – notice: Copyright © 2024 Ortiz Carrodeguas, Lorenzo Monteagudo, Guerra Chaviano, Álvarez Montané, Salomón Saldívar, Lobaina Lambert, Camacho Sosa, Bermúdez Pino, Blanco Mustelier, Valdés Rodríguez, González Piloto, Guerra de la Vega, Valdés Sánchez, Montes De Santis, Parra Zabala, Viada González, Calvo Aguilera, Saavedra Hernández, Santos Morales and Crombet Ramos 2024 Ortiz Carrodeguas, Lorenzo Monteagudo, Guerra Chaviano, Álvarez Montané, Salomón Saldívar, Lobaina Lambert, Camacho Sosa, Bermúdez Pino, Blanco Mustelier, Valdés Rodríguez, González Piloto, Guerra de la Vega, Valdés Sánchez, Montes De Santis, Parra Zabala, Viada González, Calvo Aguilera, Saavedra Hernández, Santos Morales and Crombet Ramos
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Keywords	CIMAvax-EGF realworld-data (RWD) NSCLC primary health care institutions community polyclinics
Language	English
License	Copyright © 2024 Ortiz Carrodeguas, Lorenzo Monteagudo, Guerra Chaviano, Álvarez Montané, Salomón Saldívar, Lobaina Lambert, Camacho Sosa, Bermúdez Pino, Blanco Mustelier, Valdés Rodríguez, González Piloto, Guerra de la Vega, Valdés Sánchez, Montes De Santis, Parra Zabala, Viada González, Calvo Aguilera, Saavedra Hernández, Santos Morales and Crombet Ramos. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Reviewed by: Paul Zarogoulidis, Euromedica General Clinic, Greece These authors have contributed equally to this work and share first authorship Rocio Fuentes Mateos, University of Groningen, Netherlands ORCID: Tania Crombet Ramos, orcid.org/0000-0002-2550-7292 Edited by: Xinhui Wu, University of Groningen, Netherlands
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References	Herbst (B9) 2004; 59 Evans (B26) 2022; 12 Wang (B40) 2020; 146 Miller (B2) 2022; 72 Sorich (B36) 2015; 26 Martinelli (B35) 2020; 31 Castells Martínez (B20) 2017; 38 Popa (B34) 2020; 9 Crombet Ramos (B42) 2021; 11 Kawase (B41) 2011; 42 Neninger Vinageras (B17) 2008; 26 Koller (B43) 2015; 121 Gonzalez (B12) 1998; 9 Fidias (B37) 2009; 27 Yewale (B10) 2013; 34 Holm (B21) 2013 Gonzalez (B15) 2011; 11 Cappuzzo (B39) 2010; 11 Gonzalez (B16) 2007; 3 Scott (B27) 2008 Dancey (B44) 2004; 43 Sung (B1) 2021; 71 Suresh (B31) 2018; 154 Midha (B8) 2015; 5 Pujol (B29) 2007; 2 Caras (B33) 2004; 53 Datta (B19) 2019; 13 Onoi (B5) 2020; 9 Osuna (B22) 2016; 42 Ascarateil (B13) 2015; 2 Fayers (B28) 2002; 38 Dumoulin (B30) 2020; 15 Rohilla (B4) 2023; 42 Ciuleanu (B38) 2009; 374 Garcia (B14) 2008; 14 Osoba (B23) 1999; 83 Neninger (B25) 2009; 32 Flores Vega (B24) 2023; 14 Crombet-Ramos (B11) 2015; 14 Alduais (B3) 2023; 102 Rodriguez (B18) 2016; 22 Sheikine (B7) 2016; 17 Shao (B32) 2020; 40 Mencoboni (B6) 2021; 13
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Snippet	In spite of the advances in immunotherapy and targeted therapies, lung cancer continues to be the leading cause of cancer-related death. The epidermal growth...
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