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    Home > Active Ingredient News > Antitumor Therapy > ​What is the relationship between intestinal flora and lung cancer immunotherapy?

    ​What is the relationship between intestinal flora and lung cancer immunotherapy?

    • Last Update: 2021-09-30
    • Source: Internet
    • Author: User
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    *For medical professionals' reference only.
    The opening of the 7th Zhongshan Lung Cancer Forum is coming soon.
    Come and participate! From October 8th to October 10th, 2021, the 7th Zhongshan Lung Cancer Forum and the New Technology Workshop on Bronchoscopy Interventional Diagnosis and Treatment will be held in Shanghai, focusing on the comprehensive diagnosis and treatment of lung cancer under the multidisciplinary model-what progress has been made in the early screening and diagnosis of lung cancer ? How does bronchoscopy intervention technology play a greater role in lung lesions? The medical community specially invited Professor Zhang Xin from Zhongshan Hospital of Fudan University, the chairman of the conference, to share the precise diagnosis and treatment of lung cancer as well as the highlights and characteristics of the conference
    .

     Targeted therapy genetic testing requires "specific analysis of specific circumstances".
    Under the background of precision medicine and classification and treatment, genetic testing has high clinical significance and value for patients with advanced lung cancer, whether it is newly treated or recurred, and guides treatment plans.
    , Prediction and monitoring of curative effect, genetic testing has played a certain role
    .

    Professor Zhang Xin said: "Targeted therapy for lung cancer is a typical manifestation of precision therapy.
    In addition to the EGFR and ALK targets well known by clinicians and patients, there are rare targets with low mutation rates such as ROS1, MET, RET, and NTRK.
    Point
    .

    The survival benefits of the corresponding targeted drugs of EGFR and ALK to lung cancer patients have been'self-evident.
    ' Drugs with rare mutations, such as those with rare mutations, have also been born
    .

    "The first edition of the National Comprehensive Cancer Network (NCCN) Guidelines for Non-Small Cell Lung Cancer in 2020 recommends that lung cancer patients should be tested for targets including EGFR, ALK, ROS1, BRAF, NTRK, PD-L1 and emerging targets MET, RET, HER2, and tumor mutation burden (TMB)
    .

    The scope of genetic testing and the selection of methods should be individualized based on the patient’s basic condition.
    For example, patients who are newly treated for lung cancer will usually choose to detect common genes such as EGFR because of their low probability of complex mutations.
    Regarding cycle issues, the detection method does not need to be NGS (Next Generation Sequencing), but PCR detection can be used
    .

    However, if it is a lung cancer patient who develops secondary drug resistance after treatment with first-generation and second-generation EGFR inhibitors, the necessity of NGS testing is highlighted because NGS testing has a wider range and can detect multiple genes at one time
    .

    Through the NGS test results, clinicians can discover the patient's drug resistance mechanism, thereby adjusting the medication regimen, so that the patient can receive the best and most accurate treatment
    .

     The "more precise" era of immunotherapy is still being explored.
    In addition to targeted therapy, immunotherapy has become more and more widely used in lung cancer and other major cancer types.
    Two'half ' relatively mature biomarkers, one is the expression status of PD(L)-1
    .

    Take pembrolizumab as an example, a single drug in the field of NSCLC approved by the U.
    S.
    Food and Drug Administration (FDA) In the first-line treatment indications, PD-L1 expression detection [tumor proportion score (TPS) ≥ 1%] is a companion diagnosis and a necessary condition
    .

    TMB can be regarded as'half', and patients with high TMB may be better able to get from immunotherapy The last one is that there are no mutations in common sensitive driver genes, but this does not mean that patients receive immunotherapy ineffective, but when receiving monotherapy, the efficacy of targeted drugs will be better than immunotherapy
    .

    " Professor Zhang Xin explained
    .

    In addition, Professor Zhang Xin pointed out: Many combinations of immunotherapy drugs and chemotherapy have been approved for first-line treatment indications for NSCLC, but when chemotherapy is combined with immunization, biomarkers such as PD-L1 have been proven in the past.
    What is the predictive value of the expression state? New research and new data are urgently needed to clarify
    .

     The bronchoscopy intervention technology continues to develop.
    "Diagnosis" and "treatment" Biyi Qifei Professor Zhang Xin introduced: "The 7th Zhongshan Lung Cancer Forum was jointly organized by multiple disciplines including respiratory, thoracic surgery, pathology, and radiology.
    One of the major features of this forum
    .

    It is worth mentioning that this Zhongshan Lung Cancer Forum is also a learning class for new technology of bronchoscopy interventional diagnosis and treatment
    .

    "The clinical application of bronchoscopy interventional technology can be divided into two aspects-diagnosis and Treatment
    .

    The narrowing of the large airways and central airways caused by various reasons has limited treatment methods, and interventional techniques can be recanalized by ablation or stent implantation, thereby breaking the "fetters" of traditional treatment
    .

    Except for simple airway stenosis, refractory asthma caused by excessive smooth muscle hyperplasia can also be treated with bronchoscope intervention, which weakens the contraction response of small and medium airways, thereby achieving the purpose of treatment
    .

    The mainstream treatment for early lung cancer is surgery.
    However, many patients are unable to operate for various reasons and choose alternative treatments.
    The bronchoscopy intervention technique has become a viable alternative treatment because of its less invasiveness and more options for treatment
    .

    Professor Zhang Xin introduced that radiofrequency ablation of pulmonary nodules, advanced/metastatic lung cancer multiple lesions, transairway interventional treatment of peripheral lung cancer, photodynamic therapy, cryoablation technology, etc.
    are becoming more and more clinical in the clinic.
    Application mode
    .

    In the early years, the positive rate of biopsy of peripheral lung lesions was low, and patients needed additional examinations for severe complications such as hemorrhage and pneumothorax, such as percutaneous lung puncture.
    However, with the continuous development of bronchoscope intervention techniques and related equipment, the trachea Microscopic interventional technology has been widely used in the pathological diagnosis of lung cancer and the differential diagnosis of lung lesions
    .

    Ultrasonic bronchoscopy (EBUS) can use ultrasound to locate the specific location of the lesion outside the bronchus to clearly show the relationship between the lymph nodes outside the airway, the mediastinum, and the space-occupying lesions
    .

    Transbronchiallung biopsy (TBLB) has been carried out for many years.
    With the development of various navigation and ultrasound confirmation technologies, the positive rate of diagnosis of peripheral lung lesions continues to increase.
    However, due to the limitations of equipment including X-ray fluoroscopy, the popularization of high-level TBLB in China Sexuality still needs to be improved
    .

    "In addition, there are some intractable diseases including infections that can be solved by bronchoscopy interventional technology.
    It can be said that the diagnosis of bronchoscopy interventional technology has reached full coverage of lung lesions
    .

    At present, our center has peripheral lung nodules.
    The positive rate of bronchoscopy biopsy is between 75% and 80%.
    At the same time, we are constantly optimizing the process, such as conducting rapid pathological evaluation on site to increase the positive rate of biopsy.
    If the pathology is considered as lung adenocarcinoma, it can be done as soon as possible.
    Drive gene detection, thereby saving time
    .

    " Professor Zhang Xin said
    .

    The Zhongshan Lung Cancer Forum and the new technology learning class for bronchoscopy interventional diagnosis and treatment will also show various content such as surgical demonstrations, theoretical lectures, and hands-on teaching
    .

     Based on the cutting edge, what is the connection between intestinal flora and lung cancer immunotherapy? Professor Zhang Xin will bring a wonderful report entitled "Intestinal Microflora and Lung Cancer Immunotherapy" on the second day of this Zhongshan Lung Cancer Forum, October 9th
    .

    The difference in the efficacy of immunotherapy can be attributed to the different types of tumors and individual differences in patients.
    In recent years, the involvement of intestinal flora in the regulation of immunotherapy and the underlying molecular mechanisms have also become research hotspots
    .

    Nature Medicine has published a study that suggests that patients with high adverse reactions to dual immune combination therapy have found specific intestinal flora, which means that in the future, it may be possible to manipulate the intestinal microbiota to treat the toxicity of immune combination therapy.
    , While maintaining a strong response to the combination therapy
    .

    Coincidentally, Science has published the results of fecal microbiota transplantation (FMT) overcoming the resistance of melanoma patients to anti-PD-1 therapy.
    Related studies published in top journals have confirmed that the intestinal microbiota can predict and even predict the efficacy of immunotherapy.
    The value of intervention
    .

    "In addition to research in tumor treatment, the mechanisms of intestinal flora in Alzheimer’s disease and pediatric ADHD have also been gradually discovered and confirmed
    .

    " Sorting out cutting-edge and clinically valuable content to share with you is also the original intention and purpose
    of
    the meeting .
    In this meeting I will also bring together the intestinal flora and lung cancer immunotherapy efficacy, adverse reactions, application prospects, clinical decision-making strategies, etc.
    Sharing and introduction
    .

    What is looking forward to is that the clinical research related to intestinal flora and immunotherapy jointly initiated by our department and the Gastroenterology Department has also passed the hospital ethics review and will start soon
    .

    "October 8-October 10 On the 7th, the 7th Zhongshan Lung Cancer Forum will be held in Shanghai to further explore the progress of multidisciplinary diagnosis and treatment of lung cancer and individualized treatment.
    Organize the relevant content, but as long as it is helpful to academics, I am still willing to share it with you.
    The 7th Zhongshan Lung Cancer Forum is looking forward to your participation
    .

    "Professor Zhang Xin, Chief Physician, Doctor of Medicine, Fudan University Zhongshan, Fudan University Deputy Director of the Hospital Respiratory Department Director of the Department of Pulmonary Tumors and Interventional Respiratory Diseases Member of the Intervention Group of the Respiratory Branch of the Chinese Medical Association Member of the Standing Committee of the Pulmonary Tumor Committee of the Chinese Medical Education Association Deputy Chairman of the Shanghai Anti-Cancer Association Lung Cancer Molecular Targeting and Immunotherapy Specialty Committee Deputy Chairman of the "Shanghai Medicine" magazine editor for 29 years of respiratory and lung cancer diagnosis and treatment, successively engaged in research work including lung cancer gene diagnosis and gene therapy, The combined application of targeting and chemotherapy, liquid biopsy of lung cancer, magnetic navigation-guided lung biopsy, etc.
    , participated in multiple international clinical trials as a branch PI
    .

    Participated in the compilation of 6 monographs including "Practical Internal Medicine", and published more than 30 papers
    .

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