Gain insights into the latest advances in precision targeted therapy of lung cancer, and talk about the "good strategy" for coping with TP53 mutant lung cancer CACA Jing Rui Academy

*Only for medical professionals to read for reference.
Follow the latest advances in precision targeted therapy of lung cancer such as ASCO, and solve the problem of TP53 mutant EGFR+ lung cancer treatment
.

 On June 5, 2021, the National Conference of Jingrui College of "Traveling Thousands of Miles and Achieving the Lungs" was successfully held in the form of online connection.
This conference was fortunate to invite Professor Cang Shundong from Henan Provincial People's Hospital and Chen Yunfang from Zhumadian Central Hospital Professor Li Guanghui from Zhumadian Hospital of Traditional Chinese Medicine served as the chair of the conference.
Professor Yunfang Chen served as the chair of the first half, and Professor Li Guanghui served as the chair of the second half.
He collaborated with many experts and scholars in the field of lung cancer across the country, combined with the relevant 2021 American Society of Clinical Oncology (ASCO) annual meeting.
Achievements, focusing on the latest progress in precision targeted therapy of lung cancer-how to treat EGFR-positive advanced non-small cell lung cancer (NSCLC) with TP53 mutation? What are the applications and prospects of companion diagnostic technology for lung cancer? What are the research advances of long non-coding RNA (lncRNA) in lung cancer? How can real-world data guide clinical practice? Top experts conducted wonderful sharing and exchanges around the above topics
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 Professor Cang Shundong said in his opening speech: "This conference has invited a number of'cross-border' experts and scholars outside the field of oncology to bring substantive new gains to colleagues on related issues and guide clinical practice.
Treatment concept and scientific research work
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"Focusing on the progress of TP53 mutation diagnosis and treatment, leading to a new level of EGFR-positive precision therapy▍Professor Qin Yidan: The prospect of lung cancer companion diagnosis is broad, and NGS helps achieve precision diagnosis and treatment.
Professor Qin Yidan of Invitae Gene Sequencing Company shared the current application of clinical lung cancer companion diagnosis technology And development prospects, the current foreign genetic testing can be roughly divided into two modes, namely in vitro companion diagnosis (CDx) and clinical laboratory self-built (LDT).
The development process, regulatory authorities, and use methods of the two modes are different, but are to achieve precise diagnostics and service, and the existing detection methods including polymerase chain reaction (PCR), second-generation sequencing (NGS), immunohistochemistry (IHC) and so on
.

 NGS position in the detection of lung cancer in recent years gradually rise High, the primary analysis of NGS detection should consider the included genes, sequencing depth and coverage uniformity, sensitivity, specificity and other factors, while the secondary analysis needs to consider the specific location of the mutation, allele frequency, and the effect of the mutation on the protein function.
The third-level analysis is to interpret the significance and impact of gene mutations on clinical practice, provide evidence of medication (guideline recommendations or supporting literature for drugs beyond indications) or eligibility for clinical trial selection, and consider all mutations and Biomarkers in the sample, and pass The three-level analysis accurately interprets the clinical value in order to maximize the significance of NGS detection
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There are many common types of mutations in tumors.
Among them, cross-replication mutations, inversion mutations, translocation mutations, copy number mutations and other types are difficult to detect.
Only detection DNA may have limitations, so if necessary, RNA sequencing should be added to detect splicing defects, fusion genes, etc.
, and try to provide patients with treatment opportunities.
For example, the Biomarker currently required to be tested for NSCLC already includes ALK/ROS1/RET /NTRK and other fusion genes
.
The
 promotion of the application of NGS in NSCLC detection is also related to many factors.
For example, sensitive mutations such as EGFR have obvious clinical heterogeneity, such as rare mutations, multiple different mutations at a single site, and gene polymorphism ( C797S cis/trans mutations), etc.
, need to be as detailed as possible to guide the treatment; at the same time, the NGS detection panel can include multiple genes and Biomarkers, which can comprehensively evaluate the prognosis and transformation risk of patients, and also help to find genetic cancer related Biomarker
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If conditions exist in clinical work, the drug-resistant patients should be re-tested to clarify the cause of drug-resistant
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 After guiding the selection of precise treatment drugs, NGS testing is also expected to be based on ctDNA, minimal residual disease (MRD) and other items, to individually predict the patient’s progression-free survival (PFS), overall survival (OS) and other curative effects, and try to treat Austria The resistance mechanism of new targeted drugs such as sitinib is predicted, but related research is still in its infancy, and new detection methods, detection markers, and detection-related software and hardware systems also need continuous improvement
.

  ▍Professor Fang Wenfeng: How to optimize the treatment plan for EGFR-positive advanced NSCLC with TP53 mutation? Professor Fang Wenfeng from the Cancer Center of Sun Yat-sen University introduced the progress in the first-line treatment of EGFR-positive advanced NSCLC with TP53 mutation
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At present, TKI drugs have become the preferred first-line treatment for EGFR-positive advanced patients, but most patients will still develop resistance.
Further cracking the resistance mechanism is the key to improving the effect of targeted therapy, including co-mutations in patients
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More than 90% of EGFR-positive patients have co-mutations, and the type and number of co-mutations have a significant impact on treatment response and resistance mechanisms.
However, the current EGFR-targeted therapy in clinical practice has not fully taken co-mutations into consideration
.

 For example, the Benefit study carried out by Chinese scholars showed that the median PFS of patients with combined driver gene mutations receiving first-line treatment with gefitinib was significantly shortened
.

Co-mutations can generally be divided into two categories.
One is the mutation of EGFR, MET, TP53 and other driver genes that cancer cells have in the early stage of tumor development, which may lead to primary drug resistance; the other is the genetic level of the anti-tumor treatment process.
"Pressure selection" to make more subclonal gene changes in cancer cells is related to the potential mechanism of acquired drug resistance
.

  TP53 is one of the most common co-mutations.
Some studies have reported that the proportion of EGFR-positive patients with TP53 mutations can reach 50%-60%.
A number of clinical and real-world research data have confirmed that combined TP53 mutations are the first, second, and third generations.
An important factor for the poor prognosis of EGFR-TKI treatment.
Among them, the mutation of TP53 exon 8 may be related to the special insensitivity to EGFR-TKI treatment.
Patients with OS and PFS are relatively short in first-line and later-line, single-drug or combination therapy.
, Especially for people with Del19 mutation, so TP53 exon 8 mutation may be involved in the primary resistance of EGFR-TKI
.

  Previous clinical studies did not specifically consider TP53 mutations in terms of entry and discharge criteria, but retrospective analysis of some studies also suggested the impact of TP53 gene
.

For example, in the RELAY study using erlotinib + ramucirumab as the first-line treatment, baseline sequencing showed that 43% of patients had TP53 mutations.
Such patients would benefit more from the combination therapy; Chinese scholars led the development of ACTIVE, ALTER-L004 and other studies have also shown that patients with co-mutations are more suitable for combination therapy.
For example, in the ACTIVE study using gefitinib + apatinib as the first-line treatment, patients with TP53 exon 8 mutations have greater therapeutic benefits (PFS HR=0.
24) )
.

  In addition to the use of anti-angiogenic drugs, EGFR-TKI combined with chemotherapy is also expected to become the preferred treatment strategy for patients with co-mutation of TP53.
For example, a prospective study published by the World Lung Cancer Conference (WCLC) in 2020 in China included 82 EGFR patients.
Among the mutation patients, 24 cases (29.
3%) had co-mutations such as TP53 and KRAS.
The median PFS of patients using first-generation TKI+pemetrexed chemotherapy was up to 15.
8 months, which was significantly better than the 5.
0 months of patients using TKI only (p =0.
035), while the addition of chemotherapy to patients without co-mutation did not bring significant PFS benefit
.

  A retrospective analysis of the European Lung Cancer Conference (ELCC) in 2021 showed that young EGFR-positive patients with mutation type Del19 have a higher proportion of co-mutations such as TP53, while tumors without co-mutations are more likely to have bone and lymph node metastasis (P=0.
006/0.
026)
.

In addition, in the age of NGS testing, the evaluation of the prognosis of patients with co-mutations requires consideration of the number of co-mutations.
Another retrospective study of WCLC in China in 2020 showed that for patients receiving osimertinib after-line therapy, the total number of mutations ≤4.
No TP53 mutation or EGFR amplification may be related to the longer treatment of PFS with osimertinib
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  Based on the above clinical evidence, TP53 co-mutation, especially exon 8 mutation, has a significant impact on the efficacy of EGFR-TKI.
Combination therapy with EGFR-TKI as the core may be more suitable for such patients, but precise identification of co-mutation types is required In order to achieve a truly individualized treatment, it is necessary to carry out clinical studies specifically for patients with co-mutation.
For example, the Sun Yat-sen University Cancer Center has launched a special enrollment of TP53 co-mutation EGFR-positive patients, using osimertinib + containing The clinical phase III study of platinum dual-agent chemotherapy first-line combination therapy, the efficacy data is worth looking forward to
.

 Based on the application of existing drugs for combination therapy, new drugs that specifically target TP53 mutations have also made progress in recent years.
For example, the Johns Hopkins University team published three articles in the "Science" series of journals in 2021, introducing new types of drugs.
Targeting TP53 bispecific antibody; Based on the "synthetic lethal" idea, WEE1 inhibitor AZD1775, etc.
, which sensitizes TP53 mutant cancer cells to chemotherapy, has an objective response rate (ORR) of 21% for AZD1775 in the treatment of TP53 mutant patients; in addition; There are also a variety of new drugs that directly or indirectly target TP53 mutations, which have entered the clinical phase I/II phase of research
.

 The first half of the discussion session discussed the core issues: 1.
How should genetic testing be carried out in clinical practice? How does the guide recommend? 2.
Among the common genetic testing methods, which is the most clinically needed? How to choose the detection time node? 3.
What are the current companion diagnoses for EGFR-positive patients? How to choose a treatment plan based on the co-mutation situation? Professor Li Changsheng from Nanyang Central Hospital: Co-mutation is still a "new thing" for many clinicians, but this can also explain the poor response of many patients to EGFR-TKI treatment in clinical practice, and the discovery of co-mutation must rely on NGS And other new detection methods, try to avoid missed detection
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In terms of detection time nodes, it is basically a clinical consensus that the detection before the initial treatment and the second detection after the drug resistance have been established
.

 Professor Feng Ji, Xinyang Central Hospital: The scope of NGS testing also takes into account factors such as the availability of existing drugs and the economic conditions of patients.
For example, in addition to EGFR/ALK mutations, the only rare mutations in lung cancer that have approved drugs in China are RET rearrangement, BRAF V600E mutation-related drugs have been approved, and the significance of expanding the scope of testing is open to question.
However, some genes known to be related to the efficacy and super progress of immunotherapy should also be tested.
At the same time, attention should be paid to standardize the conditions for conducting genetic testing according to the guidelines.

.

 Professor Tian Chuntao of Sanmenxia Central Hospital: For co-mutations in EGFR-positive patients, the impact of specific mutations should be analyzed.
For example, the mutation of TP53 exon 8 has been identified as a predictor of poor response to EGFR-TKI treatment, and first-line treatment may be required Choose a combination therapy with EGFR-TKI as the core
.

In addition, RB1, PTEN and other mutations suggest the tendency to transform into small cell lung cancer.
Prospective studies have been conducted to explore the value of osimertinib plus chemotherapy
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The previous method of relying on PCR to confirm the initial targeted therapy of EGFR mutations has been slightly insufficient, and NGS testing should be carried out on newly treated patients when conditions permit
.

 Professor Cang Shundong, Henan Provincial People’s Hospital: The 2021 Chinese Society of Clinical Oncology (CSCO) NSCLC diagnosis and treatment guidelines are expected to further expand the genetic testing recommendations, adding BRAF V600E, NTRK fusion, c-MET and KRAS and other genes, but in the short term due to the speed of testing and In terms of accessibility, it is still difficult to promote NGS testing in primary hospitals.
Clinical practice needs to consider the treatment needs of patients, and it needs to be monitored reasonably while following the guidelines
.

 2021 ASCO targeted therapy for lung cancer is "fruitful"; real-world data provide important reference for clinical practice ▍Professor Jianjun Luo: What impact does long non-coding RNA currently have on cancer diagnosis and treatment? Professor Jianjun Luo from the Institute of Biophysics of the Chinese Academy of Sciences introduced the discovery process of human long-chain non-coding RNA (lncRNA), as well as the status and progress of its functional research in cancer and other diseases
.

 lncRNA is also known as the "dark matter" in the genome.
The proportion of non-coding sequences in the genome in the biological world is generally proportional to the complexity of the organism.
Although it is not involved in protein coding, lncRNA can still affect protein, DNA and RNA in many ways.
, So as to play a variety of biological effects
.

  At present, a number of specialized lncRNA databases have been established internationally, and the expression characteristics of lncRNA in different diseases can be obtained through NGS and other sequencing methods to record and predict its function.
With the help of bioinformatics methods, it is expected to further explore the value of data, such as existing research and use The three lncRNA characteristics measured on more than 200 patient samples predict the overall survival of patients with esophageal squamous cell carcinoma
.

The data and samples accumulated by clinicians through diagnosis and treatment are expected to provide key materials for future related explorations
.

 Most lncRNA-related research is at the stage of laboratory-to-clinical transformation, and mature testing products are limited at home and abroad.
NGS testing panels generally do not include lncRNA, but the non-coding region where lncRNA is located may also have various changes that affect the function of the encoded protein.
For example, mutations in the enhancer region may regulate the expression of target genes, affect protocarcinoma or tumor suppressor genes, and change the risk of some diseases.
The significance of these changes still needs to be clarified by a large number of basic and translational studies
.

 ▍Professor Liu Yutao: 2021 ASCO lung cancer targeted therapy new progress Professor Liu Yutao from the Cancer Hospital of the Chinese Academy of Medical Sciences interpreted the report data related to the 2021 ASCO annual meeting with EGFR-positive early and late patients, and other targeted precision treatments
.

 (1) The success of the ADAURA study of targeted therapy for EGFR-positive early and mid-term patients has allowed osimertinib to be used as an adjuvant treatment for early-stage EGFR-positive patients.
It has been recommended by authoritative guidelines such as NCCN in the United States and a new analysis (Abstract #8525) That is, based on the ADAURA research data, the pharmacoeconomics study of treatment was carried out, and it is believed that the treatment of osimertinib is cost-effective, and the benefit for stage II patients is more significant
.

  Gefitinib and other first-generation EGFR-TKIs are used for postoperative adjuvant treatment.
In recent years, a number of relevant clinical research results have been announced.
At this ASCO annual meeting, Chinese scholars announced the prospective phase II EVAN of erlotinib treatment by Chinese scholars.
Research data (Abstract #8520), for EGFR-positive patients at stage IIIA, erlotinib adjuvant therapy significantly prolonged the median OS (84.
2 months vs.
61.
1 months, HR=0.
318) compared with standard chemotherapy, both groups The 5-year survival rates were 84.
8% and 51.
1%, respectively, suggesting a clear survival benefit
.

 The ICOMARE study (Abstract #8521) of Chinese scholars using icotinib for postoperative adjuvant treatment showed that for patients with stage II-IIIA, extending the time of icotinib adjuvant treatment from 1 year to 2 years can effectively reduce postoperative For the risk of recurrence or distant metastasis, the median DFS in the 2-year adjuvant therapy group can reach 48.
92 months, which is significantly better than the 32.
89 months in the 1-year group.
The optimal duration of adjuvant therapy still needs to be further clarified
.

The IMPACT study (Abstract #8501) of Japanese scholars using gefitinib as adjuvant therapy did not show a clear benefit of DFS and OS
.

  Neoadjuvant therapy is another important direction explored in recent years.
The NEOS study (Abstract #8524) announced at this ASCO annual meeting evaluated the efficacy and safety of osimertinib neoadjuvant therapy for 6 weeks in patients with stage II-IIIB , The effective rate (RR) of 15 patients with evaluable curative effect was 73.
3%, 14 patients could complete surgical resection, 8 patients achieved pathological decline, 1 patient achieved pathological complete remission (pCR), and no treatment Report more serious adverse events
.

 The CTONG 1103 study (Abstract #8502) carried out by Chinese scholars used erlotinib neoadjuvant therapy, compared with gemcitabine + cisplatin for IIIAN2 EGFR-positive patients.
There was no significant difference in the final OS benefit between the two groups, but the study OS data It was also significantly affected by the back-line treatment
.

  (2) Targeted therapy for EGFR-positive advanced NSCLC patients The first-generation EGFR-TKI is still continuing to explore the combination therapy, such as the NEJ009 study, which uses gefitinib + platinum-containing dual-drug chemotherapy as the first-line treatment for advanced patients, Yu Ben The latest efficacy data (Abstract #9081) was updated at the ASCO annual meeting.
The PFS and PFS2 of the gefitinib + chemotherapy group are still better than the gefitinib single-agent group, but there is no significant difference in OS between the two groups, and the treatment safety is acceptable In the phase II study (Abstract #9030) of the anti-angiogenic drug Anlotinib combined with Gefitinib/Icotinib, the median PFS of the patients reported reached 13 months, and the combined treatment ORR could reach 78%
.

  The clinical exploration of the new EGFR-TKI continues to be carried out rapidly.
For example, the results of the Phase III clinical study of the first-line treatment of ametinib (Abstract #9013) showed that the first-line median PFS of ametinib was significantly better than that of gefitinib (19.
3 months vs.
9.
9 months, HR=0.
46), which is close to the PFS of osimertinib, and the median duration of response (DoR) is also significantly prolonged
.

The small molecule inhibitor DZD9008 developed specifically for EGFR exon 20ins (EGFR exon20ins) has also performed well in early clinical studies.
The ORR of the 300mg dose group was 48.
4% (Abstract #9008)
.

 EGFR exon20ins has always been a difficulty in EGFR targeted therapy, and it is also an area where new drugs and new strategies have been intensively explored.
The US FDA has approved the bispecific antibody Amivantamab for the treatment of such patients
.

The Phase II AFACET study (Abstract #9112) announced at the ASCO annual meeting also showed that the combination of afatinib and cetuximab has a certain effect on patients with EGFR exon20ins, with ORR up to 47% (8/18).
The PFS was 5.
5 months
.

 (3) Progress in other target-targeted therapies Should the sequential "1+2 plan" or the direct use of second-generation drugs be used in ALK mutation-targeted therapy, it is still a major clinical controversy.
Japan announced at this ASCO annual meeting.
The J-ALEX study (Abstract #9022) explored the efficacy of aletinib versus crizotinib in the first-line treatment of patients with ALK mutations.
The aletinib group did not show significant advantages in median OS and 5-year OS rates
.

This may be related to the cross-use of aletinib in the study of nearly 80% of patients in the crizotinib group
.

  In the J-ALTA study expansion cohort (Abstract #9042) of brigatinib first-line treatment of Japanese patients, the ORR of the treatment can reach 97%, and the PFS rate of patients at 12 months is 93%, showing significant efficacy and good safety; The final data of the dose-climbing ALTA study (Abstract #9071) showed that the dose can be increased to 180 mg after seven days of treatment with brigatinib for crizotinib-resistant patients who tolerate this dose, the ORR of the treatment, Both PFS and OS have improved
.

  In terms of MET gene abnormalities, both Tepotinib and Capmatinib have updated efficacy data at this ASCO annual meeting.
For example, Tepotinib treatment of patients with brain metastases with MET exon 14 jumping mutations (MET ex14+) at baseline has an ORR of 47.
8% (Abstract #9084 ), the overall ORR of patients treated with MET amplification reached 42%, of which 7 patients received first-line treatment and 5 patients achieved remission (Abstract #9021); Capmatinib was used in the GEOMETRY mono-1 study expansion cohort 7 (Abstract #9020) to treat naive patients The median PFS can reach 10.
8 months, which is consistent with previous data
.

  Two new targeted drugs, Selpercatinib (LOXO-292) and Pratinib (BLU-667) for the treatment of patients with RET rearrangement, and Larotrectinib (Larotrectinib) for the treatment of NTRK fusion continue to maintain good efficacy data regardless of initial treatment Still treated patients, ORR, PFS and other efficacy indicators are significantly improved compared with the original chemotherapy; the new ROS1/NTRK inhibitor Taletrectinib has been carried out in China a phase II clinical study (Abstract #9066) to treat 15 cases of ORR in ROS1 fusion-naive patients Up to 93%, the follow-up effect is also worth looking forward to
.

 ▍Professor Zhuo Minglei: From the perspective of a clinician, Professor Minglei Zhuo from Peking University Cancer Hospital explained the application of real-world data from the perspective of a clinician, combined with existing data and personal thinking
.

 (1) The necessity of real-world research.
The concept of evidence-based medicine has profoundly affected medical clinical practice and research.
At present, there is an evidence-based medicine research system consisting of randomized controlled trials (RCT), cross-sectional studies, observational studies, and diagnostic studies.
However, various studies also have their shortcomings.
For example, the external authenticity of the gold standard RCT study is relatively low, and the results are difficult to generalize to the real world population, only the short-term efficacy and common adverse reactions can be observed, and excessive attention is paid to drugs and diseases rather than patients.
Etc.
, RCT cannot be equated with clinical practice
.

 In order to solve the deficiencies of the original research, real-world data, research and evidence came into being.
The real-world data sources are very wide, including observational research, interventional research based on real medical conditions or non-researched medical insurance, database and other sources.
After analysis, it is transformed into real-world evidence
.

In order to obtain high-quality real-world evidence, it is also necessary for data sources to be authentic and reliable, real-world research and design are rigorous, and statistical analysis is correct.
China has already issued relevant guiding guidelines and expert consensus
.

  (2) Aspects of real-world research.
Real-world research has various forms, including prospective patient registration studies, retrospective studies based on existing databases, case-control studies, etc.
, which are significantly different from traditional RCTs, and different studies have their own advantages and disadvantages.
The scope of application requires attention to relevant issues when conducting research to eliminate bias and improve the level of evidence in real-world research
.

 High-quality real-world studies can be mutually verified and complementary to the data obtained by RCTs.
For example, the clinical Phase II BENEFIT study carried out in China used the EGFR mutation level detected by ctDNA to identify patients who benefited from first-line treatment with gefitinib.
The EGFR mutation status has obvious heterogeneity and can be used to guide the use of targeted drugs.
The conclusion of this study was quickly confirmed by another domestic real-world study (JAMA Oncology, 2018 May 1, 739-742)
.

  In the FLAURA study of the first-line treatment of osimertinib and the study of the second-line treatment AURA3, the detection of ctDNA in drug-resistant patients indicated that the detection rate of MET amplification was more than 15%
.

With the increase in the use of osimertinib in China, Chinese scholars have also reported on the detection of drug resistance in the real world.
Analysis shows that the compound drug resistance gene variation accounts for about 9%, which supplements the lack of clinical research data
.

Combining evidence-based medical evidence with personal experience, and avoiding the limitations of single-center retrospective research through solidarity and collaboration, will be the basis for providing high-quality real-world research evidence
.

  In the second half of the discussion session, the core issues were discussed: 1.
Do grassroots doctors need to do scientific research? What kind of scientific research does the doctor want to do? 2.
How do you view the scientific research ideas and results brought about by the real-world clinical research of lung cancer? 3.
How to better manage patients with EGFR mutations, ALK fusion mutations, and ROS1 mutations? Professor Du Min from Zhengzhou Traditional Chinese Medicine Hospital: It is difficult for grassroots doctors to carry out scientific research in reality.
They need to have full interest and motivation in scientific research in addition to daily clinical medical activities
.

However, limited by the platform and environment, the most suitable way of scientific research is mainly retrospective research
.

The general conditions for enrollment in real-world studies are relatively loose, which has a good guiding significance for primary diagnosis and treatment
.

The optimal plan of targeted therapy needs to consider practical issues such as medical insurance.
For example, the first-generation + third-generation EGFR-TKI combination therapy is currently difficult to promote in clinical practice
.

 Professor Liu Hongbo, First People's Hospital of Zhumadian City: In addition to retrospective analysis, grassroots doctors can also summarize typical cases in clinical work, sort out treatment ideas and methods, and compare them with evidence from clinical studies recommended in the guidelines
.

Even in primary hospitals, comprehensive and comprehensive standardized genetic testing should be established to guide patients with precise treatment of EGFR mutations
.

 Professor Minglei Zhuo from Peking University Cancer Hospital: Primary hospitals may consider setting up special "targeted/immunotherapy clinics" to summarize and evaluate the drug monitoring, adverse reaction management, and subsequent treatment options of various types of patients.
Experience improves the level of diagnosis and treatment
.

These recorded data can also be used for future scientific research, especially to collect information on patients with rare mutations
.

 Professor Liu Yutao, Cancer Hospital, Chinese Academy of Medical Sciences: Real-world evidence is important information for guiding the medication of patients with rare lung cancer mutations such as ALK and ROS1.
However, it is limited by the number and quality of patients treated in each center.
The level of evidence from a single center is relatively limited and accumulated Data takes a long time, and the case information provided by basic hospitals through electronic systems can provide important data sources for large hospitals to carry out relevant analyses, bringing the sample size close to the level of phase III clinical research
.

 Professor Wang Pengyuan from Xuchang Central Hospital: By clarifying the design ideas and purpose of real-world research, and completely recording the situation of treated patients, real-world research can be designed without excessive sample size, such as the one submitted by my team at this ASCO annual meeting.
Anlotinib is used in a study of patients with slow progress after first-line treatment with gefitinib (Abstract #e21089), and prospective real-world studies have higher requirements for investigators due to the need for intervention
.

 Finally, Professor Cang Shundong from Henan Provincial People's Hospital summarized the meeting
.

Professor Cang Shundong said that the level of precision treatment of lung cancer in China in 2021 has been greatly improved compared with 10 years ago, and the learning focus of grassroots clinicians should also gradually shift from standardized treatment and multidisciplinary diagnosis and treatment to new scientific research ideas and new clinical models.
Possess good scientific research thinking, apply a large number of cases in daily diagnosis and treatment work, cooperate with high-level centers to carry out exploratory research, and ignite the "spark fire" of grassroots scientific research to truly promote the management of patients with mutations such as EGFR, ALK, and ROS1
.

*This article is only used to provide scientific information to medical professionals, and does not represent the views of this platform