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*Only for medical professionals to read for reference.
Comprehensive introduction and interpretation of compound SCLC and transformative SCLC, one-click view! On April 23-24, the 2021 CSCO Guide will be held in Beijing in a combined online and offline manner.
This conference includes lung cancer, head and neck tumors, breast cancer, gynecological tumors, urinary system tumors, melanoma and sarcoma, gastrointestinal tumors, tumor nutrition therapy, hepatobiliary and pancreatic tumors, immunotoxicity and tumor-related disease management, and hematological tumors.
In 11 special sessions, well-known experts in various oncology fields in China will interpret the guidelines for various cancers in the form of lectures and reports.
At the 2021 CSCO Guidelines Conference, Professor Liu Jiwei from the First Affiliated Hospital of Dalian Medical University brought us an interpretation of the composite SCLC and transformative SCLC parts of the 2021 CSCO Small Cell Lung Cancer (SCLC) Diagnosis and Treatment Guidelines.
What is compound small cell lung cancer? Compound small cell lung cancer (C-SCLC) refers to a mixture of SCLC and non-small cell lung cancer (NSCLC) components, among which NSCLC components can be squamous cell carcinoma, adenocarcinoma, large cell neuroendocrine tumors , Spindle cell carcinoma, giant cell carcinoma, etc.
, the mixed components can be one or more.
C-SCLC accounts for about 10% of SCLC.
It is pathologically manifested.
The SCLC components are accompanied by varying amounts of other non-small cell cancer components.
The biggest feature is that they can be distinguished in morphology.
The components of composite non-small cell lung cancer should be reported in the pathology.
Noted in.
The pathological manifestations of C-SCLC C-SCLC is about 50% of peripheral lung cancer, and most of the stages are stage I-II.
C-SCLC has a greater benefit than pure small cell lung cancer (P-SCLC) in surgical treatment, but it is more beneficial than radiotherapy and chemotherapy Not sensitive, some C-SCLC using EGFR-TKI is potentially effective.The guidelines for complex small cell lung cancer recommend interpretation of the treatment of C-SCLC so far, there is still a lack of large-sample prospective randomized controlled clinical research data, most of which are small-sample retrospective analysis and case reports.
Therefore, the 2021 CSCO guidelines for C-SCLC The recommended treatment plan for the treatment of level I and II refers to pure SCLC, and the following points are recommended as level III based on the existing evidence-based medical evidence: 1.
For those with reduced lesions after C-SCLC treatment, it is recommended to conduct a multidisciplinary team diagnosis and treatment discussion.
Surgery can be considered for those who can be completely resected (category 3).
2.
For C-SCLC with adenocarcinoma components, genetic testing is recommended.
Those with positive driver gene mutations may consider targeted therapy.
3.
Encourage repeated biopsy after treatment of drug resistance.
4.
Encourage participation in clinical trials.
What is recommended by the compound SCLC guidelines as transforming small cell lung cancer? In the course of NSCLC disease, histological types can be transformed into SCLC, collectively referred to as transforming SCLC.
Transforming SCLC and classic SCLC have similarities in pathology, molecular characteristics, clinical manifestations, and drug sensitivity, but they are not completely Being classified as classic SCLC, it may be classified as a new SCLC subtype.
The diagnosis of transforming SCLC must be biopsy of tumor tissue again, and pathological diagnosis is still the gold standard.
Relying solely on genetic characteristics and plasma testing cannot reliably determine whether a patient has undergone SCLC transformation.
How does transformative small cell lung cancer occur? For the mechanism of transforming SCLC, there are currently three hypotheses: 1.
Tumor cell heterogeneity hypothesis: Pathological diagnosis based on small specimens such as needle biopsy has limitations and cannot fully reflect the overall condition of tumor tissue, that is, there are SCLC and The possibility that the two components of NSCLC exist at the same time.
2.
Tumor stem cell hypothesis: Tumor stem cells carrying sensitive gene mutations have the potential to differentiate into neuroendocrine tumor cells.
Under the exposure pressure of TKI, it is easier to transform into SCLC.
3.
Molecular mechanism hypothesis: In the treatment of TKIs, double deletion mutations of tumor suppressor genes RB1 and TP53 appeared, and they played an important role in the transformation of SCLC.
Treatment strategies for transforming small cell lung cancer For the treatment of transforming SCLC, Chapter 12 of the 2021 version of CSCO has separately recommended guidelines.
For the risk prediction of transforming SCLC, serum NSE and pro-GRP (class 3) need to be tested.
The overall treatment part is divided into three categories: systemic rapid progress, local slow progress, and system slow progress.
The treatment of transforming SCLC with rapid systematic progress can refer to the standard SCLC chemotherapy regimen (Class 3), and the treatment of locally slowly progressing transforming SCLC requires the combination of local treatment on the basis of the standard SCLC chemotherapy regimen or the continuation of the original EGFR-TKI (Class 3).
), the systemic slowly progressing transformative SCLC treatment should also be judged on the basis of the standard SCLC chemotherapy regimen as to whether the original EGFR-TKI treatment should be continued (category 3).
The transformative SCLC guidelines recommend NSCLC targeted therapy drug resistance mechanisms.
The 2021 version of the CSCO guidelines for transformative SCLC completes the overall incidence of transformative SCLC and updates detailed data on the median time.
The case reports of C-SCLC after ALK, ROS-1 and immunotherapy resistance have been added, and the related pathways of C-SCLC gene deletion and mutation characteristics have also been systematically updated and supplemented.
The following is a complete introduction to C-SCLC, one of the resistance mechanisms of NSCLC targeted therapy in the 2021 edition of the CSCO Guidelines.
1.
EGFR-TKI: It mainly occurs in patients with EGFR-sensitive mutations and drug-resistant lung adenocarcinoma after EGFR-TKI treatment.
The incidence rate is 5%-14%.
It usually occurs 14-26 months after TKIs treatment, with a median The time is 18 months.
2.
ALK, ROS-1 and immunotherapy: There are case reports suggesting that transforming SCLC can also occur in NSCLC patients who are positive for ALK or ROS-1 fusion gene after receiving TKI treatment, and NSCLC after receiving immune checkpoint inhibitor treatment. 3.
Most transforming SCLC retain the original lung adenocarcinoma gene mutations (about 84%-88%) and SCLC gene features such as TP53 and RB1 deletion mutations; these features may be related to PIK3CA, NOTCH and ASCL1 genes Path related.
Once a patient undergoes SCLC transformation, the disease often progresses quickly, and the overall prognosis is poor, with a median survival time of 6.
0 to 10.
9 months.
Comprehensive introduction and interpretation of compound SCLC and transformative SCLC, one-click view! On April 23-24, the 2021 CSCO Guide will be held in Beijing in a combined online and offline manner.
This conference includes lung cancer, head and neck tumors, breast cancer, gynecological tumors, urinary system tumors, melanoma and sarcoma, gastrointestinal tumors, tumor nutrition therapy, hepatobiliary and pancreatic tumors, immunotoxicity and tumor-related disease management, and hematological tumors.
In 11 special sessions, well-known experts in various oncology fields in China will interpret the guidelines for various cancers in the form of lectures and reports.
At the 2021 CSCO Guidelines Conference, Professor Liu Jiwei from the First Affiliated Hospital of Dalian Medical University brought us an interpretation of the composite SCLC and transformative SCLC parts of the 2021 CSCO Small Cell Lung Cancer (SCLC) Diagnosis and Treatment Guidelines.
What is compound small cell lung cancer? Compound small cell lung cancer (C-SCLC) refers to a mixture of SCLC and non-small cell lung cancer (NSCLC) components, among which NSCLC components can be squamous cell carcinoma, adenocarcinoma, large cell neuroendocrine tumors , Spindle cell carcinoma, giant cell carcinoma, etc.
, the mixed components can be one or more.
C-SCLC accounts for about 10% of SCLC.
It is pathologically manifested.
The SCLC components are accompanied by varying amounts of other non-small cell cancer components.
The biggest feature is that they can be distinguished in morphology.
The components of composite non-small cell lung cancer should be reported in the pathology.
Noted in.
The pathological manifestations of C-SCLC C-SCLC is about 50% of peripheral lung cancer, and most of the stages are stage I-II.
C-SCLC has a greater benefit than pure small cell lung cancer (P-SCLC) in surgical treatment, but it is more beneficial than radiotherapy and chemotherapy Not sensitive, some C-SCLC using EGFR-TKI is potentially effective.The guidelines for complex small cell lung cancer recommend interpretation of the treatment of C-SCLC so far, there is still a lack of large-sample prospective randomized controlled clinical research data, most of which are small-sample retrospective analysis and case reports.
Therefore, the 2021 CSCO guidelines for C-SCLC The recommended treatment plan for the treatment of level I and II refers to pure SCLC, and the following points are recommended as level III based on the existing evidence-based medical evidence: 1.
For those with reduced lesions after C-SCLC treatment, it is recommended to conduct a multidisciplinary team diagnosis and treatment discussion.
Surgery can be considered for those who can be completely resected (category 3).
2.
For C-SCLC with adenocarcinoma components, genetic testing is recommended.
Those with positive driver gene mutations may consider targeted therapy.
3.
Encourage repeated biopsy after treatment of drug resistance.
4.
Encourage participation in clinical trials.
What is recommended by the compound SCLC guidelines as transforming small cell lung cancer? In the course of NSCLC disease, histological types can be transformed into SCLC, collectively referred to as transforming SCLC.
Transforming SCLC and classic SCLC have similarities in pathology, molecular characteristics, clinical manifestations, and drug sensitivity, but they are not completely Being classified as classic SCLC, it may be classified as a new SCLC subtype.
The diagnosis of transforming SCLC must be biopsy of tumor tissue again, and pathological diagnosis is still the gold standard.
Relying solely on genetic characteristics and plasma testing cannot reliably determine whether a patient has undergone SCLC transformation.
How does transformative small cell lung cancer occur? For the mechanism of transforming SCLC, there are currently three hypotheses: 1.
Tumor cell heterogeneity hypothesis: Pathological diagnosis based on small specimens such as needle biopsy has limitations and cannot fully reflect the overall condition of tumor tissue, that is, there are SCLC and The possibility that the two components of NSCLC exist at the same time.
2.
Tumor stem cell hypothesis: Tumor stem cells carrying sensitive gene mutations have the potential to differentiate into neuroendocrine tumor cells.
Under the exposure pressure of TKI, it is easier to transform into SCLC.
3.
Molecular mechanism hypothesis: In the treatment of TKIs, double deletion mutations of tumor suppressor genes RB1 and TP53 appeared, and they played an important role in the transformation of SCLC.
Treatment strategies for transforming small cell lung cancer For the treatment of transforming SCLC, Chapter 12 of the 2021 version of CSCO has separately recommended guidelines.
For the risk prediction of transforming SCLC, serum NSE and pro-GRP (class 3) need to be tested.
The overall treatment part is divided into three categories: systemic rapid progress, local slow progress, and system slow progress.
The treatment of transforming SCLC with rapid systematic progress can refer to the standard SCLC chemotherapy regimen (Class 3), and the treatment of locally slowly progressing transforming SCLC requires the combination of local treatment on the basis of the standard SCLC chemotherapy regimen or the continuation of the original EGFR-TKI (Class 3).
), the systemic slowly progressing transformative SCLC treatment should also be judged on the basis of the standard SCLC chemotherapy regimen as to whether the original EGFR-TKI treatment should be continued (category 3).
The transformative SCLC guidelines recommend NSCLC targeted therapy drug resistance mechanisms.
The 2021 version of the CSCO guidelines for transformative SCLC completes the overall incidence of transformative SCLC and updates detailed data on the median time.
The case reports of C-SCLC after ALK, ROS-1 and immunotherapy resistance have been added, and the related pathways of C-SCLC gene deletion and mutation characteristics have also been systematically updated and supplemented.
The following is a complete introduction to C-SCLC, one of the resistance mechanisms of NSCLC targeted therapy in the 2021 edition of the CSCO Guidelines.
1.
EGFR-TKI: It mainly occurs in patients with EGFR-sensitive mutations and drug-resistant lung adenocarcinoma after EGFR-TKI treatment.
The incidence rate is 5%-14%.
It usually occurs 14-26 months after TKIs treatment, with a median The time is 18 months.
2.
ALK, ROS-1 and immunotherapy: There are case reports suggesting that transforming SCLC can also occur in NSCLC patients who are positive for ALK or ROS-1 fusion gene after receiving TKI treatment, and NSCLC after receiving immune checkpoint inhibitor treatment. 3.
Most transforming SCLC retain the original lung adenocarcinoma gene mutations (about 84%-88%) and SCLC gene features such as TP53 and RB1 deletion mutations; these features may be related to PIK3CA, NOTCH and ASCL1 genes Path related.
Once a patient undergoes SCLC transformation, the disease often progresses quickly, and the overall prognosis is poor, with a median survival time of 6.
0 to 10.
9 months.
