Release date: 2017-11-10

01 Surgical Research: China's lung cancer surgery discussion hotspot

The hot topics of lung cancer surgery in China mainly include three aspects: 1 comparison of single-hole or multi-hole thoracoscopic surgery; 2 lung cancer lung segment and lobectomy; 3 Da Vinci robot-assisted lung cancer surgery.

Among them, there has been no convincing study of single-hole or multi-hole thoracoscopic comparisons in the past year.

In the lung cancer segment and lobectomy, at this year's IASLC WCLC annual meeting in Japan, the prospective study led by Prof. Hisao Asamura, Professor of the current session, "Lobectomy versus Segmentectomy/Wedge Resection for Lung Cancer" reported the lung segment. The indications and techniques of resection were compared and the effects of differences in surgeon segmental resection techniques on patient outcomes were compared. The final results of the study will be announced in 2020. In the conference, Professor Asamura pointed out that the standard model for radical surgery for lung cancer should now be: 1 at least lobectomy; 2 thoracoscopic or thoracoscopic hilar and mediastinal lymph node surgery (LNS) / lymph node dissection (LND); Compared with lobectomy: the right upper lung and the bilateral lower lung showed a statistically significant (P = 0.001) high recurrence rate, but only in the left upper lung, there is no difference, so the current feasible lung segment Excision can be used for patients with poor lung function reserve, non-invasive lung cancer (GGO-AIS, MIA), and in other cases, it is recommended that lobectomy be preferred.

In the Da Vinci robot-assisted lung cancer surgery, a meta-analysis of the first hospital affiliated to Guangzhou Medical University, “Robotic Versus Video-assisted Lobectomy/Segmentectomy for Lung Cancer”, suggested that robot-assisted complete resection of lung cancer is safe and feasible, robots and The perioperative clinical data of thoracoscopic surgery is similar and can replace laparoscopic surgery, although there is no long-term survival data; in addition, it is unclear whether the robot has advantages in cost-effectiveness.

summary

We should pay special attention to:

The size of the wound - related to the speed of recovery, quality of life;

Surgical quality control - technology should be subordinate to survival, and some techniques should be selective (such as single-hole chest cavity, etc.);

At present, lung cancer surgery is still: complete lobectomy (minimally invasive and thoracotomy), and constantly improve survival

02 Assisted targeted therapy after EGFR mutation-positive NSCLC

In 2017, two studies on adjuvant targeted therapy for EGFR mutation-positive NSCLC in China are worthy of attention: 1 adjuvant treatment of gefitinib versus vinorelbine/cisplatin (NP) regimen in patients with stage II~IIIA; Phase IIIA patients with erlotinib versus NP regimen adjuvant therapy study. The first study reported the main results at this year's ASCO meeting (click to read the study details), and the second was an oral report on the just-concluded IASLC WCLC (click to read the study details). These two studies provide a new option for adjuvant therapy in patients with stage IIIA EGFR mutation-positive NSCLC.

summary

These two studies have cutting-edge design ideas and both reach the primary end point:

1) Gefitinib was superior to VP, with statistical significance. The median DFS was 28.7 months vs 18.0 months (HR=0.60, P=0.005); the 3-year DFS rate was 34% vs. 27%;

2) Compared with adjuvant chemotherapy, erlotinib is more effective, HR is 0.268, P<0.001), median DFS is 42.41 months vs. 20.96 months (HR 0.60, P=0.001), and 2-year DFS rates are 81.35% and 44.62%; the 3-year DFS rates were 54.24% and 19.83%, respectively.

In terms of safety, the results of the two studies are basically consistent with previous reports, and the treatment is safe and tolerable.

Both studies suggest that postoperative adjuvant targeted therapy is safe, effective, and feasible, and will soon change clinical practice.

03 Targeted Therapy Research

In the past year, points of attention in targeted therapy include: 1 Final data on OS benefit in patients with ALK-positive advanced NSCLC (Tony Mok, ASCO LBA50 study), showing sequential ALK TKI after disease progression Survival benefits:

From these research data, we can find that the current research direction is correct. It is not an illusion to cure advanced lung cancer. The accurate interpretation of these studies is that these studies involve only a small number of patients with ALK pathway, and there are too many pathways such as EGFR. Work needs to continue; the treatment of patients without any gene activating mutations remains difficult; for early stage lung cancer carrying gene-activating mutations, it is not appropriate to target therapy, but surgery or radiotherapy + post-progressive targeted therapy.

2 First-line treatment new family added second-generation TKI dacomitinib (ARCHER 1050): ARCHER 1050 study (click to read the study details) compared the second-generation EGFR-TKI drug Dacomitinib with the first-generation drug gefitinib, the results suggest that dacomitinib can be used as EGFR mutation A new option for first-line treatment in patients with advanced NSCLC, but it is worth noting that dose adjustments in the study are more common in dacomitinib (66.0%). Does this affect clinical use? Also need clinical testing!

3 Three generations of EGFR-TKI showed efficacy in the treatment of brain metastases: approximately 40% of patients with EGFR mutation-positive NSCLC develop CNS metastasis during the course of the disease; whereas after brain metastasis (BM), the prognosis is poor, with a median PFS of approximately 3~6 months; At present, the preferred treatment for CNS transfer is usually radiotherapy, but the optimal radiation therapy mode is still unclear. The results of the BRAIN study and the AURA3 study (click to read the study details) suggest that: 1 For patients with T790M(+) advanced NSCL after EGFR-TKI therapy progression, octatinib is a new clinical option; 2 for late EGFR(+) For the first-line treatment of NSCLC, ectinib and erlotinib are also possible choices.

4 EGFR-TKI treatment progress prediction further: a study reported by the Chinese Academy of Medical Sciences Cancer Hospital in WCLC - micro-drip digital PCR (ddPCR) detection of plasma ctDNA EGFR mutation patients receiving gefitinib as a first-line treatment study BENEFIT Study (CTONG1405), as the first prospective clinical study, further clarifies the efficacy of gefitinib in the first line guided by ctDNA EGFR mutation, and explores the dynamic changes of molecular markers such as EGFR mutations, in order to accurately predict EGFR TKI The efficacy has laid the foundation.

5 Oxitinib related resistance mechanism research: Previous literature suggests that EGFR C797S/G mutation is the main resistance mechanism of octatinib, but other resistance mechanisms remain unclear. Recently, a study by Shanghai Pulmonary Hospital explored the new drug resistance mechanism of three generations of TKI Oxitinib in NSCLC patients by NGS (below), and found that 29% of Oxitinib resistance in the study In patients with EGFR secondary processes including C797, L792 or L718; in vitro data indicate that in addition to the notable C797S mutation, the L792 and L718 mutations represent other resistance mechanisms of Oxitinib; in addition, in EGFR C797-, In L792- and L718-wild-type patients, increased MET and KRAS copy number may be used as a mechanism of bypass resistance.

6 Inhibition of bypass activation of drug resistance: EGFR-activated mutant NSCLC patients initially respond to EGFR-TKI, but usually develop resistance after about 1 year, of which 50% to 60% of drug resistance is associated with T790M secondary mutation. Approximately 20% is associated with C-MET gene amplification, while others are associated with c-Met receptor overexpression. In cases where abnormal c-Met activity leads to acquired resistance to EGFR TKI, the addition of C-Met inhibitors may restore tumor sensitivity to EGFR TKI. In 2017, the results of the Phase Ib study on the highly selective c-MetTKI drug tepotinib (MSC2156119J) suggest that patients with advanced NSCLC who have progressed with gefitinib monotherapy, regardless of whether they receive TKI before receiving tepotinib For treatment, tepotinib combined with gefitinib exhibited activity; moreover, tepotinib tended to exert maximum activity in c-Met IHC 3+ and/or MET ISH positive tumors.

04 Immunotherapy research

Immunotherapy has prospered in recent years, especially among the immune checkpoint inhibitors (PD-1/PD-L1 monoclonal antibody), which have been continuously gaining research. At present, there are 371 studies on PD-1/PD-L1 monoclonal antibody in the world (129 for nivolumab and pembrolizumab, 53 for durvalumab, 50 for atezolizumab, and 10 for avelumab), while there are 21 studies in China. There were 7 nivolumab studies, 6 atezolizumab studies, 4 durvalumab studies and pembrolizumab studies.

Currently, the status of PD-1/PD-L1 inhibitors approved by the US FDA in lung cancer is:

1 nivolumab: 2015-3-4, second-line treatment of advanced squamous cell carcinoma (NSCLC); 2015-10-9, second-line treatment of advanced adenocarcinoma (NSCLC); NCCN guidelines recommend combined with ipilimumab for SCLC second-line treatment;

2 pembrolizumab: 2015-10-2, second-line treatment of advanced NSCLC (PD-L1 positive); 2016-10-24, first-line treatment of advanced NSCLC (PD-L1 ≥ 50%); 2017-5-10, combined with pemetrexed + Carboplatin first-line treatment of advanced non-squamous NSCLC;

3 atezolizumab: 2016-10-18, second-line treatment of advanced NSCLC;

4 durvalumab: 2017-9-9, ESMO meeting reported that the PACIFIC study suggested that for stage III NSCLC, after concurrent chemoradiotherapy, durvalumab maintenance therapy was three times longer than PFS (16.8 months vs. 5.6 months, P< 0.0001).

The PD-1/PD-L1 inhibitors currently being developed in China and the ongoing research on PD-1 monoclonal antibody lung cancer are summarized as follows:

Precautions

To carry out lung cancer PD-1/PD-L1 inhibitors in China, consider:

Race: effects on the pharmacokinetics of PD-1/PD-L1 inhibitors, side effects on PD-1/PD-L1 inhibitors

High mutation of EGFR gene in Chinese lung cancer patients

The prevalence of hepatitis in China (greater than 8%)

Chinese patient's weight

In summary, we need to consider the appropriate dose, side effects and superior population of Chinese patients.

(Note: The above content was compiled by Ye Yichu according to Professor Wang Changli of Tianjin Medical University Cancer Hospital at the 15th National Lung Cancer Conference. The picture in the text is from Professor Wang Changli's live PPT photo)

Source: China Medical Tribune Today Tumor (Micro Signal CMToncology)

VITAMINS & AMINO ACID

Our company is mainly engaged in the production of NATURAL PLANT EXTRACT raw materials, and is a famous supplier of plant extract raw materials in China.
Vitamin is a kind of trace organic substance that people and animals must obtain from food in order to maintain normal physiological functions. It plays an important role in human growth, metabolism and development. Vitamins in the body neither participate in the formation of human cells, nor provide energy for the human body.
Amino acids are organic compounds containing basic amino and acid carboxyl groups. A compound formed when the hydrogen atom on the carbon atom of a carboxylic acid is replaced by an amino group.
The following are the main recommended vitamin and Amino Acid raw materials.

Vitamin, amino acid, vitamin B1, vitamin B2, hydroxy acid, glutamine

Shaanxi Kepler Biotech Co.,Ltd , https://www.keplerherb.com