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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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<p><b>BACKGROUND</b>Chemotherapy is the main treatment measure of advanced non-small cell lung cancer(NSCLC).The aim of this study is to explore the efficacy,toxicity,time to disease progression(TTP) and overall survival under the combined chemotherapy with gemcitabine(GEM) plus cisplatin(DDP) in the treatment of advanced NSCLC.</p><p><b>METHODS</b>Retrospective review was conducted on 79 chemotherapy-naive cases of advanced NSCLC treated with GEM and DDP from October 1999 to November 2005.Among 79 patients,51 were male and 28 female;the median age was 53 years old(ranged from 21 to 74);there were 17 cases of squamous cell carcinoma,53 cases of adenocarcinoma,3 cases of large cell carcinoma,1 case of adeno-sqamous cell carcinoma,5 unidentified cases;there were 26 cases in IIIB stage and 53 cases in IV stage according to AJCC 1997 standard.All patients received GEM 800-1250 mg/m² on days 1 and 8 and DDP 75-80 mg/m² on day 1 or 30 mg/m² for three days by intravenous administration,with 21 days as one cycle.Each patient received 2-4 cycles chemotherapy.</p><p><b>RESULTS</b>The total clinical reponse rate(complete and partial response) was 31.6%,and clinical benefit rate(complete and partial response and stable disease) was 73.4%.1-year survival rate was 64.9%,2-year survival rate was 32%.After median follow-up of 2.33 years,median TTP was 5.06 months.The main toxicities were nausea,vomitting and hematological toxicities.The rates of grade III to IV leukopenia and thrombocytopenia were 25.4% and 31.6% respectively.Other toxicities were slight and tolerable.</p><p><b>CONCLUSIONS</b>Combined chemotherapy with GEM plus DDP as first-line treatment to advanced NSCLC is an effective and feasible regimen,which is one of the standard regimens.For old patients,this regimen is a good choice.The fit dosage of GEM for Chinese is 1000 mg/m².</p>
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<p><b>BACKGROUND</b>Gefitinib, an orally active epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), has shown targeted antitumor activity in patients with advanced non-small cell lung cancer (NSCLC). The aim of this study is to evaluate the efficacy and tolerance of gefitinib on brain metastasis in patients with NSCLC.</p><p><b>METHODS</b>The clinical characteristics, response to treatment and outcome of survival were retrospectively reviewed in eighteen NSCLC patients with brain metastasis. All these patients received gefitinib of 250mg/d after brain metastasis was diagnosed. They would discontinued the targeted treatment because of disease progression or other reasons. Twelve of them received intracranial irradiation (group A), while the other six patients didn't (group B).</p><p><b>RESULTS</b>The overall response rate and disease controlled rate of gefitinib for brain lesions were 27.8% and 88.9% respectively (one complete remission, 4 partial remission, 11 stable disease, 2 progressive disease). No correlation among gender, smoking status, intracranial irradiation and the response of gefitinib was observed. There was no survival difference between the two groups (P=0.192), with the median follow-up time of 6 months (range 1-24 months). Rash and diarrhea were the most common adverse events.</p><p><b>CONCLUSIONS</b>Gefitinib is active in patients with brain metastasis from NSCLC. It is feasible to conduct randomized clinical trials to demonstrate the role of targeted treatment for NSCLC patients with metastatic brain lesions.</p>
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Objective To study the indications of endoscopic treatment for carpal tunnel syndrome(CTS).Methods From July 2004 to September 2007,21 patients(24 wrists) with CTS received endoscopic treatment in our hospital.Under local anesthesia,an 1-cm incision was made at the level of the proximal transverse wrist crease ulnar to the palmaris longus tendon.A special cannula was inserted into the carpal tunnel,and then the transverse carpal ligment was cut and the median nerve was decompressed.All the patients were re-examined in 1,2,3,and 5 months postoperation.Results According to the criteria of Kelly,11 cases achieved excellent outcomes in 5 months,meanwhile 6 were good,2(3 wrists) were fair,and 2 were poor.One of the 2 poor cases received a second operation by traditional procedures(nerve release) 7 months after the first surgery,another case were treated by conservative therapy because of sympathetic symptoms.Conclusions ① Endoscopy is the first choice for idiopathic cases,while open surgery should be performed on secondary cases(rheumatic synovitis,fracture deformity,tumar,inflammation,gout,neurodegenerative desease etc.).② The carpal tunnel release should be used for patients with abnormal opponens function of the thumb,as well as advanced cases.③ Routine operation are the first choice for eldly patients but not for the younger ones.
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Objective To investigate carpal instability after distal radial fractures have been treated with cast immobilization or operation and its effect on clinical functions.Methods 124 patients with distal radial fracture were treated with cast immobilization,external fixation or plate internal fixation.They were followed up.Their carpal instability was evaluated according to X-ray manifestations before and after treatment;their clinical carpal functions were assessed according to Gartland and Werley scoring system.Results The follow-ups revealed five types of carpal instability:palmar or dorsal shift of the carpus,VISI(volar intercalated segment instability),DISI(dorsal intercalated segment instability)and scapholunate dissociation.The incidence of carpal instability was 58.1%before treatment,21.8%after treatment and 22.6%at the follow-ups.Functional results were excellent and good in 80.6 %of the total patients,in 84.5%of those in the stability group,and in 75.0%of those in the instability group.Conclusions Distal radial fractures usually lead to carpal instability.Operations can correct radius-carpal instability effectively,but it is difficult to correct scapholunate dissociation.The function of carpal joint is evident ly poorer in patients with carpal instability than in those with carpal stability,for it is mainly affected by the integrality of radius-carpal joint.
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Objective To explore the effect of NO on secondary spinal cord injury. Method L - arginine{L - Arg} and N - nitric-Larginine methylester{L - NAME} were infused into subarachnoid space of rats 30 min before spinal cord injury(SCI) . Spinal cord blood flow (SCBF) at trauma sites was monitored. After SCI by a Laser - Doppler flowmetry and neurological function was evaluated. Result The result showed that L - arg increased SCBF at trauma sites, but exaggerated the SCI. The proper dose of L - NAME decreased early SCBF at trauma sites, but ameliorated neural function. Large dose of L - NAME restricted NO production for a long time and resulted in spinal cord isehemia, thus exacerbating SCI. Conclusion That over - production or over - restriction of NO worsen SCI.