Befotertinib (D-0316) versus icotinib as first-line therapy for patients with EGFR-mutated locally advanced or metastatic non-small-cell lung cancer: a multicentre, open-label, randomised phase 3 study.

BACKGROUND: Befotertinib (D-0316) is a novel, selective oral third-generation epidermal growth factor receptor (EGFR) tyrosine-kinase inhibitor. This phase 3 trial compared the efficacy and safety of befotertinib with icotinib as a first-line treatment for patients with EGFR mutation-positive locally advanced or metastatic non-small-cell lung cancer (NSCLC). METHODS: This study was a multicentre, open-label, randomised, controlled phase 3 study at 39 hospitals in China. Eligible patients were 18 years of age or older, had histologically confirmed locally advanced or metastatic stage IIIB, IIIC, or IV unresectable NSCLC, and had confirmed exon 19 deletions or exon 21 Leu858Arg mutation. Patients were randomly assigned (1:1) via an interactive web response system to receive either oral befotertinib (75-100 mg once daily) or oral icotinib (125 mg three times per day) in 21-day cycles until disease progression or withdrawal criteria were met. Randomisation was stratified by type of EGFR mutation, CNS metastasis status, and gender, and participants, investigators, and data analysts were not masked to treatment allocation. The primary endpoint was independent review committee (IRC)-assessed progression-free survival in the full analysis set, which comprised all randomly assigned patients. All patients who received at least one dose of the study drug were included in safety analyses. This study was registered with ClinicalTrials.gov, NCT04206072, and the overall survival follow-up is still in progress. FINDINGS: Between Dec 24, 2019, and Dec 18, 2020, 568 patients were screened, of whom 362 were randomly assigned to the befotertinib (n=182) or icotinib (n=180) group; all 362 patients were included in the full analysis set. Median follow-up was 20·7 months (IQR 10·2-23·5) in the befotertinib group and 19·4 months (10·3-23·5) in the icotinib group. Median IRC-assessed progression-free survival was 22·1 months (95% CI 17·9-not estimable) in the befotertinib group and 13·8 months (12·4-15·2) in the icotinib group (hazard ratio 0·49 [95% CI 0·36-0·68], p<0·0001). Grade 3 or higher treatment-related adverse events occurred in 55 (30%) of 182 patients in the befotertinib group and in 14 (8%) of 180 patients in the icotinib group. Treatment-related serious adverse events were reported in 37 (20%) patients in the befotertinib group and in five (3%) patients in the icotinib group. Two (1%) patients in the befotertinib group and one (1%) patient in the icotinib group died due to treatment-related adverse events. INTERPRETATION: Befotertinib demonstrated superior efficacy compared with icotinib in first-line treatment for patients with EGFR mutation-positive NSCLC. Although serious adverse events were more common in the befotertinib than the icotinib arm, the safety profile of befotertinib was manageable overall. FUNDING: Betta Pharmaceuticals (China). TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Mitoxantrone hydrochloride injection for tracing helps to decrease parathyroid gland resection and increase lymph node yield in thyroid cancer surgery: a randomized clinical trial.

The identification and preservation of parathyroid glands (PGs) during thyroid surgery can be challenging. Many techniques have been developed to help surgeons find PGs. We have developed a novel mitoxantrone hydrochloride injection that can be used for lymphatic targeting. After local application during surgery, mitoxantrone hydrochloride injection for tracing (MHI) helps surgeons better identify and preserve PGs and helps pathologists find more lymph nodes. We conducted an open-label, multicenter, randomized clinical trial (CTR20171137) in six centers in China from 08/2017 to 12/2018. Patients with thyroid carcinoma were randomized to the MHI group or the control group. All patients received total thyroidectomy and bilateral central compartment lymph node dissection. The primary outcomes were the PG resection rate and lymph node staining rate. The full analysis set (FAS) included 461 patients, of which 228 were assigned to the MHI group, and 233 were assigned to the control group. The PG resection rates of the MHI group and the control group were 6.6% (15/228) and 26.6% (62/233), respectively, with a significant difference (P < 0.001). No PGs were stained blue with MHI. The central lymph nodes were stained blue with MHI, and the staining rate was 90.5%±12.0%. More lymph nodes were detected in the MHI group than in the control group (13.0±7.3 vs. 10.1±6.4 nodes/patient, P < 0.001). No adverse events related to MHI were observed. MHI is a safe and effective tracer that may help to preserve PGs and identify more central lymph nodes in patients with thyroid cancer.

The efficacy of adding hyperthermia to the treatment of advanced NSCLC patients based on the states of EGFR.

BACKGROUND: The study aims to explore the efficacy of adding hyperthermia to the treatment of advanced NSCLC patients based on the states of epidermal growth factor receptor (EGFR). PATIENTS AND METHODS: We included 205 advanced NSCLC patients who were received hyperthermia plus other treatment (hyperthermia group) or non- hyperthermia and other treatments (non- hyperthermia group). The OS and progression free survival (PFS) were retrospectively estimated. Using Kaplan-Meier and the log-rank test compare the OS and PFS between the groups. RESULTS: The median follow-up was 22 months. The Univariate analysis have shown that 1-year OS and PFSfirst rates in the hyperthermia group and non- hyperthermia group were 83.3% vs 71.5% (P=0.010) and 62.0% vs 42.7% (P=0.001). The subgroup analyses revealed that patients didn't have EGFR mutant who received hyperthermia had significantly higher 1 year OS and PFSfirst rates than those treated with non- hyperthermia (OS: 79.1% vs 65.2% P=0.037, PFS: 64.2% vs 36.5%, P=0.001). For patients with EGFR mutation, there was no significant difference between the two groups. The PFSfirst in first-line and PFSpost in posterior-line was no significant difference between the groups. CONCLUSIONS: This retrospective study revealed that adding hyperthermia to the treatment of NSCLC patients without EGFR mutation had better prognosis than those who did not adding hyperthermia to the regimen. Moreover, adding hyperthermia in first-line or in posterior-line treatment was no significant difference. However, these results need more prospective studies to confirm the conclusions.

Integrated Analysis and Finding Reveal Anti-Liver Cancer Targets and Mechanisms of Pachyman (Poria cocos Polysaccharides).

This bioinformatics study aimed to characterize and certify crucial anti-cancer targets, functional processes, and molecular mechanisms of Pachyman in treating hepatocellular carcinoma (HCC) by using pharmacology network and molecular docking analyses, by experimental validation. The crucial anti-HCC targets of Pachyman, including ALB, VEGFA, TNF, CASP3, SRC, EGF, CXCR4, STAT3, HRAS, HSP90AA1, MMP9, BCL2L1, FGF2, and PTPRC, were identified. In addition, the correlative networks of all crucial biotargets of Pachyman in treating HCC were created accordingly. Functionally, these crucial genes were correlated using angiogenesis and neoplastic metastasis of HCC. Interestingly, the molecular docking findings indicated that ALB and VEGFA in HCC might be potent pharmacological targets of Pachyman. In experimental validation, the clinical samples of HCC showed reduced ALB protein expression and increased VEGFA protein level. Following Pachyman treatments in vitro, the intracellular level of ALB protein was elevated, whereas the cellular content of VEGFA protein was downregulated. Taken together, current bioinformatics findings based on pharmacology network and molecular docking analyses elucidate the detailed molecular targets and signaling mechanisms of Pachyman in treating HCC. Interestingly, validated biotargets of ALB and VEGFA may be main potential biomarkers for detecting HCC medically.

New biomarkers and therapeutic targets of human liver cancer: Transcriptomic findings.

Hepatocellular carcinoma (HCC) is one of the most common causes of cancer-related deaths worldwide, causing 782,000 deaths in 2018. Poor prognosis and lack of treatment are the reasons for the high mortality rate of HCC. In the current study, we conducted a comparative transcriptomic analysis, followed by a series of bioinformatics analyses, including Gene Ontology (GO) enrichment analysis and Ingenuity Pathway Analysis (IPA), aiming to unfold the detailed molecular mechanisms underlying the development of HCC. In the comparative transcriptomic analysis of 10 pairs of HCC tumoral tissues and adjunct nontumoral tissues, we identified 115 common differentially expressed genes in HCC. The GO enrichment analysis of these genes highlighted alterations in the immune response, cell proliferation and DNA damage, energetic metabolism, cell-matrix adhesion, and filament assembly in HCC. In addition, the canonical pathway analysis of IPA further showed the importance of many cell-signaling pathways involved in the carcinogenesis of HCC. The findings of this study provide a cluster of novel biomarkers and molecular therapeutic targets for HCC diagnosis and treatment.

A Phase III, randomized, double-blind, placebo-controlled, multicenter study of fruquintinib in Chinese patients with advanced nonsquamous non-small-cell lung cancer - The FALUCA study.

OBJECTIVES: Fruquintinib is an orally active kinase inhibitor that selectively targets the vascular endothelial growth factor (VEGF) receptor. A Phase II trial has demonstrated a significant benefit in progression-free survival (PFS) for fruquintinib-treated patients with locally advanced/metastatic nonsquamous non-small-cell lung cancer (NSCLC) who have progressed after second-line chemotherapy. This Phase III trial is a randomized, double-blind, multicenter trial to confirm fruquintinib's efficacy in the same patient population. MATERIALS AND METHODS: From December 2015 to February 2018, 730 patients were screened, of whom 527 were enrolled into the study. Participants were randomized 2:1 to receive fruquintinib (n = 354) or placebo (n = 173) once daily for 3 weeks on-treatment, and 1 week off-treatment. Patients were stratified according to epidermal growth factor receptor mutation status and prior use of VEGF inhibitors. Primary endpoint was overall survival (OS). RESULTS: Median OS was 8.9 months for the fruquintinib group and 10.4 months for placebo group (hazard ratio [HR] 1.02; 95 % confidence interval [CI], 0.82-1.28; P = 0.841), with median PFS of 3.7 months and 1.0 months, respectively (HR 0.34; 95 % CI, 0.28-0.43; P < 0.001). Objective response rate and disease control rate were 13.8 % and 66.7 % for fruquintinib, and 0.6 % and 24.9 % for placebo, respectively (P < 0.001). Hypertension was the most frequent treatment-emergent adverse event (≥grade 3) observed in fruquintinib-treated patients (21.0 %). Post hoc analysis revealed that fruquintinib prolonged the median OS for patients who did not receive subsequent antitumor therapy: 7.0 months versus 5.1 months for placebo (HR 0.65; 95 % CI, 0.46-0.91; P = 0.012). Patients receiving fruquintinib also reported improvements in quality of life for most functional scales measured by EORTC QLQ-C30 and LC13 questionnaires. CONCLUSION: Although the study did not meet its primary endpoint, fruquintinib could be effective in combination with other agents for the treatment of patients with NSCLC who have failed second-line chemotherapy.

Integrated analysis of clinical significance and functional involvement of microRNAs in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is one of the most common lethal cancers worldwide. To explore the potential prognosis-associated microRNAs (miRNAs) for HCC patients, we performed integrated analyses on the miRNA expression profiles from The Cancer Genome Atlas project. Genome-wide overall survival (OS)- and progression-free survival (PFS)-associated miRNA screening were performed by multivariate Cox proportional hazards regression analyses. A five-miRNA expression signature (miR-148a, miR-3677-3p, miR-744*, miR-210, and miR-3613-5p) was identified as an indicator for HCC OS (p < .0001; hazard ratio [HR] = 2.631). In addition, a seven-miRNA expression signature (miR-127-5p, miR-146a, miR-152, miR-193a-3p, miR-331-5p, miR-500a*, and miR-550a*) was identified as a predictor for HCC PFS (p < .0001; HR = 2.608). This systematic analysis suggested that both the OS- and PFS-associated signatures have better performance in HCC survival prediction than the conventional clinicopathological parameters. Further functional enrichment analysis of the corresponding genes targeted by these signature miRNAs revealed their biological significance in the PI3K-Akt signaling pathway. In conclusion, our present study identified a five-miRNA OS-associated signature and a seven-miRNA PFS-associated signature as HCC prognostic biomarkers with potential clinical significance, which could enable the development of novel targeted therapeutic strategies for HCC treatment.

Biological characteristics of heat shock protein 90 in human liver cancer cells.

Primary hepatic cancer refers to a malignant tumor that enables lethal cancero-metastasis. And hepatocellular carcinoma (HCC) is a most common cancer, accounting for around 75% of all cases. However, effective screening and diagnostic methods of HCC are limited currently. Heat shock protein 90 (HSP90), a sensitive biomarker, is found marked elevation in various malignancies. Thus, potential association between HSP90 expression and pathological onset of HCC is needed to be investigated. In current human study, plasma samples of advanced HCC patients were collected for biochemical assays, and cancer, non-cancer tissues from biopsy were stained immunohistochemically. In cell culture study, a human HepG2 cell line was subjected to a group of assays followed by HSP90 and inhibitor treatments. As results, the clinical data of HCC patients resulted in abnormal altered levels of serous molecules when compared to diagnostical references. However, these enzymatic changes showed no statistical significance. Significantly, plasma contents of HSP90 in HCC patients were elevated in comparison with those in HCC-free adults (P<0.01). As shown in immunofluorescence stains, hepatocellular HSP90-labeled cells in alpha fetoprotein (AFP)-positive and negative HCC sections were obviously expressed. In cell culture data, HSP90-induced HepG2 cells resulted in increased cell proliferation, and proliferating cell nuclear antigen (PCNA)-, B-cell lymphoma 2 (Bcl-2)-positive cells (P<0.05). In addition, HSP90 inhibitor-treated HepG2 cells showed effectively reduced cell growth, and PCNA-, Bcl-2-positive cell counts. Taken together, our current findings demonstrate that hepatocellular HSP90 may be positively involved in development of HCC, and it is likely a potential biomarker for monitoring advanced HCC.

miR-144-3p targets FZD4 to inhibit malignant biological behaviors of liver cancer Huh-7 cells via blocking Wnt/β-catenin pathway / 中国肿瘤生物治疗杂志

@# Objective: To investigate the effect of miR-144-3p modulating proliferation, migration and apoptosis of liver cancer Huh-7 cells through blocking frizzled class receptor 4 (FZD4)/Wnt/β-catenin pathway and the possible mechanism. Methods: A total of 18 pairs of cancer tissues and corresponding para-cancerous tissues from liver cancer patients, who underwent surgery in Workers' Hospital of Liuzhou City from March 2012 to July 2017, were collected for this study; in addition, hepatic cancer cell lines (Huh-7, SMMC7721 and MHCC97) and human normal liver epithelial cell line THLE-3 were also collected. The expression of miR-144-3p in liver cancer tissues and cell lines was detected by qPCR. MiR-144-3p mimics/inhibitor and FZD4 siRNA were transfected into liver cancer Huh-7 cells; the proliferation, migration and apoptosis of Huh-7 cells were evaluated by CCK-8 assay, Transwell assay, wound healing assay and Annexin V-FITC/PI double staining flow cytometry assay, respectively. The interaction between miR-144-3p and FZD4 was verified by dual-luciferase reporter gene assay. Results: The expression of miR-144-3p was down-regulated in liver cancer tissues and cell lines (P<0.05 or P<0.01). Over-expression of miR-144-3p significantly inhibited cell proliferation viability, migration but induced apoptosis of Huh-7 cells (all P<0.01). Moreover, dual-luciferase reporter gene assay showed that miR-144-3p directly interacted with FZD4 and suppressed its expression. Furthermore, in vitro experiments verified that miR-144-3p targeted FZD4 to suppress the proliferation, migration and promote apoptosis of Huh-7 cells via blocking Wnt/β-catenin pathway (all P<0.01). Conclusion: miR-144-3p inhibits malignant biological behaviors of liver cancer Huh-7 cells via blocking Wnt/FZD4/β-catenin signaling pathway, which may provide potential molecular targets for early diagnosis or treatment of liver cancer.

The relationship between changes of cervical sagittal alignment after anterior cervical discectomy and fusion and spino-pelvic sagittal alignment under roussouly classification: a four-year follow-up study.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is widely used in the treatment of cervical degenerative disease; however, the variation of cervical sagittal alignment changes after ACDF has been rarely explored. The purpose of this study is to determine the relationship between changes of cervical sagittal alignment after ACDF and spino-pelvic sagittal alignment under Roussouly classification. METHODS: A cohort of 133 Chinese cervical spondylotic patients who received ACDF from 2011 to 2012 was recruited. All patients were categorized with Roussouly Classification. Lateral X-ray images of global spine were obtained, and preoperative and postoperative parameters were measured and analyzed, including C2-C7 angles (C2-C7), C0-C7 angles (C0-C7), external auditory meatus (EAM) tilt, sacral slope (SS), thoracic kyphosis (TK), lumbar lordosis (LL), spinal sacral angles (SSA), Superior adjacent inter-vertebral angle (SAIV), inferior adjacent inter-vertebral angle (IAIV) and et al. The Wilcoxon signed-rank test was used for intragroup comparisons preoperatively and at postoperative 48 months. RESULTS: Among the parameters, C2-C7 and C0-C7 showed significant increase, while EAM TK, and IAIV decreased significantly. In type I, EAM and TK decreased significantly, however SS showed a significant increase; in type II, TK showed a significant decrease, but SSA showed a significant increase; in type III, a significant increase of C0-C7 was observed with a significant decrease in EAM, nevertheless, LL, SS and SSA showed significant decreases; and in type IV, C2-C7 showed a significant increase and EAM decreased significantly. The percentage of lordotic alignment in cervical spine increased, which was presenting in type I, III and IV. Nevertheless, the amount of patients with straight cervical alignment increased in type II. CONCLUSION: The backward movement of head occurs is the compensatory mechanism in cervical sagittal alignment modifications after ACDF. The compensatory alteration of spino-pelvic sagittal alignment varied in different Roussouly type.

Targeting Lung Cancer Stem Cells with Antipsychological Drug Thioridazine.

Lung cancer stem cells are a subpopulation of cells critical for lung cancer progression, metastasis, and drug resistance. Thioridazine, a classical neurological drug, has been reported with anticancer ability. However, whether thioridazine could inhibit lung cancer stem cells has never been studied. In our current work, we used different dosage of thioridazine to test its effect on lung cancer stem cells sphere formation. The response of lung cancer stem cells to chemotherapy drug with thioridazine treatment was measured. The cell cycle distribution of lung cancer stem cells after thioridazine treatment was detected. The in vivo inhibitory effect of thioridazine was also measured. We found that thioridazine could dramatically inhibit sphere formation of lung cancer stem cells. It sensitized the LCSCs to chemotherapeutic drugs 5-FU and cisplatin. Thioridazine altered the cell cycle distribution of LCSCs and decreased the proportion of G0 phase cells in lung cancer stem cells. Thioridazine inhibited lung cancer stem cells initiated tumors growth in vivo. This study showed that thioridazine could inhibit lung cancer stem cells in vitro and in vivo. It provides a potential drug for lung cancer therapy through targeting lung cancer stem cells.

Nucleotide excision repair gene polymorphisms and prognosis of non-small cell lung cancer patients receiving platinum-based chemotherapy: A meta-analysis based on 44 studies.

Genetic variations are linked to DNA repair ability and varied drug metabolism that largely affects the prognosis of antineoplastic agents, including platinum. The purpose of the present meta-analysis was to determine the roles of the genetic variants of the nucleotide excision repair genes on the prognosis of platinum-based chemotherapy in patients with non-small cell lung cancer (NSCLC). A meta-analysis was performed, including 44 original studies with a total number of 5,944 patients with NSCLC according to the search strategy. The tumor responses [complete response, partial response, stable disease (SD) and progressive disease (PD)] were estimated and the Stata package was used for the comprehensive quantitative analyses. The results showed that the XPG C46T polymorphism was significantly associated with tumor chemotherapy when SD or PD was considered as a non-response [TT vs. CC: risk ratio (RR), 1.31; 95% confidence interval (CI), 1.14-1.5; and P=0.00; TT/CT vs. CC: RR, 1.23; 95% CI, 1.11-1.36; and P=0.00; and TT vs. CC/CT: RR, 1.22; 95% CI, 1.11-1.36; and P=0.00]. No significant association between the ERCC1 C118T/C8092A XPDLys751Gln and XPA A23G polymorphisms and tumor response was found. There was also no evidence found to support the use of the ERCC1 C118T/C8092A XPDLys751Gln and XPA A23G polymorphisms as prognostic predictors of platinum-based chemotherapies in NSCLC in the meta-analysis. For the XPG C46T polymorphisms, a significant association with an objective response was detected. Multiple and large-scale studies are required to further investigate the association between biomarkers and tumor prognosis.

[Clinical observation of sarcandra glabra combined chemoradiotherapy for treating patients with local advanced nasopharyngeal carcinoma].

OBJECTIVE: To observe the short-term efficacy and radiotherapy induced acute reactions of sarcandra glabra (SG) combined chemoradiotherapy for treating patients with local advanced nasopharyngeal carcinoma. METHODS: Totally 100 nasopharyngeal carcinoma phase III - IVa patients were randomly assigned to the control group and the observation group, 50 patients in each group. All patients received chemoradiotherapy. Patients in the observation group took SG decoction at the daily dose of 20 g. RESULTS: Totally 98 patients completed the treatment. There was no statistical difference in the complete remission rate, the partial remission rate, 1-year and 2-year total survival rates, or disease free progression rate between the two groups. The occurrence rate of II - III degree radioactive oral mucositis and dry mouth were obviously lower in the observation group than in the control group, showing statistical difference (P <0.05). CONCLUSION: SG combined chemoradiotherapy could attenuate radiotherapy induced acute adverse reactions in treating advanced nasopharyngeal carcinoma.