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Patients with operable non-small cell lung cancer (NSCLC) receiving neoadjuvant or adjuvant chemotherapy have a very limited improvement in 5-year survival rate. Epidermal growth factor receptor-tyrosine kinase inhibitors (EGFR-TKI) have made a breakthrough in the treatment of EGFR-mutant advanced NSCLC, which shed light for the exploration of perioperative targeted therapy in NSCLC patients. Significant progress has been made in the research of targeted therapy of the first and third generation EGFR-TKI in perioperative patients. The availability of novel potent and less toxic targeted therapy has brought new treatments for the operable NSCLC. This article reviews the progress and existing problems of adjuvant and neoadjuvant targeted therapy in NSCLC harboring EGFR mutation.
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Non-small cell lung cancer (NSCLC) is a malignant tumor with rapid progress and high malignancy, accounting for 85% of all lung cancers. Treatment has shifted from traditional surgery, radiotherapy and chemotherapy to targeted therapy. Targeted therapy can prolong the survival of patients with positive driver gene fusion. With the continuous progress of biological research, targets related to NSCLC have gradually been discovered. Among the many driving genes of NSCLC, RET fusion is an important emerging target discovered in recent years. It has been confirmed to have a high incidence in non-smoking, young and low-differentiated NSCLC patients. This article reviews RET gene fusion in NSCLC, the relationship between the two and the treatment progress.
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Hyperprogressive disease (HPD) is a novel pattern of progression caused by immune checkpoint inhibitors (ICIs). It is characterized by a dramatic tumor surge and is associated with poor clinical outcomes. Up to now, the definition of HPD is still controversial across various studies. Although it has been indicated that HPD has related to multiple clinicopathological features and genetic alterations, it is lack of biomarker to predict its occurrence, and the potential mechanism remains unknown. This review is to summarize current data on HPD specialized in the field of non-small cell lung cancer. And we expect to provide helpful clinical strategies for oncologists using ICIs. .
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KRAS mutation is one of the most frequent driver gene mutations found in patients with non-small cell lung cancer (NSCLC). KRAS-mutant NSCLC is highly heterogeneous. Various mutation types and different co-mutational signatures affect tumor biological behavior and therapeutic responses. NSCLC patients with KRAS mutations could relatively benefit from immunotherapy, while the effects of KRAS mutations on chemotherapy are still controversial. The treatment methods of KRAS-mutant lung cancer have followed the therapy of NSCLC without driver gene mutation for a long time. With the introduction of novel KRAS G12C inhibitors in the clinic, the therapeutic landscape has begun to change and has made the preliminary advance, and the combined therapies resulted in encouraging signals of efficacy both in preclinical and early phase trials. This paper reviews the biological and clinical characteristics as well as the latest treatment progress of KRAS-mutant NSCLC.
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Immune checkpoint inhibitor (ICI) has been proven to be a major breakthrough in the treatment of various tumor types. Despite the favorable results in terms of oncological outcomes, these treatments have been associated with a variety of immune-related adverse events (irAEs). Myasthenia gravis (MG) is one of rare but life-threatening irAEs, with acute onset and rapid progression after ICI initiation. Early diagnosis and active treatment are crucial. Herein, we review recent literatures to provide guidance to frequently asked questions concerning the diagnosis and management of ICI-MG.
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Immune checkpoint inhibitor (ICI) has been proven to be a major breakthrough in patients with advanced non-small cell lung cancer. Up to now, neoadjuvant therapy using ICI are rare. However, in the context of cancer immunotherapy, neoadjuvant treatment may offer an extra advantage. In this review, we will disscuss the existing preclinical data and emerging clinical findings in the neoadjuvant setting and its potential mechanism of action. We will also highlight the potential damage and the questions that are required to be answered.
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Objective To investigate the changes and clinical significance of T-lymphocyte subsets in the treatment of advanced lung adenocarcinoma. Methods Ninety six patients with advanced lung adenocarcinoma who underwent treatment in Xuanwu Hospital Capital Medical University from October 2015 to May 2016 were selected as the subjects. There were 63 cases in the transferred group and 23 cases in the un-transferred group. The peripheral blood was taken, then flow cytometry was used to detect CD3+, CD3+CD4+, CD3+CD8+, CD4+/CD8+, CD3-CD16+CD56+(NK), CD8+CD28+, CD8+CD28-, Treg cells, CD3+γδ, and the results were analyzed statistically. Results The levels of CD3+γδand Treg cells in the transferred group were significantly higher than those in the un-transferred group (6.56±3.11 vs. 3.05±2.23; 25.83±6.22 vs. 20.81±9.03) (t=1.590, P=0.026; t=2.027, P=0.044). The level of CD45RA+in the effective group (52.15 ±7.99) was significantly lower than that in the untreated group (70.26 ±17.33) (t= 1.660, P= 0.024). Conclusion The detection of peripheral blood T-lymphocyte subsets in treatment of patients with advanced lung adenocarcinoma has a certain value in predicting the therapeutic effect and prognosis.
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Objective To evaluate the diagnostic values of microRNAs (miRNAs) as plasma biomarkers for early diagnosis of non-small cell lung cancer (NSCLC). Methods The levels of 10 miRNAs in plasma of 59 patients with early stage (stage Ⅰ-ⅢA) NSCLC (lung cancer group) and 59 benign lesions (control group) were detected by real-time quantitative polymerase chain reaction (RT-PCR). The levels of serum cytokeratins antigen 21-1 (CYFRA21-1), carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) and other tumor markers were detected by electrochemiluminescence immunoassay (ECLIA), chemiluminescence immunoassay (CLIA) and immunoradiometric assay (IRMA). The early diagnostic value of miRNAs and other markers were evaluated by receiver-operating-characteristic (ROC) curve analysis. The sensitivity, specificity and area under the curve were calculated for the cut-off value. Results Plasma CYFRA21-1, miR-486 and miR-210 levels were significantly different in lung cancer group and control group (CYFRA21-1: 8.896±3.681 vs. 5.892±2.028, P= 0.020; miR-486:2.778±0.778 vs. 1.746±0.892, P< 0.001;miR-210: 4.836 ±1.374 vs. 2.829 ±1.503, P< 0.001). Area under ROC curve of CYFRA 21-1, miR-486 and miR-210 was 0.624 (sensitivity: 0.576, specificity: 0.797), 0.848 (sensitivity: 0.831, specificity: 0.780) and 0.751 (sensitivity: 0.746, specificity: 0.746), respectively. MiR-486, miR-210 combined with CYFRA21-1 had the highest diagnostic efficiency, and the area under the curve was 0.924 (sensitivity: 0.847, specificity:0.811), miR-486 combined with miR-210 had the highest diagnostic efficiency, and the area under the curve was 0.892 (sensitivity: 0.831, specificity: 0.780). Conclusions MiR-486 and miR-210 could be potential biomarkers for diagnosis of NSCLC. Plasma miRNAs combined with tumor markers can improve the diagnostic efficacy of early stage NSCLC.
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Human epidermal growth factor receptor 2 (HER-2) is overexpressed in approximately 30%of breast cancer patients. The monodonal antibodies of HER-2 have been proved to be effective in not only metastatic but also early stage HER-2 positive breast cancer since 1990S. With the development of cell biology, molecular biology and immunology, immunotherapy becomes a new treatment for breast cancer. Great improvement has been made in cancer vaccines targeting HER-2, including peptide vaccines, protein vaccines,cell vaccines,dendritic cell-associated vaccines and DNA vaccines.This paper reviews some studies and unsolved problems in cancer vaccines for HER-2 positive breast cancer.
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Human epidermal growth factor receptor 2 (HER-2) is overexpressed in approximately 30%of breast cancer patients. The monodonal antibodies of HER-2 have been proved to be effective in not only metastatic but also early stage HER-2 positive breast cancer since 1990S. With the development of cell biology, molecular biology and immunology, immunotherapy becomes a new treatment for breast cancer. Great improvement has been made in cancer vaccines targeting HER-2, including peptide vaccines, protein vaccines,cell vaccines,dendritic cell-associated vaccines and DNA vaccines.This paper reviews some studies and unsolved problems in cancer vaccines for HER-2 positive breast cancer.
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Objective To evaluate the efficacy and adverse effects of gefitinib as the first line treatment in elderly patients with lung adenocarcinoma.Methods 81 elderly patients of previously untreated advanced lung adenocarcinoma,who were non-smokers and unsuitable for chemotherapy,received gefitinib treatment until disease progression or intolerable toxicities occurred.The curative effect performance status of improvement and adverse effects were observed.Results All of the patients were evaluable.Partial response rate and stable disease rate of gefifinib were 25.9 ％ (21/81) and 48.1％ (39/81),respectively.55.5 ％ (45/81)of patients had performance status improved after treatment.Conclusion Gefitinib has curative effect and is well tolerated in the treatment of elderly patients with previously untreated advanced lung adenocarcinoma.
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Objective The purpose of this study is to evaluate Surgical Procedure and Prognosis for elderly stage 1NSCLC patients above 70 years old.Methods The patients who were stage Ⅰ non-small cell lung cancer from 2003 to 2007were enrolled ( n =71 ).The median age was 74 years ( ranged from 70 to 84 years).The median follow-up of patients was 30months( ranged from 2 to 81 months).Results The percentages of postoperative complications after sublobar resection and lobectomy patients were 36.4％ and 46.9％,respectively.The period in hospital were 11.36 days and 12.24 days.The 3 year survival was 85.9％ for patients undergoing sublobar resection and 78.8％ for lobectomy.The 5 year survival was 56.4％ and 56.9％ respectively.No significant difference was observed between two types of surgical procedure in the elderly.Staging is the independent factor of prognosis.Conclusion Lobectomy is still the main therapy method for elderly stage Ⅰ NSCLC patients.Especially,for those who can undergo radical resection.But sublobar resection also appears to be a viable surgical treatment for patients with cardiopulmonary physiologic impairment.
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Background and purpose:Breast cancer is a rare disease in women aged less than 25.Furthermore,there were fewer studies reporting the outcomes of this cohort and the knowledge regarding its biological characteristics and clinical features were limited. The aim of this retrospective study was to examine and audit the experience of our institution in treating the extremely young patients with breast cancer,to focus on the clinical presentation and pathological fi ndings,and to identify the prognostic factors which might be helpful in identifying those patients with a worse prognosis. Methods:From Jan 1980 to Dec 2005,there were 54 breast carcinoma patients in women aged 25 years or less treated in our hospital.We retrospectively analyzed their clinical,histological and treatment variables as well as 5-year overall survival(OS) and 5-year disease-free survival(DFS) . Results:There were 0.48% of all breast cancer cases who occurred in age of 25 or less in our institute in the period. We found 77.8% to be invasive ductal carcinoma and none of the patients had any family history of breast cancer or ovarian cancer. Clinically,68.5% were stage Ⅰ or Ⅱ,53.7% had lymph node metastasis. 79.6% were classifi ed as T1 or T2. Regarding the biological features,the frequencies of positive ER and PR were low(29.6%,36.0%,respectively) ,and the frequency of positive c-erbB2(22.2%) was higher. Lymphovascular invasion occurred in eight patients. Thirty-eight patients received adjuvant chemotherapy. 26 patients in this study died of breast cancer. The 5-year DFS and OS were 54.3% and 55.5%,respectively. In lymph node-positive patients,chemotherapy improved their 5-year OS signifi cantly(P=0.007) . The patients who might have a worse prognosis were usually with diagnostic delay more than 3 months(P=0.019) ,higherclinical stage(P=0.000) ,larger tumor size(P=0.007) ,lymph node-positive(P=0.000) and lymphovascular invasion(P=0.011) . Multivariate’ analysis revealed that both diagnostic delay more than 3 months and lymph node-positive were the independent prognostic factors(P=0.034,P=0.027,respectively) . Conclusion:Breast cancer is a rare condition in women aged 25 or less. Invasive breast cancer occurring at this subgroup has more aggressive biological behaviors. Diagnostic delay of more than 3 months and lymph node metastasis are considered adverse prognostic factors in the current study. The general principles of managing adolescents and very young women with breast cancer are no different to those applying to older women in current study,but development of tailored treatment for this population is still crucial.