Pay attention to the precise diagnosis and treatment of rare mutations, and start a new journey of integrated diagnosis and treatment in the targeted outpatient clinics

*Only for medical professionals to read and reference, fully implement precise diagnosis and treatment, and pay attention to rare mutation treatment! With the development of precision therapy, tumor driver genes are constantly being discovered, and the types of targeted drugs are increasing.
Research on targeted drugs is expanding the treatment population from "common mutation targets" to "rare mutation targets"
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"Rare mutations" refer to targets with a low detection rate.
For "large" cancers like lung cancer, even for rare mutations, there are tens of thousands of new patients every year.
Such patients are still worthy of attention
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Based on this, on March 18, 2021, the Lung Cancer Rare Mutation Targeting Clinic of Beijing Hospital was officially opened
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The Medical Oncology Channel invited Professor Li Lin from Beijing Hospital to share opinions on related topics
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"Rare mutations", it is not uncommon to talk about the original intention of the rare mutation targeted outpatient clinic for lung cancer.
Professor Li Lin said, "In recent years, the precision diagnosis and treatment of lung cancer has continued to develop, from the initial widespread concern of EGFR, ALK, ROS1, etc.
Targets, some other driver genes are gradually discovered in the clinic.
These targets have corresponding targeted drugs, although their mutation frequency is not so high, the audience is relatively small, and they are often ignored
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For example, MET14 exon skipping The incidence of mutations in advanced non-small cell lung cancer (NSCLC) is 1%-3%, but in the large population base of lung cancer, this gene abnormality is actually not uncommon in clinical practice
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MET pathway abnormalities in NSCLC are mainly manifested as MET14 Exon skipping mutation and MET amplification, the former is the primary driver gene of lung cancer, and the latter is the main cause of resistance to EGFR targeted therapy
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Therefore, the diagnosis and treatment of abnormal MET pathway is very important in clinical practice.
It is one of the pathogenic factors of lung cancer and also a factor that causes the progress of EGFR-targeted drugs
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Whether it is from the development of medicine or from the perspective of doctors and patients, it is particularly necessary to pay attention to such a rare group as MET, BRAF, and NTRK
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With the support of the hospital, the Lung Cancer Rare Mutation Targeted Clinic will be opened on March 18, 2021, so that patients can receive scientific treatment guidance and precise treatment services
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It is of special significance to patients, doctors, the development of lung cancer diagnosis and treatment, and the entire medical community
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 Accurate diagnosis helps precise diagnosis and treatment of rare mutations.
Professor Li Lin pointed out that for patients who come to the outpatient clinic for rare mutations of lung cancer, first are lung cancer patients, and secondly, they need to have a genetic test report that proves to carry "rare mutations", based on the results of genetic testing of pathological tissues, It is the basis of precision treatment
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In recent years, genetic testing technology has continued to develop.
From the initial detection of only a few genes such as EGFR, ALK, and ROS1, to the direct detection of more than 10 genes, it has now developed to the detection of larger panels.
The genetic detection of large panels can detect There are many small targets such as MET and RET, but the genetic testing platform must have nationally recognized qualifications, and the test results are more reliable
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Accurate detection of the mutation target can be followed for precise treatment.
Many patients with "rare mutations" are clinically available, and the effective rate of targeted therapy is very high
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Due to the relatively small audience, it takes a certain process from drug research and development, clinical trials to marketing
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For example, for MET14 exon skipping mutations, Syvotinib has shown good clinical efficacy.
In a case of Syvotinib in the treatment of MET14 exon skipping mutations in pulmonary sarcomatoid carcinoma (PSC) and other types of NSCLC The results of the Chinese multi-center, single-arm Phase II clinical trial of safety and safety were announced at the 2020 American Society of Clinical Oncology (ASCO) Annual Meeting.
The independent review committee (IRC) evaluated the objective response rate (ORR) of 49.
2%.
The control rate (DCR) was 93.
4%, and the median duration of response (DOR) reached 9.
6 months
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In this regard, the National Medical Products Administration (NMPA) of China also officially included the new drug listing application of Syvotinib for priority review in 2020
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 Integrate medical resources and realize the integration of diagnosis and treatment of rare lung cancer mutations.
In order to better serve patients, Beijing Hospital has established an integrated lung cancer diagnosis and treatment center.
Professor Li Lin introduced that the integrated diagnosis and treatment center of lung cancer has two meanings: first, it is the allocation of diagnosis and treatment resources.
Integration, Lung Cancer Diagnosis and Treatment Integration Center is a multi-disciplinary cooperation, integrating the advantages of multiple disciplines of lung cancer sub-specialists such as internal medicine, surgery, radiotherapy, pathology, imaging, and minimally invasive oncology.
It has established a diagnosis and treatment group, which is routine.
Carry out an integrated outpatient clinic
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The diagnosis and treatment of rare mutations in lung cancer requires a team to participate in the process from diagnosis to treatment and rehabilitation
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The second is the integration of regional medical care.
Another important concept of the integration of diagnosis and treatment is that "central hospitals drive surrounding grassroots hospitals", including grassroots hospitals around or outside Beijing, hoping to drive the overall level of diagnosis and treatment, and achieve two-way development.
Make progress together
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Large hospitals can drive the formulation of preliminary diagnosis and treatment plans.
After the plan is determined, they can return to the primary hospital for treatment, and then be transferred to the large hospital to determine the resistance mechanism and formulate the next treatment plan after drug resistance occurs
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Regarding how to improve the level of diagnosis and treatment of rare mutations in grass-roots hospitals, Professor Li Lin said, “We must first strengthen the doctor’s learning, understand each target and detection method, improve the concept of detection, know the targeted drugs for the corresponding target, and then consider the drug Accessibility, how to allow patients to use such drugs; secondly, we must strengthen the education of patients and their families, so that patients or their families can properly understand the meaning and treatment of rare mutations, and even participate in the formulation of treatment plans
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" In short, The integrated diagnosis and treatment center is not only beneficial to patients, but also beneficial to the development of doctors and hospitals, but also to the rational use of social medical resources
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 Pay attention to the diagnosis and treatment of rare mutations and improve the comprehensive level of targeted therapy.
Professor Li Lin emphasized that the establishment of the diagnosis and treatment clinic for rare mutations in lung cancer is the hospital's emphasis on the diagnosis and treatment of rare mutations in lung cancer.
It improves patients' awareness of the disease and promotes the treatment of rare mutations.
Norms
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The rare mutation clinic is inseparable from precise diagnosis and treatment and integrated construction
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In fact, lung cancer itself is a tumor dominated by the elderly.
In the treatment of rare mutations in lung cancer, comprehensive treatment and management should be given.
Blood pressure problems, heart problems, diabetes and other basic diseases that occur during tumor treatment or targeted drug treatment Or complications require comprehensive management
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Do your best to prolong the survival period of patients and improve the quality of life of patients
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Professor Li Lin's rare mutation clinic hours: every Wednesday morning
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Expert profile Professor Li Lin, director of the Department of Oncology, Chief Physician, PhD supervisor, Chinese Human Health Science and Technology Promotion Association, Vice Chairman, Chinese Association for the Advancement of Human Health, Vice Chairman, China Association for Geriatric Health Member of the Committee of Immunotherapy Experts of the Society of Oncology; Standing Committee of the Lung Cancer Subcommittee of the Chinese Geriatric Oncology Committee; Standing Committee of the Committee of Chemotherapy on Cancer, China Medical Education Association; Vice Chairman, Beijing Cancer Society; Chairman, Lung Cancer Specialty Committee, Beijing Cancer Society; Vice President, Lung Cancer Specialty Committee, Beijing Anticancer Association Chairman, Beijing Medical Award Foundation, Lung Cancer Youth Committee, Vice Chairman, Head of the Internal Medicine Group, Standing Committee Member, Oncology Branch of Beijing Medical Association, JCO Chinese Edition Lung Cancer Special Edition Editorial Board Pacific Journal of Clinical Oncology Editorial Board Aging Medicine Editorial Board Reference for Cancer Journal Source: [1]MET Exon 14 Skipping Mutations in Non–SmallCell Lung Cancer: An Overview of Biology, ClinicalOutcomes, and Testing Considerations DOI: https://doi.
org/10.
1200/PO.
20.
00516[2]https://www.
iarc.
fr/faq/latest-global-cancer-data-2020-qa/*This article is only used to provide scientific information to medical professionals and does not represent the views of this platform