RÉSUMÉ
Non-small cell lung cancer (NSCLC) is the most common pathological type of lung cancer. The systemic antitumor therapy of advanced NSCLC has undergone renovations of chemotherapy, targeted therapy and immunotherapy, which results in greatly improved survival for patients with advanced NSCLC. Immune checkpoint inhibitors (ICIs), especially targeting programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1), has changed the treatment paradigm of NSCLC. ICIs have become the standard treatment for advanced NSCLC without epidermal growth factor receptor(EGFR) mutation or anaplastic lymphomakinase(ALK) translocation in the first- or second-line setting, and for locally advanced NSCLC following concurrent radiotherapy and chemotherapy. ICIs are also promising in adjuvant/neoadjuvant therapy. More and more ICIs have been approved domestically for the treatment of NSCLC. Led by the NSCLC expert committee of Chinese Society of Clinical Oncology (CSCO), this consensus was developed and updated based on thoroughly reviewing domestic and foreign literatures, clinical trial data, systematic reviews, experts' discussion and the consensus(2019 version). This consensus will aid domestic clinicians in the treatment of NSCLC with ICIs. .
RÉSUMÉ
Non-small cell lung cancer (NSCLC) is the most common pathological type of lung cancer, most NSCLC patients are at advanced stage at the time of diagnosis. For patients without sensitive driven-oncogene mutations, chemotherapy is still the main treatment at present, the overall prognosis is poor. Improving outcomes and obtaining long-term survival are the most urgent needs of patients with advanced NSCLC. In recent years, immunotherapy has developed rapidly. Immune checkpoint inhibitors (ICIs), especially targeting programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1), have made a breakthrough in the treatment of NSCLC, beneficial to patients' survival and changed the treatment pattern for NSCLC. It shows more and more important role in the treatment of NSCLC. Led by NSCLC expert committee of Chinese society of clinical oncology (CSCO), relevant experts in this field were organized. On the basis of referring to domestic and foreign literature, systematically evaluating the results of Chinese and foreign clinical trials, and combining the experiences of the experts, the experts group reached an agreement to develop this consensus. It will guide domestic counterparts for better application of ICIs to treat NSCLC.
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EGFR tyrosine kinase inhibitors (TKIs) treatment has been established as standard therapy for EGFR-mutated adenocarcinomas. In the studies which published prospective randomized trials comparing EGFR TKIs with chemotherapy, a very low percentage of EGFR-mutated non-adenocarcinomas was enrolled in clinical trials. The efficacy of TKIs treatment for EGFR-mutated non-adenocarcinomas and their relationship with clinicopathological characteristics remain debatable. The results of retrospective studies show that the frequency of EGFR mutation is lower in non-adenocarcinoma than that of adenocarcinoma and efficacy of TKIs treatment for non-adenocarcinoma is inferior to adenocarcinoma. Smoking status is significantly associated with the efficacy of TKIs treatment for EGFR-mutated non-adenocarcinomas. The EGFR mutation rate and efficacy of TKIs treatment in adenosquamous cell carcinoma are higher than those of squamous cell carcinoma or large cell lung carcinoma. It may be concluded that the incidence of EGFR mutations in patients with non-adenocarcinoma NSCLC from mainland China is not very low and it is reasonable that EGFR TKIs could be an option for the treatment of EGFR-mutated non-adenocarcinoma NSCLC, especially for patients with adenosquamous histology and non-smokers. It is necessary to conduct a large-sample prospective study to understand the clinicopathological characteristics of non-adenocarcinomas and to evaluate the efficacy of EGFR TKI treatment or/and chemotherapy for EGFR-mutated non-adenocarcinoma NSCLC.
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The combination of chemotherapy with anti-epidermal growth factor receptor antibodies such as cetuximab and panitumumab which prolong the survival time in the past few years have been widely adopted for the treatment of metastatic colorectal cancer.However,a large number of patients develop resistance to these agents,while there is no standard treatment after acquired resistance yet.Therefore,finding out the mechanisms of acquired drug resistance and putting forward reasonable methods to overcome the acquired resistance will be improve its curative effect.
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Circulating endothelial cells (CEC) are endothelial cells which are detected in the peripheral blood. There are very few CEC in healthy adults while the number is obviously increasing in patients with arthrosclerosis, diabetes mellitus, lupus erythematosus, et al. Nowadays, flow cytometry analysis and immunomagnetic isolation for CEC are employed successfully in clinic and scientific research. Several research findings have confirmed that there is intimate relation between CEC and tumorigenesis. Because of the important role in angiogenesis and tumor growth, CEC would be a perspective tumor marker in antiangiogenesis and would also predict the chemotherapy efficacy.
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Objective To explore the relationship between DNA repair gene XRCC1 and XPD polymorphisms and individual susceptibility to prostate cancer. Methods PCR-restriction fragment length polymorphism assay was used to analyze the XRCC1 (C26304T and G28152A) and XPD A35931C polymorphisms in 358 prostate cancer patients and 312 healthy controls. Unconditional logistic regression analysis was performed to calculate odd ratio (OR) and 95% confidence interval (CD for estimating the correlation between different genotypes and prostate cancer risks. Results Forty-seven(13.1%) cases present XRCC1 28152AA genotype in prostate cancer group, while 24 cases in the control group (7. 1%), individuals with this genotype had a significantly increased risk for prostate cancer (OR 1. 924, 95%CI=1.126 - 3. 288, P=0. 017). There was no significant difference between two groups at XRCC1 C26304T and XPD A35931C sites. Combined analysis of the three sites polymorphisms showed that individuals with XRCC1 28152 AA and XPD 35931AC+CC genotype had a higher risk of prostate cancer than those with three wild genotypes (OR = 3. 087,95%CI 1. 081 - 8.813;OR = 3. 376,95%CI 1.067-10.683;OR 3. 216,95%CI=1. 439-7.188,P = 0. 004). Analysis stratified by age of onset, PSA, Gleason score and T stage revealed that XRCC1 28152AA and XPD 35931 AC+CC high-risk genotype was especially associated with early age at onset of prostate cancer (P<0. 05). Conclusions The XRCC1 and XPD genotypes may be contributed to the risk of developing prostate cancer, particularly for younger patients.
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<p><b>BACKGROUND</b>To evaluate the results of combined chemotherapy with paclitaxel (PTX, taxol) plus cisplatin (DDP) in the treatment of advanced non small cell lung cancer (NSCLC).</p><p><b>METHODS</b>From January 1997 to December 2002, forty-seven patients with advanced non-small cell lung cancer received PTX 135-180 mg/m² by intravenous infusion, on day 1, and DDP 40 mg/time by intravenous infusion,on days 1-3. The treatment was repeated every 3 weeks, up to 2 or 3 cycles.</p><p><b>RESULTS</b>Forty-six patients were evaluable for efficacy. One patient got complete response (2.2%), and 16 got partial response (34.8%), with an overall response rate of 37.0%. The main toxicities were myelosuppression, nausea and vomiting, and other side effects were mild.</p><p><b>CONCLUSIONS</b>A high response rate can be obtained in advanced NSCLC by PTX plus DDP. PTX is a promising antitumor agent with tolerable toxicity.</p>
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Purpose:To study the expression and clinical significance of PTEN in non-small cell lung cancer. Methods:Immunohistochemical staining was used to determine the expression of PTEN in 10 cases of normal lung issues and 56 cases of non-small cell lung cancer. Results:The positive incidences of PTEN expression in NSCLC was 59% while positive expression was found in all normal lung issues. The expression of PTEN was correlated to degree of differention of cancer, lymph node metastasis and clinical stages. The PTEN negative group was seen to have the worst survival rate among all groups. Conclusions:The results suggest that PTEN gene plays an important role in carcinogenesis and progress of NSCLC. Expression of PTEN may be valuable in prognosis assessment of NSCLC.