Advances in the Treatment of EGFR Exon 20ins Mutant NSCLC / 中国肺癌杂志

Lung cancer has become one of the most dangerous cancers to human health and the mortality rate is the highest among all the causes of cancer death. Non-small cell lung cancer (NSCLC) accounts for about 80%-85% of lung cancer. Chemotherapy is the main treatment for advanced NSCLC, but the 5-year survival rate is low. Epidermal growth factor receptor (EGFR) mutations are the most common driver mutations in lung cancer, but EGFR exon 20 insertions (EGFR ex20ins) mutation belongs to one of the rare mutations, accounting for about 4%-10% of overall EGFR mutations, thus around 1.8% of advanced NSCLC patients. In recent years, targeted therapies represented by EGFR tyrosine kinase inhibitors (TKIs) have become an important treatment option for patients with advanced NSCLC, however, NSCLC patients with EGFR ex20ins mutation are not sensitive to most of EGFR-TKIs treatments. Currently, some of the targeted drugs for EGFR ex20ins mutation have achieved significant efficacy, while some of them are still under clinical investigation. In this article, we will describe various treatment methods for EGFR ex20ins mutation and their efficacy.
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Clinical significance of lymph node metastasis-related indexes in evaluating the prognosis of initially treated stage N2b colorectal cancer / 中国医师进修杂志

Objective To analyze the clinical significance of lymph node metastasis-related indexes in evaluating the prognosis of initially treated stage N2b colorectal cancer. Methods Two hundred and six patients with initially treated stage N2b colorectal cancer in Shenzhen People′s Hospital from January 2009 to November 2013 were retrospectively analyzed. All patients underwent radical resection of colorectal cancer. The correlation between lymph node metastasis-related indexes and postoperative 5-year overall survival rate was analyzed, including number of negative lymph nodes, number of positive lymph nodes, lymph nodes ratio (LNR), log odds of positive lymph nodes (LODDS). Results The postoperative 5-year overall survival rate was 54.4% (112/206), and the postoperative 5-year recurrence-free survival rate was 48.1% (99/206). Univariate analysis result showed that angioma thrombus or nerve invasion, T stage, postoperative adjuvant therapy, number of positive lymph nodes, number of negative lymph nodes, LNR and LODDS were significantly correlated with the postoperative 5-year overall survival rate (P＜0.01 or ＜0.05). Multivariate analysis result showed that number of negative lymph nodes, number of positive lymph nodes, LNR and LODDS were independent risk factors of postoperative the 5-year overall survival rate ( RR=2.371, 2.295, 2.758 and 2.671; 95% CI 1.598 to 3.485, 1.556 to 3.360, 1.880 to 4.058 and 1.814 to 3.915; P＜0.01). The areas under curve of negative lymph nodes, number of positive lymph nodes LNR and LODDS in predicting postoperative the 5-year overall survival rate were 0.668, 0.657, 0.692 and 0.684, and there was no statistical difference (P＞0.05). Conclusions The number of negative lymph nodes, number of positive lymph nodes, LNR and LODDS in initially treated stage N2b colorectal cancer patients are independent prognostic factors.

Effect of S-1 maintenance chemotherapy following DCF regimen in patients with advanced gastric cancer / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the efficacy and adverse effect of DCF regimen with subsequent S-1 maintenance chemotherapy in patients with advanced gastric cancer (AGC).</p><p><b>METHODS</b>Sixty AGC patients without disease progression after 4 to 6 cycles of DCF regimen as the first-line chemotherapy were randomized into maintenance group and control group (30 patients each). The patients in the maintenance group received maintenance chemotherapy with S-1 (40 mg/m(2), twice daily for 14 days; 21 days for a treatment cycle) until disease progression or with intolerant toxicity, and those in the control group received optimal supportive care.</p><p><b>RESULTS</b>The response rate (CR+PR) was 33.3% in the maintenance group, significantly higher than that in the control group (3.33%, P<0.05), and the disease control rate (CR+PR+SD) also differed significantly between the two groups (73.3% vs 46.7%, P<0.05). The median time to progression was 7.9 months in the maintenance group and 6.8 months in the control group, with median overall survival time of 13.8 and 11.7 months, respectively (P>0.05). The most common adverse effect in the maintenance group included nausea, vomiting, leucocytopenia, and hand-foot syndrome; no death occurred in relation to the therapy.</p><p><b>CONCLUSION</b>S-1 maintenance chemotherapy, with a tolerable toxicity profile, can improve the RR, DCR and median time to progression in AGC patients who respond to DCF regimen, but its efficacy still awaits further evaluation.</p>

Clinical Analysis of Pancytopenic Acute Leukemia or Hyperleukocytic Acute Leukemia / 中国医师杂志

Objective To explore the clinical characteristics of pancytopenic acute leukemia(PAL) and hyperleukocytic acute leukemia(HAL). Methods 183 patients with primary AL were analyzed retrospectively and divided into three groups according to patients' hemogram. Results Among these patients, 38 cases(20 8%) were PAL(group A), 42 cases(23 0%) were HAL(group B) and 103 cases(56 3%) were generic type(group C). 23 0% cases of acute myeloid leukemia(AML), 56 3% acute promyelocytic leukemia and 16 9% acute lymphoblastic leukemia( ALL) appeared PAL. The manifestations of group A were mainly milder infiltration of extra-bone marrow, more severe cytopenias. The early mortality, short and long-term effectiveness were similar to those of group C. 23 8% AML, 51 2% acute monoblastic leukemia and 18 6% ALL presented HAL. There were higher tumor burden,obviously infiltration of extra-bone marrow, higher early mortality, more refractory treatment, poorer prognosis in group B as compared with group A or C. Conclusions Pancytopenia or hyperleukocytosis were common manifestations in primary AL. It is important to understand these features of patients' hemogram for diagnosis, treatment and prognosis evaluation of leukemia.

Bone marrow and peripheral blood examination in non-Hodgkin lymphoma at initial diagnosis / 中国实用内科杂志

Objective To explore the value of bone marrow and peripheral blood examination in non-Hodgkin lymphoma(NHL) at initial diagnosis.Methods Smears of bone marrow and peripheral blood from 103 cases of NHL were stained according to Wright. Paraffin-embedded sections of bone marrow and lymphadenopathy biopsy were stained according to H-Giemsa-E. Immunotyping of NHL was performed immunohistochemically.Results Bone marrow involvement (BMI) by NHL was found in 28 (27 2%) cases.In 8 of the 28 cases without superficial lymphadenopathy,the diagnosis of NHL was established through bone marrow and peripheral blood examination.Seven of the 28 cases in stage Ⅰ?Ⅱ?Ⅲ were confirmed to be in stage Ⅳ based on bone marrow examination. Lymphoma cells in bone marrow and peripheral blood varied in morphology,they were mainly of four patterns:blast type?polymorphic lymphocyte type?small lymphocyte type?histiocyte-like lymphocyte type.Patients with BMI were more likely to have cytopenias in peripheral blood and trilineage of bone marrow depressed than those without BMI.Patients without BMI had a stimulated phenomenon in bone marrow.Conclusion Examination of bone marrow and peripheral blood is important for diagnosis and staging of NHL,especially for the diagnosis of patients without histological evidence of lymph node.