Settlement: Cancer Information Source: Oncology Information
The Lung -Cancer Multi -Disciplinary Treatment Summit Forum and the Ninth Army's Ninth Lung Cancer Diagnosis and Treatment Class was successfully held in Beijing on December 9, 2017. Yesterday's previous episode reported the response, today we will continue to continue!
Mother Speech 4: Shi Yuankai Professor
Precision Medicine New Drug Clinical Research: change and opportunity
treatment is still not ideal enough, but advanced patients The proportion of accounting is still the highest, so this is still an urgent need to solve question. In recent years, the diagnosis and treatment of lung cancer has made significant progress from the classification of histology to the present classification of molecular pathology. As far as the scale of clinical trials. Since the 1990s, chemotherapy -related clinical studies are characterized by a huge amount of samples, which can even be more than a thousand cases. The consumption of human and material resources cannot be ignored. The emergence of this situation is due to the lack of methods and logo that lacks screening people.
and EGFR-TKI-related clinical studies were used at the beginning of the design. It was also used by large samples because of the unclear selection of the crowd. It was not until the analysis of the EGFR mutant status analysis of 437 patients in the iPass study before it began Sample volume reduction. For example, the Adjuvant clinical trial that was seen this year, only 222 patients were admitted to the group, which achieved the research purpose.
is therefore continuously explored as molecular targeting target targets, and the number of clinical trial samples is getting less and less. Anti -tumor vascular drugs still need to adopt a large amount of samples due to the current lack of choices for advantageous people. In recent years, the hot immunotherapy , its efficacy forecasting logo needs to be further confirmed, but for the present, the expression of PD-L1 can guide clinical drugs to a certain extent. In summary of
, with the continuous deepening of molecular biology research, the clinical trial time of drugs is gradually shortened, the scale of clinical trials is reduced, and the pace of new drug listing has been accelerated. The molecular target clearly promotes the process of precision treatment of tumor, and accelerates accurate treatment of drugs to clinical.
Great Coffee: Professor Zhang Li (Guangzhou) hosted, Professor Chen Xiaoyuan, Professor Hu Bei, Professor Zhang Li (Beijing), Professor Shi Yuankai
Chen Xiaoyuan: Regarding the reform of clinical research policies in recent years. The government released a document 10.8 this year, which is specially related to the development of new drugs: 1. The approval of clinical trials from the approval system to filing . Research and development; 2. The certification of clinical trial institutions has also been changed to the filing system, and any hospital can use relevant resources for clinical research. These changes have provided great convenience for the speed of approval of clinical research. In the future, the approval of new drugs will also make a series of changes to provide convenience for the new drugs to bring benefits to patients as soon as possible.
Hu Bei: Under new opportunities, the challenge to researchers is still very large. More drugs will enter the country, and our companies will develop more generic drugs. The increase in drugs is gradually driving over our cognitive level, so safety research is more important. In terms of drugs and efficacy, it can be confirmed by less group groups, but in terms of safety, this condition will reduce our understanding of drug toxicity, and may cause some problems after large -scale application of new drugs.
tension (Beijing): The current threshold for clinical trials has gradually decreased, which is a good opportunity. Is it possible to carry out some "0 -stage tests" in the future? In addition, the acquisition of specimens has a vital role in the research and development of new drugs. Organizing the organizational specimen after the progress of the patient has a good help to interpret the direction of drug resistance and disease progress.
Mother Speech 5: Professor Fan Yun
SCLC Treatment: Classic and Fashion
small cell lung carcinoma , as a special pathological type, has strong invasion, early metastases, early recurrence.90%of small cell lung cancer is related to smoking, so is there a high mutation that is suitable for immunotherapy? In the case of high efficiency in the first line, the effective efficiency of the second line has decreased significantly. Although many explorations have been made for the treatment of small cell lung cancer, there is still no obvious progress so far.
1985 to the present, small cell lung cancer still uses the initial platinum dual drug scheme as a standard treatment; the 5 -year survival rate has been maintained at about 5%.
has some defects in the past brain radiotherapy research on preventive whole brain radiotherapy. For SCLC patients brain metastasis determined CT instead of MR, therefore leaked some patients with brain metastases when the base lines. The clinical studies of doing have confirmed that preventive omnidirectional radiotherapy has not improved to survive time.
has a targeted drug study for small cell lung cancer to use antiovascular generating drugs. It can be found from the figure below that although some research prompts the extension of PFS, OS still has no improvement. The results of the III clinical study of the EC+Bevarzab solution was published in JCO in 2017, and OS did not improve. As a result of maintenance treatment, Sotan was also announced on JCO, and it was prompted that there was no extension of OS.
is currently targeted at the NOTCH channel inhibitor ROVA T. It is aimed at the NOTCH ligand DLL3. It has achieved good results in phase I clinical research and carried out two phase III clinical studies, which involves SCLC. Drugs for first -line and second -line. Although the Aurora kinase inhibitors in myc channels have confirmed good results although the clinical research has confirmed that it has a good effect, it is still a long distance from the application.
immunotherapy in SCLC research conducted by Nivo and PEMBRO's drugs, although it can achieve better orr, it also brings an increased toxic side effect.
summarizes: The classic traditional treatment still has not found a new breakthrough point; the research direction of new drugs still needs to be more accurate.
said five: Professor Huang Cheng hosted, Professor Zhang Shucai, Professor Wang Yan, Professor Song Xia, Professor Fan Yun
HT Single The heterogeneity of tumor is more likely to benefit from subsequent treatment. The rapid recurrence patients are generally due to the complexity of the heterogeneity of tumors. Therefore, how to improve the treatment effect in SCLC's compound treatment, and the exploration of the efficacy logo is the most important link among them.
Wang Yan: Looking back at the rapid development of NSCLC for nearly ten years, it can be found that the disease changes of SCLC are similar to squamous carcinoma. Exploration is important. The recent immunotherapy may be an important development direction. The reason why it is still not ideal is that the impact of small cell lung cancer itself on the body's immune system has not been known.
Song Xia: The incidence of SCLC is about 15%in reporting, but the ratio of SCLC in our clinical practice is often higher than 30%. Why is there such a gap? In addition, patients with SCLC patients often have polarization time. Therefore, how to achieve the purpose of prognosis and prediction through the screening of logo is one of the focus of SCLC's research in the future.
keynote speech 6: Professor Wang Jie
new technology helps precise medical treatment: Questions and challenges
In this era of personalized lung cancer, we must first have diagnosis and treatment after testing. Sequencing second -generation sequencing technology until 2005. The three -generation sequencing based on single -cell is also on the way to practice. In December 2017, the FDA approved two sequencing Panels to treat different tumor species for treatment and guidance. The combination of
second -generation sequencing and liquid biopsy can bring many new opportunities to the diagnosis and treatment of lung cancer. Early evolution of early lung cancer, the treatment guidance of advanced lung cancer, and the establishment of the Biomarker system for immunotherapy, all thanks to the technologies such as freshmen today. But there are three issues that we must consider at present.
First, how to achieve more refined genetic analysis on the basis of personalized therapy on the basis of layered layers? For example, in the study of the first -generation and second -generation TKI, about 20%of patients will develop diseases in the short -term medication, and the same is still the case in the three generations of drugs. Benefit has given us some tips that such patients usually have high heterogeneity and carry some genes that promote cancer. Therefore, for such patients, we may not only adopt more single treatment in the future, but also targeted therapy. Union or combination with chemotherapy.
is second. Whether it is EGFR or ALK's TKI, it cannot get rid of the fate of drug resistance. Different drug -resistant mechanisms increase the complexity of treatment. Therefore, it is very important to use existing targeting drugs.
is third. Immunotherapy has entered our clinical practice. The exploration of logo still needs to continue. Whether it is the expression of PD-L1 or TMB, it has its limitation. 23%of patients with low TMB patients can benefit from immunotherapy. Is
likely to integrate the existing predicted signs to establish a system? In addition, how immunotherapy should be exposed with other existing treatment methods.
summarizes that in the future, based on new technologies, the diagnosis and treatment system of lung cancer will be more refined and bring better benefits to patients.
big coffee said 6: Week Costen Professor hosted, Professor Xie Shaokun, Professor Jiang Da, Professor Liu Ye
Liu Ye: Our precision medicine is based on precision testing. For clinical speaking, the targets and paths revealed by new technologies can bring new choices to patients.
Weekly: We now have a good way to detect EGFR to guide TKI medications, but 60%of patients PFS is shorter than one year. Therefore, it can be known that EGFR is still not enough to meet clinical needs. Do you need to perform replenishment?
Jiang Da: For patients with lung cancer, it is necessary to detect conventional 8-9 genes. For individual patients, the second -generation sequencing can be considered to further explore the characteristics of the disease.
Weekly Celebration: What help can the sequencing company provide at present?
Xun Shaokun: Patients facing different needs of clinical needs, different detection products are established based on NGS. Specifically, clinicians usually have certain confusion about how to choose the right testing company. Therefore, we are cooperating with my country's drug supervision bureaus and the Health and Family Planning Commission to promote the more convenient choice of doctors. We are also conducting new technical platforms, including how to perform multi -dimensional applications such as liquid biopsy, immunotherapy, early inspection and early screening. In addition, the integration of testing data and clinical data with doctors is also one of our next key tasks.
Week Cai: Is there any NGS data for the Chinese population, such as the TMB we are concerned about, and the distribution among Chinese patients?
Xun Shaokun: As far as lung cancer is concerned, about 30,000 NGS information has been accumulated. Only about 10%of the test results can be used to evaluate TMB. The number is around 8-10, and 25%of patients will show a higher TMB.
Weekly Celebration: One of the problems facing lung cancer in the treatment of lung cancer is the heterogeneity resistance. For such patients, the sensitivity of liquid biopsy is still unsatisfactory, and the tissue biopsy for multiple metastasis may not be able to fit clinical applications in clinical application How to view this situation?
Liu Ye: Patients after drug resistance are indeed the heterogeneity between the tumor metastases and the original stove, but this heterogeneity may not be enough to lead to the appearance of drug resistance. Get as well as as much biopsy as much as possible, supplemented by liquid biopsy at the same time, you can best discover the real situation of the disease, which is conducive to accurate guidance for the next treatment.
Weekly Vocal: Can the test results of NGS bring some prompts to the heterogeneity of the tumor?
Xun Shaokun: The detection Panes we are currently applied include known drug resistance mechanisms, such as T790M, CMET amplification, etc., which can provide some inspiration for subsequent treatment.
Zhou Caicun: In clinical practice, we often encounter low-abundance T790M detected by NGS in TKI-resistant patients. Is it responsible for the drug resistance? How to understand?
Cai Shaokun: From the current research, the abundance of T790M itself is not very important, but its relative ratio to the abundance of sensitive mutations is very meaningful for the guidance of third-generation medication. At the same time, the very low-frequency T790M Mutations are often accompanied by the presence of other resistance mechanisms.
The annual multidisciplinary lung cancer treatment summit forum has come to an end. Let’s meet on December 8, 2018. See you there!
