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Relapse or metastatic esophageal squamous cell carcinoma (ESCC) has poor prognosis and limited treatment options. Chemotherapy based on platinum agents combined with fluorouracil or taxanes is the standard first-line treatment for it. Molecular-targeting agents, mainly epidermal growth factor receptor inhibitors including cetuximab, panitumumab, nimotuzumab and gefitinib, have failed to improve the survival of patients with advanced ESCC. Anlotinib, one of the small molecule multi-target tyrosine kinase inhibitors, can prolong the median progression free survival in patients treated with above the second line. Compared with chemotherapy, immune checkpoint inhibitors (including nivolumab, pembrolizumab and camrelizumab) significant improve overall survival times in patients with ESCC who fail to the first line chemotherapy, and can be selected as the standard second line treatment. Immunotherapy combined with chemotherapy or anti-angiogenic therapy for first-line treatment of advanced ESCC is also being studied.
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Objective:To investigate the effects of different treatment modes on the survival of patients with non-small cell lung cancer (NSCLC) brain metastases, and to evaluate the clinical values of diagnosis-specific graded prognostic assessment (DS-GPA) model and graded prognostic assessment model for lung cancer using molecular markers (Lung-molGPA).Methods:The clinical data of 195 NSCLC patients with brain metastases treated in the Cancer Hospital of Shantou University Medical College from January 2011 to December 2015 were retrospectively analyzed, including 112 patients without brain metastasis (metachronous brain metastases) at the first diagnosis, and 83 patients with brain metastases at the first diagnosis (simultaneous brain metastases). The treatment modalities of brain metastases included single local cranial radiation, chemotherapy, target therapy and combined cranial radiation with chemotherapy or target therapy, chemotherapy plus target therapy, et al. Kaplan-Meier method was used for survival analysis, Cox regression method was used for univariate and multivariate survival analyses, and DS-GPA and Lung-molGPA models were used for survival analysis.Results:The median time to brain metastases in all patients was 14.1 months (95% CI 12.2-16.0 months). The median progression-free survival (PFS BM) time of all patients was 4.3 months (95% CI 3.4-5.2 months), and the median overall survival (OS BM) time of brain metastases was 6.7 months (95% CI 4.6-8.8 months). There was no difference in PFS BM and OS BM between patients with synchronous and metachronous brain metastases ( P = 0.446, P = 0.080). Receiving anti-tumor therapy, especially combining targeted therapy could improve median OS BM. Low Karnofsky score ( RR = 1.698, 95% CI 1.238-2.329, P = 0.001) and bone metastasis ( RR = 1.505, 95%CI 1.089-2.081, P = 0.013) were independent risk factors for the OS BM of NSCLC patients with brain metastases, and chemotherapy ( RR = 0.460, 95% CI 0.289-0.731, P = 0.001) and brain radiotherapy ( RR = 0.541, 95% CI 0.391-0.749, P < 0.01) were independent protective factors for the OS BM of NSCLC patients with brain metastases. The OS BM difference between patients grouped by DS-GPA and Lung-molGPA models was statistically significant (median OS BM time of patients with DS-GPA model 0.0-1.0, 1.5-2.0 and 2.5-3.0 points were 4.2, 9.4 and 10.9 months, respectively, P = 0.015; median OS BM time of patients with Lung-molGPA model 0.0-1.0, 1.5-2.0 and 2.5-3.0 points were 4.1, 8.7 and 13.0 months, respectively, P < 0.01). Conclusions:The prognosis of NSCLC patients with brain metastases is poor, and anti-tumor therapy can prolong their survival. High Karnofsky score, without bone metastasis, receiving chemotherapy or brain radiotherapy are independent good prognostic factors for NSCLC patients with brain metastases. Both DS-GPA and Lung-molGPA models can predict the survival of NSCLC patients with brain metastases.
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Desmoplastic small round cell tumor (DSRCT) is a rare and high malignant soft tissue tumor with very poor prognosis.It usually occurs in the abdominopelvic cavity of adolescents and young males.DSRCT is prone to occur distant metastasis,mainly in the liver and lung.The histopathological manifestation is featured with nests of small round blue cells separated by desmoplastic stroma.DSRCT can co-express epithelial,neural and mesenchymal markers.The molecular characteristic of DSRCT is the production of EWSWT1 fusion protein via the translocation of chromosome t (11;22) (p13;q12).Treatments of DSRCT include radical resection or cytoreductive surgery,high intensity systemic chemotherapy,local radiotherapy and hyperthermic intraperitoneal chemotherapy.
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The cytotoxic agents pemetrexed and docetaxel and the epidermal growth factor receptor (EGFR)tyrosine kinase inhibitors(TKIs)erlotinib and gefitinib are standard second-line therapies for non-small cell lung cancer. For patients without the EGFR mutation,more and more evidence has suggested the superiority of chemotherapy over targeted therapy. Adding targeted agents to standard second-line treatment is an trend of exploration,but without promising results nowadays. Crizotinib,targeting at anaplastic lymphoma kinase,has been shown excellent efficacy for second-line therapy in non-small cell lung cancer.
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Objective To evaluate the effects of antitumor,toxicity and survival of second-line chemotherapy with docetaxel and capecitabine in patients with advanced esophageal squamous cell carcinoma.Methods Thirty eligible patients with measurable lesions received 1-hour intravenous treatment of docetaxel (60 mg/m2 on day 1) plus oral capecitabine (825 mg/m2 twice daily on days 1-14) every 3 weeks for up to 6 cycles.Results Patients received a median of two cycles of treatment (range 2-6).The median follow-up interview was 15.4 months (3.0-31.5 months).Intent-to-treat efficacy analysis demonstrated an overall response rate of 23.3 ％ (0 complete and 7 partial) and stability of 43.3 ％ (13 cases).The median time to progression was 3.0 months (95 ％ CI 1.929-4.071).The median survival was 8.3 months (95 ％ CI6.848-9.752).Severe adverse events (grade 3/4) reported were neutropenia (10 cases),anaemia (5 cases),thrombocytopenia (3 cases),hand-foot syndrome (4 cases),and fatigue (3 cases).Conclusion Docetaxel plus capecitabine have a manageable adverse event profile and promising activity in advance esophageal squamous cell carcinoma as a second-line treatment.
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Targeted therapy of anti-angiogensis strategy is the standard treatment for metastatic renal cell cancer.In recent years,a number of new generation of anti-angiogensis agents have been tested in clinical trials,some of which have achieved promising outcomes.Other pathway inhibitors such as inhibitors of mamma-lian target of rapamycin and fibroblast growth factor receptor pathway have made progresses in some extent.
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Objective To evaluate the association between non-Hodgkin's lymphoma (NHL) and hepatitis B virus (HBV).Methods The positive rate of hepatitis B virus surface antigen (HBsAg) in 393 patients of NHL who were admitted. The colorectal cancer patients and healthy persons were also enrolled as control. Results The positive rate of HBsAg in NHL patients (26.5 ％) was significantly higher than that in colorectal cancer patients (14.5 ％) and healthy persons (8.8 ％),respectively (x2=55.713,P＜0.001).The characteristics of HBV-infected patients with NHL were similar to those who were HBV-uninfected in terms of sex,stage and B symptoms,whereas the HBV-infected patients were younger than the HBV-uninfected patients (the median age was 47ys vs 52ys,t =-1.911,P=0.021).In the HBsAg-positive NHL group,B-cell subtype was much more common than T-cell subtype (80.8 ％ vs 15.4 ％,P=0.043).Regarding colorectal cancer patients and healthy persons as control groups,the positive rate of HBsAg was significantly higher in B-cell NHL patients than that in the control groups, respectively ( 29.6 ％ vs15.5 ％ vs 8.8 ％,Wald value were 25.174 and 55.139,respectively,P＜0.001).The positive rate of HBsAg of HBV between T-cell NHL (16.7 ％) and control groups were not significantly different. Conclusions An association is present between HBV infection and NHL,especially in B-cell subtype.
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Objective To evaluate the association between B-cell non-Hodgkin lymphoma (NHL) and hepatitis B virus (HBV).Methods The positive rates of HBV markers in 284 patients of B-cell NHL who were admitted to our department between January 2003 and December 2009 were investigated.The positive rates of HBV markers in colorectal cancer patients were used as controls.Results The HBsAg-positive rates of patients aged 18～ 39 and stage m/Ⅳ patients were 42.6 ％ (26/61) and 37.0 ％ (50/135),which was higher than other groups.The x2 value and P value were 7.573 and 6.874,0.023 and 0.009,respectively.Compared with the control group, the B-cell NHL had significantly higher prevalence of positive HBsAg and positive HBeAg (29.6 ％ vs 14.5 ％,6.7 ％ vs 0.8 ％ ).The Wald values were 25.174 and 20.496,respectively.Both of the P value were ＜0.001 and lower prevalence of positive anti-HBs (45.4 ％ vs 58.0 ％,Wald =11.062,P =0.001).The coexpression of HBsAg, HBeAg and anti-HBc was higher in the B-NHL group than in the control group (6.0 ％ vs 0.8 ％,x2 =31.619,P ＜0.001).Similarly,the coexpression of HBsAg,anti-HBe,and anti-HBc was higher in the B-NHL group (16.2 ％ vs 11.5 ％,x2 =4.542,P =0.033).Significantly higher rate of positive anti-HBc and negative anti-HBs was observed in the B-NHL group (37.0 ％ vs 24.5 ％,Wald =17.708,P ＜ 0.001),whereas the same group showed a lower rate of negative anti-HBs compared with the control group (20.8 ％ vs 27.8 ％, Wald =5.646, P =0.017).Conclusion This finding of a positive association between HBV infection and B-NHL suggests that HBV may play an etiologic role in the induction of B-NHL.
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Objective To evaluate the curative effect and toxicities of platinum-based double regimens for patients aged ≥ 65 with advanced non-small-cell lung cancer (NSCLC) and identify the prognosis factors. Methods 70 patients aged ≥65 with staged ⅢA-Ⅳ NSCLC, who received platinum-based double regimens as first line treatment, were emrolled.Response rates and toxicities were evaluated.Progression free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Cox regression analysis was used to identify the potential prognosis factors.Results The median chemotherapy cycles was 3.The overall response rate was 41.5 % (22/53), and there was no difference between patients aged ＜70 and ≥70 (χ2 =1.945, P =0.378).The median PFS and OS were 6.0 months and 12.5 months.The chemotherapyrelated hematologic toxicities were common.Multivariate analysis revealed that performance status, numbers of metastasis, chemotherapy cycles were significant independent predictive factors for OS. Conclusion In elderly advanced NSCLC, platinum-based doublets show inspiring efficacy, but with more adverse events, and could not be all well tolerated. It should be personalized. Patients with poor performance status and multiple organs metastasis are hard to benefit from combined chemotherapy.Three to six cycles of chemotherapy is the optimal duration for patients who could be well tolerated.
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<p><b>BACKGROUND</b>Chemotherapy is one of the important treatment methods for advanced non-small cell lung cancer (NSCLC). The aim of this study is to evaluate the efficacy of the combination of vinorelbine (NVB) and cisplatin (DDP) in the treatment of advanced NSCLC.</p><p><b>METHODS</b>Forty-eight patients with stage IIIB and IV NSCLC were treated with NVB (25mg/m² ,iv,d1 and d8) and DDP (40mg/m², d1 and d2).</p><p><b>RESULTS</b>The overall response rate (RR) was 48%, median survival time was 10 months, and 1-year survival rate was 35%. The RR of patients with first-line chemotherapy was 55%, median survival time was 11 months, the RR of patients with second-line chemotherapy was 35%, median survival time was 8 months; the RR of patients with stage IIIB was 54%, median survival time was 10 months, the RR of patients with stage IV was 41%, median survival time was 9 months. The main toxicities were myelosuppression, nausea, vomiting and phlebitis.</p><p><b>CONCLUSIONS</b>The combination of NVB and DDP in the treatment of advanced NSCLC has a high response rate and tolerable side effects, which can be adopted as the first-line treatment of advanced NSCLC, or the second line treatment that still need further studies.</p>