*For medical professionals only for reading reference
Big names in the field gathered together to share classic lung cancer diagnosis and treatment cases and explore the ways of lung cancer immunotherapy!
Lung cancer is the first malignant tumor in my country with annual incidence and deaths. Among them, small cell lung cancer (SCLC) accounts for about 15% of all lung cancers. It is characterized by high malignancy, extremely prone to recurrence, and extremely poor prognosis. Patients urgently need effective treatment methods to improve prognosis. In recent years, immunotherapy and chemotherapy have become the first-line treatment plan for SCLC in a wide range of periods. It has been widely used and highly recognized in my country's clinical practice, making immunotherapy comprehensively rewrite the diagnosis and treatment pattern of SCLC.
In order to further promote the in-depth development of the lung cancer treatment field in my country, and to improve the level of SCLC immunotherapy and standardized diagnosis and treatment through communication and cooperation, the "Full Case" lung cancer diagnosis and treatment practice sharing project sponsored by China Medical and Health Development Foundation was conducted in the form of sharing real cases of clinical frontline lung cancer diagnosis and treatment, and wonderful academic exchanges and discussions were conducted across the country in the form of sharing real cases of clinical frontline lung cancer diagnosis and treatment.
After multiple rounds of preliminary competitions, the finals of the "East District" and "Central District" lung cancer diagnosis and treatment practice sharing projects "East District" and "Central District" came on the same day with a combination of online and offline methods. The participating doctors and many experts in the lung cancer diagnosis and treatment field attended the meeting jointly presented two wonderful academic feasts!
Professor Han Baohui, Chest Hospital Affiliated to Shanghai Jiaotong University, Professor Zhou Jianying, Professor Zhou Jianying, Reijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Professor Gao Beili, , jointly serves as the chairman of the "East District" final. In his opening speech, the professors expressed that they hope to show the SCLC immunotherapy level of participants through this final, so as to further explore the mystery of the breakthrough of lung cancer, improve clinicians' scientific understanding of lung cancer, and lead new hopes for lung cancer diagnosis and treatment, so as to continuously improve the long-term survival and quality of life of lung cancer patients, and contribute to turning lung cancer, especially advanced lung cancer, into a chronic disease.
Figure 1. Professor Han Baohui gave an opening speech
Figure 2. Professor Zhou Jianying gave an opening speech
Prof. Wang Baocheng, the 960th Hospital of the People's Liberation Army, and Professor Shu Yongqian of the Jiangsu Provincial People's Hospital, as the chairman of the "Central District" final, also pointed out in his opening speech that in order to achieve the important goal of increasing the overall cancer 5-year survival rate by 15% by 2030, it is necessary to effectively improve the diagnosis and treatment level of lung cancer. The "Full Case" lung cancer diagnosis and treatment practice sharing project will use real clinical cases as a carrier and expert comments as a bridge, so that clinicians can do their best to make every patient get the most accurate diagnosis and receive the most standardized, individualized, safe and efficient treatment.
Figure 3. Professor Wang Baocheng gave an opening speech
Figure 4. Professor Shu Yongqian gave an opening speech
Each game of the "Full Case" lung cancer diagnosis and treatment practice sharing project, a total of 6 contestants participated in each game. The contestants took the stage to share their own cases in turn, and conducted practical questions and answers to one randomly selected from the high-quality case pool prepared by the conference, showing the contestants' lung cancer immunotherapy skills. The expert jury combined the performance of case explanation and on-site answers, and scored the contestants and awarded various awards. The following will bring exciting content from the two district finals.
"East District" final highlights
The 6 contestants who participated in the East District finals are: Professor Bao Zhang and Professor Yao Yinnan of the First Affiliated Hospital of Zhejiang University School of Medicine, Professor Shen Shengping and Professor Zhao Lei of the Chest Hospital of Shanghai Jiaotong University, Professor Zhong Min of the First Affiliated Hospital of Nanchang University, and Professor Zhou Qinfei of the 6 contestants all revolved around the immunotherapy of real-world SCLC. In the end, Professor Bao Zhang of the First Affiliated Hospital of Zhejiang University School of Medicine performed excellently in the self-case sharing and practical question-and-answer sessions, and was unanimously selected as the champion of this final by the expert jury.
The real-world immunotherapy case shared by Professor Bao Zhang is shown as follows:
A male, 61 years old, was admitted to the hospital in November 2020 due to "chest tightness, breath and cough and sputum for 1 month". The patient has a history of smoking, smoking 30 packs per year, and has quit smoking for 1 year; the lung CT was admitted to the hospital and found that the left lung occupied and mediastinal lymph nodes were enlarged. The pathological diagnosis of SCLC was SCLC in the bronchoscopic biopsy sample, immunohistochemistry : Ckpan(+), P40(-), Ki-67(70%), TTF-1 (+), CgA (+), Syn (+), CD56 (+), CD45(+), and initial diagnosis was SCLC (cT4N3M0, stage IIIC).
After multidisciplinary discussion, the patient's first-line treatment plan was determined to be duvalibilizumab + etoposide + carboplatin (EP regimen chemotherapy). The efficacy evaluation reached partial remission (PR) after 2 cycles of treatment, but the patient developed fatigue after 4 cycles of treatment, and there were adverse events related to immune such as autoimmune thyroiditis, myositis, and increased blood sugar. The patient stopped the medication by himself; by June 2021, the patient still felt weak, so he suspended immunotherapy and reduced chemotherapy for EP regimen. The patient felt unbearable and did not continue to treat it.
In October 2021, the patient's cough symptoms worsened again. After the chest CT was checked, the lesions were significantly enlarged, approaching the pre-treatment level. The disease progression (PD) was determined, that is, the progression-free survival period (PFS) of the first-line treatment of the duvalizumab + EP regimen was 12 months; the second-line treatment was immunized by the duvalizumab + EP regimen and reached PR again, and the treatment was changed to the single drug of duvalizumab after 4 cycles of treatment. PD occurred again in July 2022, and the second-line treatment of PFS was 9 months. The third- and fourth-line treatment plans of the patients are duvalizumab + albumin-bound paclitaxel and duvalizumab + EP plans, but both of them have rapid PD after one month of treatment. Currently, the fifth-line treatment uses anlotinib single agent.
Treatment Process Summary of the treatment process of
This patient reflects that immunotherapy represented by duvalilizumab is also effective in localized SCLC (LS-SCLC). The performance of immunotherapy is moved to LS-SCLC before the immunotherapy is used, and the performance of consolidation treatment after synchronous chemoradiation or as consolidation treatment after synchronous chemoradiation is worth looking forward to.
"middle district" final highlights
"middle district final" 6 contestants, First Affiliated Hospital of China University of Science and Technology Professor Hu Nana, Professor Liu Chengxin of the Cancer Hospital of Shandong First Medical University, Professor Qian Yingying of Nanjing First Hospital, Professor Wang Jun of Zhengzhou University, and Professor Xu Shisheng of Qingdao Municipal Hospital all shared cases of SCLC immunotherapy. Professor Yuan Dongmei of the Eastern Theater Command General Hospital brought a case of initial diagnosis of inoperable local advanced non-small cell lung cancer , but was actually diagnosed with SCLC parallel immunotherapy. Finally, after the expert jury, Professor Yuan Dongmei of the Eastern Theater Command General Hospital won the championship of this final.
The lung cancer immunotherapy case shared by Professor Yuan Dongmei is shown as follows:
A female, 68 years old, "intermittent cough and sputum cough for more than 2 years, and was diagnosed with lung cancer for nearly 1 month." She was first admitted to the hospital in August 2020. The patient intermittently coughed in the middle of 2018 and coughed a small amount of white sputum. In July 2020, her chest CT was found in a local hospital. She showed that the dorsal segment of the right lower lobe is occupied, and malignant tumors were considered; fibroscopic biopsy pathology showed: low-differentiated cancer. Later, the patient underwent a consultation in the hospital with PET/CT and pathological sections in the other hospital. Both were considered as hypodifferentiated carcinoma of the right lower lung, with possible metastasis of the right hilar lymph node. Immunohistochemistry: CK5/6 (+), p63 minority (+), CK8 (+), CgA (-), CK7 (+), Ki67 about 30%+, NapsinA (-), P40 (-), Syn (-), TTF-1 (-), CK5/6 (-), PD-L1 10%+; Gene mutations: TP53 (+), TMB-H. After the patient was admitted to the hospital, the relevant examination was improved and the preliminary diagnosis was: right lung non-small cell lung cancer (T3N2M0, stage IIIB, EGFR/ALK/ROS1 negative, TP53 positive, PD-L1 10%+, TMB-H). After discussion by multidisciplinary teams, the first line adopted albumin-bound paclitaxel + cisplatin chemotherapy for two cycles, and the efficacy evaluation reached PR. So in October 2020, the robot-assisted right middle and lower lobe lobectomy + lymph node dissection was performed, but the postoperative pathological biopsy was indicated as SCLC. The postoperative adjuvant treatment plan was considered to use PD-L1 inhibitor + EP regimen chemotherapy.
Starting from December 2020, the patient received 4 cycles of treatment for duvalibumab + EP regimen, and then received 1 cycle of treatment for duvalibumab single drug maintenance. Considering that the patient's metastatic lymph node pathological biopsy is also SCLC, it is recommended that the patient undergo local radiotherapy, but after the PET/CT examination, the patient's mediastinal lymph node and liver metastasis were found, hence the above two metastases underwent TOMO radiotherapy (50Gy/10fx), and the duvalibumab maintenance treatment was continued for 2 cycles, and the liver metastases were treated with anlotinib (2W/1W intermittent treatment). In July 2021, due to the patient's right lung infection, immunotherapy was suspended.
In September 2021, the patient's infection was controlled and the patient's re-examination was repeated. He saw new metastases in the right lobe of the liver, but other lesions in the whole body were well controlled. The third-line treatment continued to dovalibilizumab + anlotinib regimen, and TOMO knife radiotherapy (37.5Gy/5fx) was performed on the new lesions in the right lobe of the liver. The patient's condition continued to be controlled. By the re-examination in July 2022, multiple metastases in the liver were considered to occur again. The fourth-line treatment plan was adjusted to dovalibilizumab + sofantinib. The patient is still continuing to follow up.
The diagnosis process of this case is relatively tortuous, which brings certain challenges to the treatment team composed of multiple disciplines. However, after clarifying the pathological diagnosis of SCLC, duvalibumab immunotherapy was used, combined with radiotherapy, chemotherapy and anti-angiogenesis treatment, and long-term control of primary and oligometastatic lesions was achieved, reflecting the excellent value of immunotherapy in SCLC treatment.
Summary and thinking on the treatment process of this case
The chairman of the conference gave high praise to the final. The contestants brought meticulous and comprehensive case sharing and patient analysis, which fully reflected the standardized level of SCLC immunotherapy, and the overall performance was dazzling. We look forward to the restoration of offline academic exchanges in the future and further improving the precise treatment level of lung cancer for clinical middle-aged and young workers!
*This article is only used to provide scientific information to medical personnel and does not represent the views of this platform
