Current status and breakthroughs in treating advanced non-small cell lung cancer with EGFR exon 20 insertion mutations.

Recently, targeted therapy and immunotherapy have emerged as effective treatment options for non-small cell lung cancer (NSCLC). This progress has been facilitated by the rapid development of diagnostic and therapeutic technologies and the continuous research and development of new drugs, leading to a new era in precision medicine for NSCLC. This is a breakthrough for patients with common mutations in the human epidermal growth factor receptor (EGFR) gene in NSCLC. Consequently, the use of targeted drugs has significantly improved survival. Nevertheless, certain rare genetic mutations are referred to as EGFR exon 20 insertion (ex20ins) mutations, which differ in structure from conventional EGFR gene mutations, namely, exon 19 deletion mutations (19-Del) and exon 21 point mutations. Owing to their distinct structural characteristics, patients harboring these EGFR ex20ins mutations are unresponsive to traditional tyrosine kinase inhibitor (TKI) therapy. This particular group of patients did not fall within the scope of their applicability. However, the activating A763_Y764insFQEA mutation elicits a more pronounced response than mutations in the near and far regions of the C-helix immediately following it and should, therefore, be treated differently. Currently, there is a lack of effective treatments for EGFR ex20ins mutations NSCLC. The efficacy of chemotherapy has been relatively favorable, whereas the effectiveness of immunotherapy remains ambiguous owing to inadequate clinical data. In addition, the efficacy of the first- and second-generation targeted drugs remains limited. However, third-generation and novel targeted drugs have proven to be effective. Although novel EGFR-TKIs are expected to treat EGFR ex20ins mutations in patients with NSCLC, they face many challenges. The main focus of this review is on emerging therapies that target NSCLC with EGFR ex20ins and highlight major ongoing clinical trials while also providing an overview of the associated challenges and research advancements in this area.

Implicit Attitudes of New-Type Drug Abstainers towards New-Type Drugs and Their Relapse Tendencies.

Over the last decade, new-type drugs have been replacing traditional-type drugs in China. However, studies of implicit attitudes towards new-type drugs are insufficient and contradictory results exist. Previous studies have suggested that implicit attitudes and relapse tendencies are a dual structure model, but that is for traditional or mixed drug addicts. For new drug addicts, is the dual structure model completely suitable or partially supported? This study attempts to explore this point. At a drug rehabilitation center, we randomly selected 50 abstainers (25 males and 25 females; age range: 21-41 years) who only took new-type drugs prior to abstention to participate in this study. Participants complete the General Situation Questionnaire, the Drug Use Characteristics Questionnaire, the Drug Relapse Risk Scale (DRRS), and the Single Category Implicit Association Test (SC-IAT). The relationship between implicit attitudes and relapse tendencies of new-type drug abstainers towards new-type drugs was investigated. The results showed: (1) abstainers had negative attitudes towards new-type drugs, and the data had statistical correlation with abstainers' drug use characteristics and each relapse risk index; (2) females held relatively positive implicit attitudes towards new-type drugs; (3) being female and divorced could significantly predict abstainers' implicit attitudes; (4) there is no significant correlation between implicit attitudes and relapse tendencies of new-type drug abstainers towards new-type drugs, which partially supports the dual structure model; (5) fender influences the self-assessment of relapse probability. Compared with traditional or mixed drug addicts, the dual structure model is only partially supported for new-type drug abstainers towards new-type drugs. That is because being female and divorced are the main factors influencing implicit attitudes and relapse tendencies. A few women or divorced people regard consuming new drugs as the source of happiness and forget the harm brought by the drugs themselves in their implicit attitude, which leads to more drug abuse in their explicit behavior. Therefore, we should pay more attention to women who have become new-type drug addicts and pay special attention to the impact of divorce.

[Relationship between new-type drug use and high risk sex behavior in men who have sex with men].

Objective: To understand the relationship between new-type drug use and high risk behavior in men who have sex with men (MSM) in Shandong province. Methods: Cross-sectional surveys was conducted to collect the information about demographics, sexual and drug use behaviors of MSM and HIV-related services in MSM in three sentinel surveillance sites in Shandong from April to July in 2019. Blood samples were taken from the MSM for serological tests of HIV antibody and syphilis antibody. Results: A total of 1 203 MSM were included in this study. The average age of the MSM was 30.2±8.9 years. Among these MSM, 67.7% (815) were unmarried; 66.9% (805) had education level of college or above; 62.2% (721/1 160) had unprotected sex behaviors and 16.3% (189/1 160) had group sex behavior in the past six months and 54.2% (652/1 203) ever used new-type drugs. HIV infection and syphilis prevalence rates were 3.1% (37/1 203) and 4.7% (56/1 203), respectively. Multivariable logistic analysis indicated that MSM who had unprotected anal sex in the past six months were more likely to be from Qingdao (aOR=1.59, 95%CI:1.13-2.23), with education level of high school or below (aOR=1.61, 95%CI: 1.20-2.16), with male sex partners from bars/dance halls or other venues (aOR=1.69, 95%CI: 1.06-2.69), with HIV knowledge awareness score <6 (aOR=1.55, 95%CI: 1.01-2.37), with ≥2 sex partner in the past week (aOR=1.48, 95%CI: 1.12-1.95), to have group sex behaviors in the past six months (aOR=2.43, 95%CI:1.61-3.67) and to use new-type drugs (aOR=1.46, 95%CI: 1.11-1.91). MSM who had group sex were more likely to have following features: being from Qingdao (aOR=2.21, 95%CI: 1.45-3.38), non-Shandong residents (aOR=2.13, 95%CI: 1.28-3.55), HIV knowledge awareness score ≥6 (aOR=3.11, 95%CI: 1.55-6.25), ever having unprotected anal sex behaviors (aOR=2.60, 95%CI: 1.71-3.96) and ever having male commercial sex (aOR=3.38, 95%CI: 1.92-5.95) in the past six months, ever using new-type drugs (aOR=2.71, 95%CI: 1.82-4.04), and never having HIV testing in the past year (aOR=2.66, 95%CI: 1.59-4.43). Conclusion: New-type drug use is common in MSM in Shandong. The use of new-type drugs promotes unprotected sex and group sex in MSM. Surveillance and intervention measures targeting this population should be strengthened.

[Study on the prevalence of HIV infection and related risk behaviors among male new-type drug users in Qingdao, Shandong province].

Objective: To understand the characteristics of new-type drug consumption, sexual behaviors and the prevalence of HIV infection among male new-type drug users in Qingdao, Shandong province. Methods: A cross sectional survey was conducted from 2015 to 2016. Participants were recruited from MSM community-based organizations (CBO) and general community through snowball method, relying on volunteers and male peer educators who were on new-type drugs themselves. Face-to-face interview was carried to collect information on drug use and sexual behaviors. Blood samples were collected to test HIV, syphilis and HCV antibodies. Urine samples were collected to test the evidence of new-type drugs. Qualitative variables and quantitative variables were analyzed using Chi-square test/Fisher's exact test and Student's t-test respectively. Multivariate logistic regression was used to analyze related factors of binary variables. Results: A total of 1 034 newtype drug users were recruited, including 431 (41.7%) MSM population and 603 (58.3%) who were not MSM. Compared with the the group of people who were not MSM, people in the the MSM group were younger, unmarried and with higher level of education. The proportion of methamphetamine users were 49.7% (214/431) and 100.0% (603/603) among the groups of MSM or not MSM, respectively. People in the MSM group, 66.8% (288/431) used 5-Methoxy-N, N-diisopropyltryptamine (5-MeODIPT, "foxy" ) in the last six months. However, none from the not-MSM group ever used 5-MeO-DIPT. In the last six months, proportions of sharing new-type drugs with more than two people in the MSM or not groups were 87.9% (379/431) and 97.7% (588/602), respectively (χ(2)=39.84, P<0.01). Proportions of unprotected sexual behavior among the MSM or not groups were 47.5% (285/600) and 7.4% (32/430) respectively (χ(2)=190.10, P<0.01). The proportions of 'group sex' after using drugs among the two groups were 78.1% (335/429) and 5.5% (33/600) respectively (χ(2)=573.73, P<0.01). The prevalence rates of HIV, syphilis and HCV antibody positive among the MSM or not groups were 2.1% and 0.2%, 3.3% and 6.3%, 0.0% and 0.3%, respectively. Conclusion: The prevalence of sharing new-type drugs with more than two people was high among male new-type drug users in Qingdao city. Male new-type-drug-users who were MSM, presented both high prevalence of group sex and HIV infection, and with less condom use. Intervention measures towards this sub-population should be strengthened.

Study on the prevalence of HIV infection and related risk behaviors among male new-type drug users in Qingdao, Shandong province / 中华流行病学杂志

Objective: To understand the characteristics of new-type drug consumption, sexual behaviors and the prevalence of HIV infection among male new-type drug users in Qingdao, Shandong province. Methods: A cross sectional survey was conducted from 2015 to 2016. Participants were recruited from MSM community-based organizations (CBO) and general community through snowball method, relying on volunteers and male peer educators who were on new-type drugs themselves. Face-to-face interview was carried to collect information on drug use and sexual behaviors. Blood samples were collected to test HIV, syphilis and HCV antibodies. Urine samples were collected to test the evidence of new-type drugs. Qualitative variables and quantitative variables were analyzed using Chi-square test/Fisher's exact test and Student's t-test respectively. Multivariate logistic regression was used to analyze related factors of binary variables. Results: A total of 1 034 newtype drug users were recruited, including 431 (41.7%) MSM population and 603 (58.3%) who were not MSM. Compared with the the group of people who were not MSM, people in the the MSM group were younger, unmarried and with higher level of education. The proportion of methamphetamine users were 49.7% (214/431) and 100.0% (603/603) among the groups of MSM or not MSM, respectively. People in the MSM group, 66.8% (288/431) used 5-Methoxy-N, N-diisopropyltryptamine (5-MeODIPT, "foxy" ) in the last six months. However, none from the not-MSM group ever used 5-MeO-DIPT. In the last six months, proportions of sharing new-type drugs with more than two people in the MSM or not groups were 87.9% (379/431) and 97.7% (588/602), respectively (χ(2)=39.84, P<0.01). Proportions of unprotected sexual behavior among the MSM or not groups were 47.5% (285/600) and 7.4% (32/430) respectively (χ(2)=190.10, P<0.01). The proportions of 'group sex' after using drugs among the two groups were 78.1% (335/429) and 5.5% (33/600) respectively (χ(2)=573.73, P<0.01). The prevalence rates of HIV, syphilis and HCV antibody positive among the MSM or not groups were 2.1% and 0.2%, 3.3% and 6.3%, 0.0% and 0.3%, respectively. Conclusion: The prevalence of sharing new-type drugs with more than two people was high among male new-type drug users in Qingdao city. Male new-type-drug-users who were MSM, presented both high prevalence of group sex and HIV infection, and with less condom use. Intervention measures towards this sub-population should be strengthened.

Study on the prevalence of HIV infection and related risk behaviors among male new-type drug users in Qingdao, Shandong province / 中华流行病学杂志

Objective To understand the characteristics of new-type drug consumption,sexual behaviors and the prevalence of HIV infection among male new-type drug users in Qingdao,Shandong province.Methods A cross sectional survey was conducted from 2015 to 2016.Participants were recruited from MSM community-based organizations (CBO) and general community through snowball method,relying on volunteers and male peer educators who were on new-type drugs themselves.Face-to-face interview was carried to collect information on drug use and sexual behaviors.Blood samples were collected to test HIV,syphilis and HCV antibodies.Urine samples were collected to test the evidence of new-type drugs.Qualitative variables and quantitative variables were analyzed using Chi-square test/Fisher's exact test and Student's t-test respectively.Multivariate logistic regression was used to analyze related factors of binary variables.Results A total of 1 034 new-type drug users were recruited,including 431 (41.7％) MSM population and 603 (58.3％) who were not MSM.Compared with the the group of people who were not MSM,people in the the MSM group were younger,unmarried and with higher level of education.The proportion of methamphetamine users were 49.7％ (214/431) and 100.0％ (603/603) among the groups of MSM or not MSM,respectively.People in the MSM group,66.8％ (288/431) used 5-Methoxy-N,N-diisopropyltryptamine (5-MeO-DIPT,"foxy") in the last six months.However,none from the not-MSM group ever used 5-MeO-DIPT.In the last six months,proportions of sharing new-type drugs with more than two people in the MSM or not groups were 87.9％ (379/431) and 97.7％ (588/602),respectively (x2=39.84,P＜0.01).Proportions of unprotected sexual behavior among the MSM or not groups were 47.5％ (285/600) and 7.4％ (32/430) respectively (x2=190.10,P＜0.01).The proportions of ‘group sex’ after using drugs among the two groups were 78.1％ (335/429) and 5.5％ (33/600) respectively (x2=573.73,P＜0.01).The prevalence rates of HIV,syphilis and HCV antibody positive among the MSM or not groups were 2.1％ and 0.2％,3.3％ and 6.3％,0.0％ and 0.3％,respectively.Conclusion The prevalence of sharing new-type drugs with more than two people was high among male new-type drug users in Qingdao city.Male new-type-drug-users who were MSM,presented both high prevalence of group sex and HIV infection,and with less condom use.Intervention measures towards this sub-population should be strengthened.