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08 November 2021, Volume 48 Issue 11 Previous Issue    Next Issue

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Original Articles

Efficacy and safety of camrelizumab combined with albumin paclitaxel as second-line therapy for advanced esophageal squamous cell carcinoma Zhang Yuping, Wu Deping 2021, 48 (11):  649-654.  doi: 10.3760/cma.j.cn371439-20210409-00129 Abstract ( 381 )   HTML ( 36 )   PDF (4339KB) ( 97 )   Save Objective To evaluate the efficacy and safety of camrelizumab combined with albumin paclitaxel in second-line treatment of advanced esophageal squamous cell carcinoma (ESCC). Methods Seventy-two patients with advanced or metastatic ESCC who had failed first-line treatment admitted to the Department of Oncology of the Affiliated Hospital of West Anhui Health Vocational College from May 12, 2019 to August 20, 2020 were enrolled. The patients were given camrelizumab combined with albumin paclitaxel (the experimental group, n=45) or second-line chemotherapy (docetaxel or irinotecan, the control group, n=27) according to patients' preference. Besides, the objective response rate (ORR), disease control rate (DCR), incidence of adverse events, overall survival (OS) and progress free survival (PFS) were assessed. Results The ORR of the experimental group and the control group were 26.7% (12/45) and 7.4% (2/27) respectively, with a statistically significant difference (χ 2=3.996, P=0.046). The DCR of the two groups were 48.9% (22/45) and 29.6% (8/27) respectively, with no statistically significant difference (χ 2=2.575, P=0.109). In terms of adverse events, the experimental group was better tolerated, and the incidence of grade 3 or above adverse events was lower [28.9% (13/45) vs. 55.6% (15/27)], which was 48% lower than that of the control group, with a statistically significant difference (χ 2=5.049, P=0.025). One patient in the control group had a treatment-related death. The median OS was 8.9 months (95%CI: 7.9-9.8) in the experimental group and 6.5 months (95%CI: 5.6-7.3) in the control group, with a statistically significant difference (χ 2=5.068, P=0.024). The median PFS was 2.2 months (95%CI: 1.6-2.7) in the experimental group and 1.8 months (95%CI: 1.5-2.0) in the control group, with a statistically significant difference (χ 2=4.799, P=0.028). Conclusion Camrelizumab combined with albumin paclitaxel in second-line treatment of advanced ESCC patients has proven efficacy and tolerable safety, which may be a potential second-line treatment for advanced ESCC. Figures and Tables | References | Related Articles | Metrics

Clinical observation of apatinib mesylate in the treatment of metastatic renal carcinoma Wu Guang, Yu Yuandong, Chen Ping 2021, 48 (11):  655-659.  doi: 10.3760/cma.j.cn371439-20201230-00130 Abstract ( 234 )   HTML ( 18 )   PDF (3634KB) ( 83 )   Save Objective To assess the efficacy and safety of apatinib mesylate in the treatment of metastatic renal carcinoma. Methods Between October 2018 and April 2020, 32 patients with metastatic renal carcinoma were enrolled in the Department of Oncology of Shiyan People's Hospital of Hubei Province, Taihe Hospital and Sinopharm Dongfeng General Hospital. Apatinib mesylate was administered at an initial dose of 500 mg once daily. The main research end point was progression-free survival (PFS), secondary study destination included objective response rate (ORR), disease control rate (DCR) and safety. Multivariate analysis of PFS was carried out by Cox regression. Results The median follow-up time was 6.5 months (from 2 to 10). All 32 patients could be evaluated for efficacy. Efficacy evaluation showed 0 cases of complete remission, 14 cases (43.75%) of partial remission, 10 cases (31.25%) of stable disease, 8 cases (25.00%) of progressive disease, the ORR was 43.75% (14/32), and DCR was 75.00% (24/32). The PFS of patients had no significant correlation with gender, age, pathological type and previous surgery (all P>0.05), but was significantly correlated with the site of metastasis (HR=0.032, 95%CI: 0.003-0.411, P=0.008). The median PFS for all patients was 9.5 months (8.3-10.7 months), and there was a significant difference in the median PFS between patients with lung metastasis (n=21) and those with other sites (n=11) (9.5 months vs. 6.2 months, χ 2=14.812, P<0.001). The main adverse reactions were hypertension (37.50%, 12/32), hand-foot syndrome (31.25%, 10/32), proteinuria (18.75%, 6/32), neutropenia (25.00%, 8/32), anemia (28.13%, 9/32), thrombocytopenia (18.75%, 6/32), nausea/vomiting (15.63%, 5/32) and elevated transaminase (15.63%, 5/32), most of which were grade 1 or 2. The incidence of grade 3 adverse reactions was 28.13% (9/32), without grade 4 adverse reactions. After dosage reduction and symptomatic treatment, the symptoms could be controlled. Conclusion Apatinib mesylate can effectively prolong PFS in metastatic renal carcinoma patients with good safety, and can be used as a treatment option for metastatic renal carcinoma. Figures and Tables | References | Related Articles | Metrics

Clinical study of intraperitoneal infusion of bevacizumab combined with albumin paclitaxel and carboplatin in carcinomatous peritoneal adhesion from ovarian cancer Zheng Jing, Yao Sheng, Shen Wenjie, Sun Zhijia, Zhao Hui, Fu Yan, Gao Ke, Du Nan 2021, 48 (11):  660-665.  doi: 10.3760/cma.j.cn371439-20210607-00131 Abstract ( 600 )   HTML ( 15 )   PDF (4103KB) ( 89 )   Save Objective To observe the clinical effects of intraperitoneal perfusion of bevacizumab combined with albumin paclitaxel and carboplatin in the treatment of malignant peritoneal adhesion caused by ovarian cancer. Methods From January 2016 to December 2020, 54 patients treated in our hospital with malignant peritoneal adhesions caused by ovarian cancer were enrolled in this study. They were randomly divided into experimental group (n=27) and control group (n=27) according to the random number table method. The treatment regimen of the experimental group was intravenous infusion of albumin paclitaxel plus intraperitoneal infusion of carboplatin and bevacizumab. The treatment regimen of the control group was intra-venous infusion of albumin paclitaxel plus intraperitoneal infusion of carboplatin. The treatment was repeated every 21 days, and the therapeutic effect was evaluated every two cycles. The treatment lasted for six cycles. The efficacy and incidence of adverse reactions were compared between the two groups. Results The remission rate of incomplete malignant bowel obstruction of the experimental group was higher than that of the control group [85.19% (23/27) vs. 59.26% (16/27)], the total effective rate of the experimental group was higher than that of the control group [74.07% (20/27) vs. 44.44% (12/27)], and there were statistically significant differences (χ2=4.523, P=0.033; χ 2=4.909, P=0.027). After treatment, the levels of vascular endothelial growth factor (VEGF) in ascites of the experimental group and the control group were significantly lower than those before treatment [(80.33±1.41) pg/ml vs. (310.45±3.35) pg/ml, t=449.884, P<0.001; (135.68±1.60) pg/ml vs. (310.46±3.09) pg/ml, t=499.281, P<0.001], and after treatment, the VEGF level in the experimental group decreased more significantly than that in the control group (t=-134.907, P<0.001). Patients in the experimental group and the control group tolerated the treatment well, and there were no significant differences in the incidences of adverse reactions such as hypertension (11.11% vs. 3.70%, χ2=0.270, P=0.603), neutropenia (14.81% vs. 11.11%, χ 2<0.001, P>0.999), peripheral neuropathy (3.70% vs. 0, χ2<0.001, P>0.999), diarrhea (7.41% vs. 3.70%, χ2<0.001, P>0.999), nausea (3.70% vs. 0, χ2<0.001, P>0.999), epistaxis (7.41% vs. 0, χ2=0.519, P=0.471) or albuminuria (3.70% vs. 0, χ 2<0.001, P>0.999) between the two groups. Conclusion Intraperitoneal perfusion of bevacizumab combined with chemotherapy is superior to simple chemotherapy in the treatment of malignant peritoneal adhesion caused by ovarian cancer. Figures and Tables | References | Related Articles | Metrics

Application study of EAC mobilization scheme in autologous hematopoietic stem cell transplantation of lymphoma Chen Lina, Guo Zhi, Liu Xuanyong, Chen Xiao, Zhang Yihuizhi, Li Xumian, Wei Liya, Wang Yueqiao, Xie Jing 2021, 48 (11):  666-672.  doi: 10.3760/cma.j.cn371439-20200713-00132 Abstract ( 230 )   HTML ( 11 )   PDF (6909KB) ( 41 )   Save Objective To explore the safety and efficacy of EAC [etoposide+cytarabine+cyclophosphamide (CTX)] mobilization scheme for mobilizing stem cells in patients with lymphoma undergoing autologous hematopoietic stem cell transplantation (ASCT). Methods A total of 36 patients with lymphoma who had collected peripheral blood stem cells through EAC or CTX+granulocyte colony stimulating factor (G-CSF) mobilization scheme in Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from June 2018 to March 2020 were retrospectively analyzed. Among them, 16 patients used EAC mobilization (EAC group), and 20 patients used CTX (CTX group). When white blood cells≤1.0×10 9/L, G-CSF (10 μg/kg per day) was given subcutaneously in two doses. The changes of hematology indexes, the number of collected cells, adverse reactions during mobilization collection and hematopoietic reconstitution after ASCT were observed. Results The peripheral blood stem cells were collected on 5 d (3-8 d) after EAC+G-CSF mobilization and 7 d (4-12 d) after CTX+G-CSF mobilization. The success rates of collection in the EAC group and CTX group were 100% (16/16) and 75.0% (15/20) respectively, the high-quality collection rates were 87.5% (14/16) and 25.0% (5/20) respectively, and there were statistically significant differences (P=0.041; P<0.001). The median of CD34 + cells of the two groups was 13.67×106/kg and 3.45×106/kg respectively, the median of mononuclear cells was 7.16×108/kg and 5.09×108/kg respectively, the median of CD34+ cells/mononuclear cells was 1.44% and 0.67% respectively, and there were statistically significant differences (Z=-4.219, P<0.001; Z=-2.118, P=0.034; Z=-3.104, P=0.002). In the EAC group and CTX group, the incidences of grade 3 and above granulocytopenia were 100% (16/16) and 90.0% (18/20) respectively, the incidences of grade 3 and above hemoglobin reduction were 43.8% (7/16) and 25.0% (5/20) respectively, the incidences of grade 3 and above thrombocytopenia were 87.5% (14/16) and 65.0% (13/20) respectively, and there were no statistically significant differences (P=0.492; P=0.298; P=0.245). There were no significant differences in the incidences of infection, adverse reactions of digestive system or other adverse reactions between the two groups (all P>0.05). All patients accepted improved Bucy scheme before ASCT. The median implantation time of neutrophils and platelets was 9.0 d and 10.5 d in the EAC group, which was 12.0 d and 13.5 d in the CTX group, and there were statistically significant differences (Z=-4.698, P<0.001; Z=-3.757, P<0.001). Conclusion EAC mobilization scheme can significantly increase the number of hematopoietic stem cell. This scheme has a high success rate of high-quality collection and the adverse reactions are within the controllable range. It provides a high-quality mobilization scheme for hematopoietic stem cell mobilization and collection, which is worthy of clinical promotion and application. Figures and Tables | References | Related Articles | Metrics

Reviews

Advances in neoadjuvant therapy of esophageal cancer involved in organ preservation Du Chen, Su Siyu, Wang Lige, Yu Guiping 2021, 48 (11):  673-677.  doi: 10.3760/cma.j.cn371439-20201111-00133 Abstract ( 183 )   HTML ( 17 )   PDF (4882KB) ( 94 )   Save Esophageal squamous cell carcinoma is one of the most common cancer in China, and locally advanced stage remains a heterogeneous and complex disease. Its treatments are constantly evolving. To date, radiochemotherapy and surgery are involved in the comprehensive treatment of this disease. However, because of the specifical anatomical location of esophagus, its physiological function will be impaired after surgical resection. If similar survival is obtained in esophageal cancer, an organ preserving strategy without surgery is of great significance for improving the quality of life. As a non-invasive tumor treatment method, neoadjuvant therapy plays an important role in the comprehensive treatment of preserving the esophagus. Recently, there are studies investigating the role of organ preserving strategy in the comprehensive treatment of esophageal cancer with neoadjuvant therapy, and the recognition of these advances will provide reference value for the comprehensive treatment of esophageal cancer. References | Related Articles | Metrics

Application of immune checkpoint inhibitors combined with radiotherapy in non-small cell lung cancer Wang Peiwei, Weng Yiming, Cui Xue, Peng Min 2021, 48 (11):  678-682.  doi: 10.3760/cma.j.cn371439-20210126-00134 Abstract ( 176 )   HTML ( 15 )   PDF (4106KB) ( 78 )   Save The emergence of immune checkpoint inhibitors (ICIs) has greatly changed the treatment strategy of non-small cell lung cancer (NSCLC). Although ICIs are effective, there are still many patients who cannot benefit from immunotherapy alone. The current research direction focuses on the combination of multiple treatment schemes. Radiotherapy can upregulate immunogenic cell surface markers, and regulate the expressions of immune checkpoints. A large number of preclinical and clinical studies are exploring the efficacy and safety of ICIs combined with radiotherapy in various clinical stages of NSCLC, including radiotherapy timing, optimal dose, dose distribution and so on. References | Related Articles | Metrics

Research progress of immune checkpoint inhibitors in the treatment of lung cancer Ma Jun, Zhang Hongying, Wu Aiping, Gao Guangyi 2021, 48 (11):  683-687.  doi: 10.3760/cma.j.cn371439-20201231-00135 Abstract ( 233 )   HTML ( 18 )   PDF (3696KB) ( 75 )   Save In recent years, immune checkpoint inhibitors are a milestone in the treatment of lung cancer. There are many kinds of immune checkpoints, which are closely related to the efficacy and drug resis-tance of immunotherapy, including programmed death-1 (PD-1), programmed death ligand-1 (PD-L1), cytotoxic T-lymphocyte antigen 4 (CTLA-4), killer cell immunoglobulin-like receptor (KIR), T cell immunoglobulin and ITIM domain (TIGIT), T-cell immunoglobulin and mucin domain-containing protein 3 (TIM-3), etc. PD-1/PD-L1 inhibitors have been approved by China National Medical Products Administration and U.S. Food and Drug Administration for the first-line treatment of lung cancer, which can improve overall survival and progression-free survival of patients. The double immunotherapies of CTLA-4 inhibitors or TIGIT inhibitors combined with PD-1/PD-L1 inhibitors also achieve good results, however, more serious adverse events may occur.The KIR and TIM-3 targets are closely related to the drug resistance of immunotherapy. References | Related Articles | Metrics

Research advances of m6A methylation modification in digestive system neoplasms Liu Peipei, Yang Mengxue, Yan Xuebing 2021, 48 (11):  688-692.  doi: 10.3760/cma.j.cn371439-20210906-00136 Abstract ( 176 )   HTML ( 17 )   PDF (3873KB) ( 64 )   Save N6-methyladenosine (m6A) methylation modification is defined as the methylation at the N6 position of adenosine. This dynamic process is regulated by writer, eraser and reader. Accumulating evidence indicates that m6A methylation modification is involved in the initiation and development of various digestive system neoplasms including proliferation, invasion, metastasis and chemoresistance. A further understanding about the role of m6A methylation modification in digestive system neoplasms will benefit the development of a novel precise diagnostic and therapeutic strategy and finally improve the overall prognosis of patients. References | Related Articles | Metrics

Treatment options for colorectal cancer primary lesions with unresectable metastases at risk of acute abdomen Shi Yue, Li Shen, Feng Jifeng 2021, 48 (11):  693-697.  doi: 10.3760/cma.j.cn371439-20210714-00137 Abstract ( 251 )   HTML ( 12 )   PDF (3893KB) ( 67 )   Save For patients with metastatic colorectal cancer, it is still controversial whether the primary tumor needs surgery when the metastasis is unresectable. The effect of palliative surgical resection of the primary lesion on improving the prognosis and prolonging survival is still uncertain while the risks of acute abdomen trigger the discussion of early palliative surgical resection of the primary tumor. Evaluating and predicting the risk of acute abdomen complicated by colorectal cancer will help to choose the treatment of the primary lesion of unresectable metastatic colorectal cancer. References | Related Articles | Metrics