The Stone of His Mountain Can Attack Jade: The "Three-Plate Axe" of China's Lung Cancer Survival Leap

Source: Cancer Cell notes that the accelerated decline in mortality after the approval of EGFR targeted drugs is widespread and is more pronounced in Asian countries with higher EGFR mutation rates (China, Japan, Singapore), and the group-level effect of EGFR targeted drugs on lung cancer prognostication is confirmed from a global perspective.
on the other hand, the prognosm of non-metastasis lung cancer also improved significantly, and the nodes with accelerated mortality rates matched the time when LDCT screening was approved in the United States, suggesting an increase in cure rates associated with LDCT screening prevalence and early intervention.
He's team further strated the rate-based mortality rate in phases based on NSCLC, showing a rapid decrease in phase IV mortality since the approval of targeted therapies in 2013 and an accelerated decrease in mortality in phase I-III patients after the approval of LDCT screening in 2011.
, it is suggested that targeted therapy can help reduce mortality in patients with advanced NSCLC, and lung cancer screening is a major factor in reducing mortality in patients with early stage lung cancer.
he's team predicts that early screening, new drug applications and a combination of tools will improve the prognosmation of lung cancer patients.
the stone of his mountain, you can attack jade.
the above conclusions under the current situation of lung cancer diagnosis and treatment in China, what are the enlightenments? Targeted treatments face timeless drug resistance problems, how can clinicians optimize the treatment process? What are the practical dilemmas faced by the early screening of lung cancer in China? How can the fusion of various treatment methods be promoted? The Rubik's Cube specially invited Professors He Jianbing and Liang Wenhua of the First Hospital affiliated with Guangzhou Medical University (National Respiratory Medical Center) to comment on the following for the benefit of readers.
Medicine Rubik's Cube: What do you think of the role of domestic targeted drug market in improving the survival of lung cancer patients? Viewpoint: At the individual level, a large number of randomized controlled clinical trials (RPTs), including IPASS, OPTIMAL, LUX-LUNG, FLAURA, and post-market real-world studies (RWS), confirm the enormous role of EGFR-targeted drugs in mutant populations: the efficiency of first- and second-generation targeted drugs 65%, the medium disease control time of 10-12 months, the efficiency of the third generation of drugs 80%, the middle control time of 18 months, so that the total survival of such patients (OS) from less than 1 year, after standardized treatment can be increased to 3-4 years.
policy level, China has accelerated the entry of targeted drugs into health insurance and reduced prices in recent years, so that a wider range of patients can actually benefit.
these two factors, the study also saw a decline in mortality among late-stage patients in China after the drug was approved at the group level.
Medicine Rubik's Cube: At present, in the field of targeted treatment, first-generation, second-generation, third-generation drug single-drug and the corresponding joint treatment strategy have accumulated a considerable amount of evidence-based medical evidence, how to optimize the sequence, maximize the prognostication is an inevitable problem for clinicians.
Your team has previously published a mesh meta-analysis in The BMJ that provides an in-depth look at the best first-line treatment options for NSCLC in the advanced stages of EGFR-sensitive mutations. Viewpoint: Although EGFR targeted drugs are superior in efficacy, but with the accumulation of clinical application experience, the medical community also realized that a considerable number of patients show primary drug resistance, that is, after the drug tumor does not shrink, or control time is less than half a year.
we have done a lot of research on this, the reasons are very complex, including 19del and L858R sub-type differences, combined with other path path mutations or primary T790M drug-resistant mutations.
a number of targeted measures, the main solution at present is joint treatment.
In addition, for non-primary drug-resistant tumors, combined therapy also has mechanisms such as increasing the inhibition intensity of the EGFR path, further reducing tumor load to reduce tumor resistance, and so on, so as to improve efficacy.
Therefore, in our previous BMJ-published study, we combed through all the current mainstream programs, and the first finding was that the joint program showed significant advantages over the single-drug program, especially the combination chemotherapy, which significantly improved the overall survival rate.
second is the EGFR Del19 and L858R two different mutant subsypes, with different optimal treatment options.
But the study also has certain limitations, such as the failure to classate the common mutation, many of the potential joint programs in the study, such as three-generation targeted drug combination chemotherapy, targeted drugs at the same time combined chemotherapy and anti-vascular, one-generation joint three-generation target drug and other programs, have not been included in the analysis.
Based on some of the current evidence and our research, we propose a treatment process based on the general principle that combined common mutations require joint targeted therapy or chemotherapy; EGFR inhibition is insufficient and requires increased dosage or penetration: What are the real dilemmas for early screening of lung cancer in China? Your team has made a lot of explorations in this area, could you give me a brief introduction? Viewpoint: Chest CT is still the only recommended screening method, other screening methods are being explored, and in principle, the current sensitivity does not meet the screening requirements.
With the gradual promotion of CT screening, many hospitals received more and more early lung cancer, on the one hand, it did improve the cure rate, our center in Guangzhou from 2015 to continue to carry out free screening of lung cancer "love lung program", found that more than 90% of lung cancer has been cured.
, on the other hand, due to the high sensitivity of CT, there are a large number of false positive nods, resulting in "side effects" of overtreated and anxiety.
In this end, we have designed a pulmonary nod cloud platform to help patients consult, and have been exploring ways to improve the accuracy of the identification and diagnosis of lung nods through artificial intelligence reading and plasma DNA-based lung cancer marker analysis to reduce unnecessary overtreated treatment.
, such as the ctDNA methylation tool we have developed, can reduce the proportion of unnecessary operations from 30 percent to 15 percent.
believe that in the near future, as testing costs fall and sensitivity increases, blood testing tools such as ctDNA are expected to replace CT as a more accurate and easy screening tool.
another major problem facing lung cancer screening in China is the identification of high-risk groups.
On the one hand, screening is a cost-effective issue, both individually and socially, and therefore not recommended for all people, all ages;
During the lung cancer screening process in Guangzhou, we deliberately opened up places outside the high-risk groups defined in some of the guidelines to explore the definition of high-risk groups belonging to the Chinese, and found that more than half of the lung cancer patients eventually detected were not "high-risk groups" in the guidelines.
we're doing a lot of research to better target the right people for lung cancer screening.
Medicine Rubik's Cube: In your article, your team looks forward to a combination of treatments that will further significantly improve the survival rate of lung cancer patients. And how do you move forward? Viewpoint: Our team has always attached great importance to the comprehensive treatment strategy of lung cancer, tumor stages are artificially divided, with phases to determine the scope of application of treatment has a certain degree of rationality, but far from perfect.
strategy should be combined with the basic principles of treatment and the biological behavior of tumors.
The study identified the huge group effect of targeted drugs on advanced lung cancer within the range of its adaptive disease, but there are still many questions worth exploring when targeting and even immunotherapy should be involved, out of the framework of late-stage treatment.
, for example, this year's ESMO-heavy ADAURA study further established the status of postoperative ancillary therapy for early lung cancer.
Is likely to make targeted drugs the standard for long-term postoperative control recurrence; the EVIDENCE registration study led by our center has just completed its analysis and is currently being approved by relevant departments, or will lead to the first lung cancer target drug in the country to be approved for assisted treatment of adaptive disorders; NADIM research tips Pre-immune new complementary therapy can achieve 70% complete remission (the complete disappearance of cancer cells), achieving a complete cure that simple surgery may not be able to fully achieve, and further, we are using these "advanced" drugs to challenge lung cancer in the in-place stage, which will profoundly change existing treatment strategies.
, local treatment, especially surgery, has long been considered a "no-go zone" for advanced metastasis lung cancer.
At present, surgery has been extremely minimally invasive, even to achieve the same day recovery, the impact on the immune system has been much smaller than the previous large incision open surgery; stereotactic radiotherapy is also considered to consolidate the efficacy of systemic treatment, increase the efficacy of immunotherapy;
, through the integration and comprehensive use of various means, I believe we will witness another leap in the survival of lung cancer as a whole.