Single-center study of different treatment for advanced or unresectable angiosarcoma patients / 中华肿瘤杂志

Objective: To evaluate the efficacy and safety of different medical treatment in advanced or unresectable angiosarcoma. Methods: This study was a single-center retrospective clinical study. Fifty-five advanced or unresectable angiosarcoma patients treated in Sun-Yat Sen University Cancer Center from January 2005 to August 2020 were enrolled. There were 34 patients who received first-line doxorubicin-based chemotherapy (doxorubicin group), 12 patients received first-line doxorubicin or liposome doxorubicin plus paclitaxel or albumin bound paclitaxel chemotherapy (combination therapy group), and 4 patients received first-line paclitaxel-based treatment (paclitaxel group). There were 6 patients who received anti-angiogenesis targeted therapy, another 2 patients received anti-PD-1 antibody plus anti-angiogenesis targeted therapy. Targeted therapy and immunotherapy plus targeted therapy included 5 cases of first-line therapy and 3 cases of second-line therapy. The therapeutic effect was evaluated by RECIST 1.1 standard. The adverse reactions were evaluated by CTCAE4.0 standard. Kaplan-Meier survival analysis was evaluated with Log rank test. Cox proportional hazard model was used to analyze the influencing factors. Results: There were 18 patients achieved partial response (PR) in 34 patients in the doxorubicin group, median progression-free survival (mPFS) was 4.5 months, and median overall survival (mOS) was 15 months. Four patients achieved PR in 12 patients in the combination therapy group, mPFS and mOS were 4 months and 19 months. Two patients achieved PR in 4 patients in the paclitaxel group, mPFS and mOS were 3 months and 9 months. However, only 1 in 6 patients achieved PR for anti-angiogenesis targeted therapy, mPFS and mOS were 3 months and 16 months. Two patients who received anti-PD-1 immunotherapy combined with anti-angiogenesis targeted therapy acquired PR for 17 months and more than 16 months. Median PFS (7.5 months) were longer in those with primary liver, lung and spleen angiosarcoma than in those with other primary site (3.0 months, P=0.028). The mOS (20 months) was longer in females than that in males (12 months, P=0.045). Primary tumor site, sex, age and treatment were not independent prognostic factors for angiosarcoma patients (P>0.05). Grade 3-4 cardiac toxicity was found in 2 patients in the combination therapy group. Conclusions: Doxorubicin-based and paclitaxel-based chemotherapy are the most important treatment for advanced angiosarcoma. Potential efficacy for targeted therapy combined with anti-PD-1 immunotherapy are showed in some patients with long duration of response and moderate adverse event.

Therapy of myasthenia gravis: looking forward to the era of targeted immunotherapy / 中华神经科杂志

Myasthenia gravis is mainly acetylcholine receptor antibody-mediated, T cells-dependent and complement participated acquired autoimmune disease characterized by impairment of the neuromuscular transmission. The main clinical feature of the disease is the presence of fatigability or muscle weakness. Most patients can be successfully managed with nonspecific immunotherapies such as corticosteroid and non-steroidal immunosuppressants. However, the side effects caused by long-term corticosteroid therapy are still a hurdle in the treatment of myasthenia gravis (MG). Oral non-steroidal immunosuppressants, as add-on therapy, can greatly reduce the relapse of the disease, but some drugs have a slow onset of action and the potential for significant toxicity, and even increase the risk of infection and neoplasms with long-term treatment. Despite these therapies, a minority of patients can be refractory because of incompletely responding or not well tolerated to available therapies. Thus, the need to avoid the use of corticosteroids, or at least reduce their use as much as possible should concern all patients with MG. Targeted immunotherapy is a therapeutic monoclonal antibody or antibody fragment targeting immune cells, complement, neonatal Fc receptor and cytokines. Recently, targeted immunotherapy has completed phase Ⅱ and Ⅲ clinical trials in patients with MG, and some of them have been approved by Food and Drug Administration. These promising biologics showed efficacy in symptoms persistent improvement, steroids reduction and were well tolerated, now evolving into powerful tools changing the algorithm of MG. This paper summarizes the results of clinical trials of new biologics in MG and looks forward to the prospect of MG treatment.

Research progress in targeted immunotherapy combined with ra-diotherapy for stageⅢ/Ⅳmelanomas / 中国肿瘤临床

Melanoma is the most aggressive and lethal malignant tumor in skin cancers. Operation resection is used to treat stageⅠ/Ⅱmelanomas, but traditional operation, chemotherapy, and radiotherapy inflicts adverse effects on late-stage melanomas. StageⅢ/Ⅳmelanomas are some of the most ineffectively treated tumors with poor prognosis. As a cancer treatment, targeted immunotherapy in-hibits negative regulatory factors and enhances systemic anti-tumor immune effects. Radiotherapy not only kills tumor cells, but also en-hances systemic immune responses. Recent studies showed that targeted immunotherapy combined with radiotherapy can promote con-trol on local and distant tumors and prolong overall survival. The synergistic effects of these two therapies are superior to a single thera-py. This review summarized the progress on these research fields.