Professor Zhou Caicun: How to standardize the immunotherapy of non-small cell lung cancer?

*It is only for medical professionals to read.
Reference specifications and precision complement each other.
The immunotherapy of non-small cell lung cancer has a long way to go
.

According to the latest global cancer burden data released by the International Agency for Research on Cancer (IARC) of the World Health Organization in 2020 [1], the incidence and mortality of lung cancer are ranked second and first in global cancers respectively
.

Non-small cell lung cancer (NSCLC) is the most common pathological type of lung cancer, and most patients with NSCLC are already at an advanced stage when they are diagnosed
.

 In recent years, tumor immunotherapy has developed rapidly.
Immune checkpoint inhibitors (ICIs), especially ICIs that block the PD-1/PD-L1 signaling pathway to restore the body's killing effect on tumors, have made breakthroughs in the treatment of NSCLC.
, Which brings survival benefits to patients, changes the treatment pattern of NSCLC, and shows an increasingly important position
.

The "Expert Consensus on the Treatment of Immune Checkpoint Inhibitors for Non-Small Cell Lung Cancer in China (2020 Edition)"[2] (hereinafter referred to as "Expert Consensus") has been updated and released again this year.
The "medical community" invited Shanghai Lung, affiliated to Tongji University Professor Zhou Caicun from the Hospital conducted in-depth discussions around the release of the "Expert Consensus"
.

 Expert consensus, diagnosis and treatment standards, and diagnosis and treatment guidelines each focus on Professor Zhou Caicun's wonderful video The standardization of lung cancer treatment is always the focus of attention.
The National Health Commission has issued the corresponding diagnosis and treatment guidelines for lung cancer [3], and the Chinese Society of Clinical Oncology (CSCO) will also update Publish diagnosis and treatment guidelines [4], "Expert Consensus", "Diagnosis and Treatment Norms" and "Diagnosis and Treatment Guidelines" have their respective focuses
.

 Professor Zhou emphasized: “The National Health and Medical Commission formulates diagnosis and treatment specifications from a general direction, which plays a programmatic role, but it cannot be updated once a year.
Immunotherapy has been the place where lung cancer treatment has made the most progress in recent years.
The CSCO guidelines are updated once a year to cover content.
Many, in-depth discussions on lung cancer immunotherapy may need to be improved
.

Therefore, it is urgent to update expert consensus in time to summarize and discuss lung cancer immunotherapy, including immunotherapy pathogenesis, immunotherapy recommendation timing, immunotherapy adverse reaction management and The efficacy of immunotherapy and other aspects
.

From the perspective of immunotherapy, the "Expert Consensus on the Treatment of Immune Checkpoint Inhibitors for Non-small Cell Lung Cancer in China" is the most thorough explanation
.

"The diagnosis and treatment of lung cancer is targeted, and the expert consensus helps standardize management.
Professor Zhou Caicun Wonderful video How to achieve precision in lung cancer Standardized diagnosis and treatment? Professor Zhou discussed the aspects that this "Expert Consensus" update focuses on norms: "The first-line treatment of advanced lung cancer is recommended according to histological type, PD-L1 expression level and driver gene status
.

For patients with positive driver genes, the "Experts" The Consensus emphasizes that targeted therapy is prioritized and immunotherapy is not the first choice; after targeted therapy fails, chemotherapy and bevacizumab are recommended on the basis of immunotherapy
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For patients with negative driver genes, the PD-L1 tumor ratio score (TPS ) ≥50% can choose immunotherapy alone or immunotherapy plus chemotherapy; for patients with low or no PD-L1 expression, the "Expert Consensus" emphasizes the addition of chemotherapy on the basis of immunotherapy
.

Second-line treatment for lung cancer is recommended, partly Drugs need to be tested for PD-L1, and more drugs do not need to be tested for PD-L1
.

” In addition, Professor Zhou also talked about hepatitis, autoimmune diseases, human immunodeficiency virus (HIV) positive and elderly lung cancer patients undergoing immunotherapy.
Special attention should be paid to protection
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In addition, immunotherapy may produce false progress
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It can be seen that the "Expert Consensus" has carried out in-depth explanations of these details and has high applicability
.

 Standardized treatment and precision treatment complement each other.
Professor Zhou Caicun's wonderful video Is there any contradiction between standard treatment and precision treatment of lung cancer? For this issue, Professor Zhou made a specific analysis: “Achieving standardized treatment requires precise treatment for lung cancer patients.
The combination of the two is not only beneficial to the patient, but also to the doctor’s self-protection, and to a certain extent, it can avoid falling into medical treatment.
Disputes, and the update and release of the "Expert Consensus" further implements standardized management of the concept of precision treatment of lung cancer
.

From this perspective, there is no contradiction between standardized treatment and precision treatment, and they are actually complementary
.

 " "Lung cancer The implementation of patient immunotherapy plus chemotherapy treatment strategy does not mean to ignore the original concept of targeted therapy
.
The
relationship between the two is not completely competitive.
For lung cancer patients with positive driver genes, targeted therapy is the first choice.
Emphasis on targeting first; for patients with negative driver genes, immune combined chemotherapy can be used for treatment, while patients with negative driver genes and high PD-L1 expression can also be treated with immune monotherapy
.

Treatment not only needs to focus on efficacy, but also on efficacy.
Cost-effective and toxic side effects
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” Professor Zhou further explained
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The long-term survival data of patients in China is worth looking forward to.
The relevant research in the field of lung cancer in China has been carried out later than abroad, and the long-term survival data of patients has not yet been released
.

In foreign countries, lung cancer patients with PD-L1 TPS ≥50% are treated with immune monotherapy, and the five-year survival rate has reached 31.
9% [5], which means that 1/3 of patients survive for more than 5 years.
This data is encouraging
.

In a few years, the results of our country’s research will be announced, which may reveal the long-term survival data of patients, so immunotherapy will truly cure some lung cancer patients.

.

 "For patients with locally advanced lung cancer, the original standard treatment plan was concurrent radiotherapy and chemotherapy, with a median overall survival (OS) of 29.
1 months
.

Now, after concurrent radiotherapy and chemotherapy, immunotherapy can be maintained for one year, which can reach 47.
5 months.
Median OS[6]
.

"Professor Zhou shared this exciting data
.

 Multi-center collaboration, Chinese data guidance and practice by Professor Zhou Caicun Wonderful video Foreign research data differs from China’s.
Diagnosis and treatment of lung cancer needs to see Chinese real-world research data.
Real-world data does not represent clinical research data.
Clinical research is based on strict specifications and conditions.
In the enrolled patients, many immune-related adverse reactions (irAE) did not occur during clinical trials
.

 Professor Zhou called for clinical multi-center collaboration: “A predictive model can be established through real-world data to implement more standardized management of adverse reactions
.
We
look forward to the unity of multiple centers in China to establish a large-scale database to accelerate the progress of lung cancer immunotherapy research and use Chinese people.
The data guides clinical practice.
This is the way to explore the diagnosis and treatment of lung cancer in the future
.

"The theory is deeply rooted in the hearts of the people, and the multi-disciplinary management team of "passing, helping and leading" is built.
Wonderful video by Professor Zhou Caicun.
More far-reaching communication is inseparable from the full education and cooperation of the School Association
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"Professor Zhou said
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The clinical work and research of lung cancer immunotherapy may wish to carry out online education work like CSCO, and pass the latest ideas and latest treatment strategies of immunotherapy to experts in the field of lung cancer
.

Another important task is to establish an academic alliance for adverse reaction management.
In the past, lung cancer immunotherapy was mostly carried out in developed areas.
Now more and more grass-roots hospitals have gradually implemented lung cancer immunotherapy, but the doctors in the grass-roots hospitals lack relevant experience in diagnosis and treatment.
, Encounter irAE or face the dilemma of being helpless
.

"The current arduous task is to provide help to doctors in primary hospitals through the model of'passing, helping, and leading', that is, large hospitals lead small hospitals, and small hospitals lead regional hospitals to seek common development
.

In addition, expert team management irAE is also indispensable.
irAE is diversified, including neurological encephalitis, Guillain-Barre syndrome, endocrine disorders, hyperthyroidism, diabetes, hepatitis, dermatitis, enteritis, and pneumonia.
This requires multidisciplinary coordination to deal with
.

" Professor Zhou has high hopes for the establishment of a multidisciplinary management team
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Expert profile Prof.
Caicun Zhou, Director of the Department of Oncology, Shanghai Pulmonary Hospital Affiliated to Tongji University, Director, Institute of Oncology, Tongji University School of Medicine, enjoys a special allowance from the State Council, Director of the Board of Directors of the International Association for Lung Cancer Research (IASLC), Chairman of the CSCO Special Committee on Non-Small Cell Lung Cancer Chairperson of the Thoracic Oncology Committee, Shanghai Anti-Cancer Association, Chairperson of the Lung Cancer Molecular Targeting and Immunotherapy Special Committee, Chinese Anti-Cancer Association, Chair-designate Committee of Oncology Drug Clinical Research Committee, CSCO Translational Oncology Professional Committee, Shanghai Leading talent, the most important subject leader, Standing Committee of the Lung Cancer Professional Committee of the Chinese Anti-Cancer Association Standing Committee of the Chinese Medical Association Oncology Branch References: [1] Sung H, FerlayJ, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F.
Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36cancers in 185 countries.
CA Cancer J Clin.
2021 Feb 4.
doi:10.
3322/caac.
21660[2] Zhou Caicun, Wang Jie, Wang Baocheng, etc.
Expert consensus on immune checkpoint inhibitor therapy for cell lung cancer (2020 edition)[J].
Chinese Journal of Lung Cancer,2021,24(4):217-235.
DOI:10.
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issn.
1009-3419.
2021.
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[3] Notice on the issuance of 18 tumor diagnosis and treatment specifications (2018 edition) including primary lung cancer.
Retrieved Dec 26, 2018 fromhttp:// Chinese Clinic CSCO Guidelines for the Diagnosis and Treatment of Non-Small Cell Lung Cancer (2020 Edition).
Beijing: People's Medical Publishing House.
[5] Reck M, Rodríguez-Abreu D, Robinson AG, et al.
Five-Year Outcomes WithPembrolizumab Versus Chemotherapy for Metastatic Non-Small-Cell Lung CancerWith PD-L1 Tumor Proportion Score ≥ 50%.
[J].
Journal of Clinical Oncology.
DOI: 10.
1200/JCO.
21.
00174[6]Faivre-Finn Corinne, Vicente David,Kurata Takayasu et al.
Four-Year Survival With Durvalumab After Chemoradiotherapy in Stage III NSCLC-an Update From the PACIFIC Trial.
[J] .
J Thorac Oncol, 2021, 16: 860-867.
DOI:10.
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jtho.
2020.
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015*This article is only used to provide scientific information to medical professionals and does not represent the views of this platformjtho.
2020.
12.
015*This article is only used to provide scientific information to medical professionals and does not represent the views of this platformjtho.
2020.
12.
015*This article is only used to provide scientific information to medical professionals and does not represent the views of this platform