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08 February 2023, Volume 50 Issue 2 Previous Issue    Next Issue

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Clinical efficacy of osimertinib and icotinib in first-line treatment of EGFR-positive metastatic NSCLC Ning Tingting, Hu Qinyong, Li Qian, Yang Pengcheng 2023, 50 (2):  65-70.  doi: 10.3760/cma.j.cn371439-20221028-00014 Abstract ( 216 )   HTML ( 15 )   PDF (885KB) ( 150 )   Save Objective To investigate the real-world efficacy of osimertinib and icotinib in metastatic non-small cell lung carcinoma （NSCLC） patients. Methods A retrospective analysis was performed on clinical data of 151 newly-diagnosed patients with epidermal growth factor receptor （EGFR）-positive advanced NSCLC in Renmin Hospital of Wuhan University from March 2018 to May 2022. The patients were divided into osimertinib group （n=53） and icotinib group （n=98） according to treatment method. The objective response rate （ORR），disease control rate （DCR），progression-free survival （PFS） and overall survival （OS） were compared between the two groups. The factors influencing prognosis were analyzed by using Cox regression models. Subgroup analysis was performed according to metastatic site and EGFR mutation type. Results ORR was 56.6% （30/53） and 59.2% （58/98） for patients in the osimertinib group and icotinib group，respectively，with no statistically significant difference （χ2=0.09，P=0.759）. DCR was 83.0% （44/53） and 91.8% （90/98） for patients in the osimertinib group and icotinib group，respectively，with no statistically significant difference （χ2=2.68，P=0.102）. The median PFS was 11.7 months and 11.8 months for patients in the osimertinib group and icotinib group，respectively，with no statistically significant difference （χ2=0.06，P=0.802）. The median OS was not reached for patients in both the osimertinib group and icotinib group，with no statistically significant difference （χ2<0.01，P=0.969）. The results of multivariate analysis showed that adrenal metastases （HR=1.89，95%CI： 1.04-3.41，P=0.036） was an independent prognostic factor for PFS. Gender （HR=2.22，95%CI： 1.08-4.58，P=0.031） and adrenal metastases （HR=4.87，95%CI： 1.76-13.46，P=0.002） were independent prognostic factors for OS. The results of the subgroup analysis showed that in patients with pleural metastases （median PFS： 11.7 months vs. 9.3 months，median OS： not reached vs. not reached），adrenal metastases （median PFS： 8.7 months vs. 5.6 months，median OS： 20.0 months vs. 15.3 months），19DEL mutations （median PFS： 14.5 months vs. 13.3 months，median OS： not reached vs. 40.7 months），the osimertinib group tended to have better survival outcomes. Conversely，in patients with contralateral lung metastases （median PFS： 8.3 months vs. 11.2 months，median OS： not reached vs. 40.7 months），bone metastases （median PFS： 11.7 months vs. 11.8 months，median OS： not reached vs. 34.5 months），liver metastases （median PFS： 8.7 months vs. 9.1 months，median OS： not reached vs. 23.8 months），brain metastases （median PFS： 11.7 months vs. 15.3 months，median OS： 22.4 months vs. 35.3 months） and 21L858R mutations （median PFS： 9.5 months vs. 10.0 months，median OS： 22.4 months vs. not reached），the icotinib group tended to have better survival outcomes，but with no statistically significant differences （all P>0.05）. Conclusion Both osimertinib and icotinib have good therapeutic efficacy in patients with EGFR-positive advanced NSCLC，thus can be used as first-line treatment options. Figures and Tables | References | Related Articles | Metrics

Value of cell paraffin block immunohistochemistry and pleural effusion CRKL and MIC-1 in the diagnosis of malignant pleural effusion Liao Lihua, Wang Shaohong, Chen Hongcai, Zhao Yongqiang 2023, 50 (2):  71-75.  doi: 10.3760/cma.j.cn371439-20220527-00015 Abstract ( 123 )   HTML ( 12 )   PDF (869KB) ( 68 )   Save Objective To study the value of cell paraffin block immunohistochemistry and pleural fluid Crk like protein （CRKL） and macrophage inhibitory cytokine-1 （MIC-1） in the diagnosis of malignant pleural effusion. Methods A total of 98 patients with pleural effusion treated in Shantou Central Hospital from February 2020 to February 2021 were retrospectively selected as the research objects，including 58 benign cases and 40 malignant cases. The levels of CRKL and MIC-1 in pleural effusion were detected by enzyme-linked immunosorbent assay. The pleural effusion was analyzed by cell paraffin block immunohistochemistry. The levels of various indexes in benign group and malignant group were compared. The diagnostic value of cell paraffin block immunohistochemistry and pleural effusion CRKL and MIC-1 for benign and malignant pleural effusion was analyzed by receiver operating characteristic （ROC） curve. Results With pathological results as the gold standard，54 cases of benign and 44 cases of malignant were diagnosed by cell paraffin block immunohistochemistry. The diagnostic accuracy was 75.5% （74/98），and the sensitivity and specificity were 75.0% （30/40） and 75.9% （44/58） respectively. The levels of pleural effusion CRKL [2.84 （2.17，3.98） ng/ml vs. 1.88 （0.94，2.62） ng/ml]，MIC-1 [2.28 （1.67，2.98） ng/ml vs. 1.76 （1.22，2.32）] ng/ml] in the malignant group were higher than those in the benign group，with statistically significant differences （Z=-4.57，P<0.001； Z=-3.09，P<0.001）. The optimal critical value of CRKL in pleural effusion for the diagnosis of malignant pleural effusion was 2.33 ng/ml，the area under the curve （AUC） was 0.76 （95%CI： 0.66-0.85），and the sensitivity and specificity were 67.5% （27 /40），74.1% （43/58）. The optimal critical value of MIC-1 in pleural effusion for the diagnosis of malignant pleural effusion was 2.10 ng/ml，the AUC was 0.74 （95%CI： 0.64-0.85），and the sensitivity and specificity were 60.0% （24/40），82.8% （48/58）. The AUC of MIC-1 and CRKL in pleural effusion combined with cell paraffin block immunohistochemistry for the diagnosis of malignant pleural effusion was 0.83 （95%CI： 0.75-0.91），and the sensitivity and specificity were 85.0% （34/40） and 70.7% （41/58）. The sensitivity and AUC of combined diagnosis were significantly higher than those of CRKL and MIC-1 alone （sensitivity： χ2=4.26，P=0.046； χ2=6.27，P=0.012； AUC： Z=3.53，P<0.001； Z=4.14，P<0.001）. Conclusion CRKL and MIC-1 in pleural effusion of patients with malignant pleural effusion are highly expressed，which can be used as indicators for the diagnosis of malignant pleural effusion. Detection combined with cell paraffin block immunohistochemistry can improve the diagnostic value of malignant pleural effusion. Figures and Tables | References | Related Articles | Metrics

Observation on the efficacy of different stents in the treatment of patients with advanced esophageal cancer Ji Shiyu, Zhang Mingxin, Xie Huahong, Bai Yuan, Wang Tong 2023, 50 (2):  76-81.  doi: 10.3760/cma.j.cn371439-20220726-00016 Abstract ( 164 )   HTML ( 19 )   PDF (730KB) ( 92 )   Save Objective To explore the efficacy and safety of treating advanced esophageal cancer by implanting the common stent and the radioactive 125I particle stent with endoscope. Methods The clinical data of patients with advanced esophageal cancer admitted to Jingbian County People's Hospital of Shaanxi Province，the First Affiliated Hospital of Xi'an Medical University，Xijing Hospital of Digestive Diseases of Air Force Medical University and the First Hospital of Yulin of Shaanxi Province from December 2014 to December 2020 were retrospectively analyzed. Patients were divided into common stent group （n=66） and radioactive particle stent group （n=34） according to different stent types. The postoperative complications，Karnofsky performance status （KPS） score，dysphagia score，restenosis rate and quality of life were compared between the two groups. Results The incidences of postoperative retrosternal pain in the common stent group and the radioactive particle stent group were 65.2% （43/66） and 47.1% （16/34） respectively. The incidences of pharyngeal pain and hoarseness were 12.1% （8/66） and 5.9% （2/34）. The incidences of abdominal pain were 9.1% （6/66） and 2.9% （1/34）. The incidences of errhysis were 3.0% （2/66） and 2.9% （1/34）. The incidences of vomiting and nausea were 7.6% （5/66） and 5.9% （2/34） respectively. There were no statistically significant differences between the two groups （χ2=3.04，P=0.081； χ2=0.40，P=0.527； χ2=0.53，P=0.467； χ2<0.01，P>0.999； χ2<0.01，P>0.999）. In the two groups，KPS scores in the first，second，third and sixth month after operation were higher than those before operation （all P<0.05）. KPS scores of the radioactive particle stent group in the second，third and sixth month were significantly higher than those of the common stent group [（89.73±7.84） points vs. （82.37±7.42） points，t=4.62，P<0.001； （93.63±8.13） points vs. （88.33±7.28） points，t=3.74，P<0.001； （92.78±6.26） points vs. （87.28±8.73） points，t=3.77，P<0.001]. The dysphagia scores of patients in the two groups in the first，second，third and sixth month were lower than those before operation （all P<0.05）. The dysphagia scores of the radioactive particle stent group in the third and sixth month after operation were significantly lower than those of the common stent group [（0.68±0.12） points vs. （2.33±0.32） points，t=26.20，P<0.001； （0.82±0.22） points vs. （2.67±0.24） points，t=36.92，P<0.001]. In the third month after operation，the restenosis rate of the radioactive particle stent group was significantly lower than that of the common stent group [5.88% （2/34） vs. 42.4% （28/66），χ2 =14.27，P<0.001]. The scores of QLQ-C30 and OES-18 scales in the first，second，third and sixth month after operation were lower than those before operation （all P<0.05）. The scores of QLQ-30 scale in the radioactive particle stent group in the second，third and sixth month were significantly lower than those in the common stent group [（19.12±3.02） points vs. （21.22±2.87） points，t=3.39，P=0.001； （15.04±1.68） points vs. （20.43±2.23） points，t=12.39，P<0.001； （14.38±2.18） points vs. （19.77±3.67） points，t=9.20，P<0.001]. The scores of OES-18 scale in the radioactive particle stent group were also significantly lower than those in the common stent group [（17.13±2.07） points vs. （20.64±2.11） points，t=7.95，P<0.001； （15.22±1.88） points vs. （19.24±1.76） points，t=10.62，P<0.001； （14.74±2.36） points vs. （18.53±3.27） points，t=6.01，P<0.001]. Conclusion The radioactive particle stent can improve the quality of life of patients with advanced esophageal cancer with esophageal stenosis，so as to improve dysphagia and reduce the restenosis rate after operation. However，whether it is obviously superior to common stent in prolonging survival time and reducing complications needs to be further confirmed by a multicenter，prospective，large-sample randomized controlled study. Figures and Tables | References | Related Articles | Metrics

Clinical efficacy of Compound Kushen Injection combined with SOX regimen in the treatment of elderly patients with advanced gastric cancer Yang Jun, Li Rong, Zeng Jianchang 2023, 50 (2):  82-86.  doi: 10.3760/cma.j.cn371439-20220506-00017 Abstract ( 119 )   HTML ( 13 )   PDF (714KB) ( 71 )   Save Objective To explore the clinical efficacy and influence on quality of life of Compound Kunshen Injection combined with SOX regimen （Tigio + Oxaliplatin） in the treatment of elderly patients with advanced gastric cancer. Methods A total of 76 elderly patients with advanced gastric cancer admitted to Caidian District People's Hospital of Wuhan from May 2017 to December 2021 were retrospectively analyzed. Patients were divided into study group （n=38） and control group （n=38） according to different treatment methods. The study group was treated with Compound Kunshen Injection combined with SOX regimen，and the control group was treated with SOX regimen. All patients received at least 2 cycles of chemotherapy. The disease control rate （DCR），the changes of serum carcinoembryonic antigen （CEA） and carbohydrate antigen 199 （CA199） before and after treatment of the two groups were compared. The occurrence of adverse reactions to chemotherapy and the improvement of quality of life related indicators before and after treatment were observed in the two groups. Results The DCR of the study group was 84.2% （32/38） and that of the control group was 63.2% （24/38），with a statistically significant difference （χ2=4.34，P=0.037）. After treatment，CEA levels in both study group and control group were decreased compared with those before treatment [7.92 （5.00，50.23） ng/ml vs. 40.08 （6.37，68.18） ng/ml，Z=3.53，P<0.001； 40.24 （20.12，53.69） ng/ml vs. 41.32 （11.50，63.90） ng/ml，Z=2.06，P=0.044]，and CEA level in the study group was decreased more significantly than that in the control group （Z=1.99，P=0.048）. After treatment，CA199 levels in both study group and control group were decreased compared with those before treatment [20.23 （17.34，71.31） U/ml vs. 70.14 （12.75，96.95） U/ml，Z=2.70，P=0.007； 54.25 （30.54，76.75） U/ml vs. 62.28 （23.00，84.80） U/ml，Z=2.37，P=0.018]，with no statistically significant difference in the reduction level of CA199 between the two groups （Z=0.73，P=0.463）. Most of the adverse reactions in the two groups during chemotherapy were grade 1-2，which disappeared after symptomatic treatment. Compared with the control group，the study group had lower incidence of gastrointestinal reaction [26.3% （10/38） vs. 52.6% （20/38），χ2=5.50，P=0.019]，myelosuppression [18.4% （7/38） vs. 44.7% （17/38），χ2=6.09，P=0.014] and peripheral neurotoxicity [21.1% （8/38） vs. 44.7% （17/38），χ2=4.83，P=0.028]. The improvements of QOL score [78.9% （30/38） vs. 55.3% （21/38），χ2=4.83，P=0.028]，Karnofsky performance status score [71.1% （27/38） vs. 47.4% （18/38），χ2=4.41，P=0.036]，hemoglobin [73.7% （28/38） vs. 50.0% （19/38），χ2=4.52，P=0.034] and pain control [65.8% （25/38） vs. 24.1% （16/38），χ2=4.29，P=0.038] of the study group were better than those of the control group，with statistically significant differences. Conclusion Compound Kunshen Injection combined with SOX regimen in the treatment of elderly patients with advanced gastric cancer can not only improve the DCR of patients，but also reduce the serum levels of tumor markers CEA and CA199，among which the CEA decline is more obvious，reduce the incidence of adverse reactions of chemotherapy and improve the quality of life of patients. Figures and Tables | References | Related Articles | Metrics

Reviews

Lumican and tumor therapy resistance Hu Ge, Xia Fan, Wu Xueya, Wang Yun, Xu Xiuli 2023, 50 (2):  87-90.  doi: 10.3760/cma.j.cn371439-20220621-00018 Abstract ( 105 )   HTML ( 6 )   PDF (697KB) ( 69 )   Save Lumican is a member of the small leucine-rich proteoglycan family，which is involved in cell processes related to tumorigenesis and development，such as epithelial-mesenchymal transition，cell proliferation，migration，invasion and adhesion. The expression of Lumican in different tumors is positively or negatively correlated with tumor progression，and can be used as a reference for tumor prognosis and efficacy evaluation. Further study of the correlation and potential mechanism between Lumican and tumor therapy resistance can provide new ideas for predicting clinical therapeutic efficacy. References | Related Articles | Metrics

Clinical application of PARP inhibitors in breast cancer Li Lixi, Zhang Di, Luo Yang, Ma Fei 2023, 50 (2):  91-96.  doi: 10.3760/cma.j.cn371439-20221023-00019 Abstract ( 180 )   HTML ( 8 )   PDF (727KB) ( 113 )   Save Poly adenosine diphosphate ribose polymerase （PARP） inhibitors lead to synthetic lethality in homologous recombination repair-deficient （HRD） tumors by inhibiting DNA damage repair. Two PARP inhibitors，olaparib and talazoparib，have been approved for the salvage treatment of breast cancer susceptibility gene (BRCA) mutation，human epidermal growth factor receptor 2 （HER2） negative advanced breast cancer，and adjuvant treatment of early breast cancer. PAPR inhibitor single agent shows good antitumor activity and controllable safety. A number of clinical studies on PAPR inhibitors combined with chemotherapy，radiotherapy，antiangiogenic therapy and immunotherapy are being carried out. The indications of PARP inhibitors also extend from BRCA mutation to HRD，from ovarian cancer and breast cancer to other solid tumors，promising to benefit more patients in the future. References | Related Articles | Metrics

Immunotherapy for EGFR-mutant non-small cell lung cancer after EGFR-TKI acquired resistance Zhang Bixia, Ding Jianghua 2023, 50 (2):  97-101.  doi: 10.3760/cma.j.cn371439-20220719-00020 Abstract ( 156 )   HTML ( 9 )   PDF (752KB) ( 183 )   Save Epidermal growth factor receptor （EGFR）-mutant advanced non-small cell lung cancer （NSCLC） was previously regarded as a cold tumor according to tumor immune microenvironment （TIME）. However，recent studies have found that EGFR-tyrosine kinase inhibitors （EGFR-TKIs） treatment can transform the host immunity from immunosuppressive to immunosupportive state，bringing new hope for immunotherapy. There are four main therapeutic strategies for patients after EGFR-TKIs acquired resistance： immunotherapy alone （Im），immunotherapy plus chemotherapy （Im+C），immunotherapy plus antiangiogenic drugs （Im+A），and immunotherapy combined with antiangiogenic drugs and chemotherapy （Im+A+C）. Among them，the efficacy of Im is extremely limited，being significantly lower than that of chemotherapy alone，while there is still scarce evidence for the efficacy of Im+A with few clinical studies. The combination of Im+C and Im+A+C shows better efficacy than chemotherapy alone. Im+A+C has a superior clinical outcome to Im+C. Additionally，the EGFR L858R mutation subgroup benefits more from Im+C than the EGFR 19 del mutation subgroup. The T790M-negative subgroup has a greater benefit from Im+A+C than the T790M-positive subgroup. In general，the strategy of combining immunotherapy with chemotherapy and/or an antiangiogenic drug represents a novel and promising method for treating EGFR-mutant NSCLC after EGFR-TKI failure. References | Related Articles | Metrics

Influencing factors of pneumonitis in the period of thoracic radiotherapy combined with immunotherapy Huang Huayu, Gong Hongyun, Song Qibin 2023, 50 (2):  102-106.  doi: 10.3760/cma.j.cn371439-20221115-00021 Abstract ( 143 )   HTML ( 3 )   PDF (717KB) ( 93 )   Save The combination of thoracic radiotherapy and immunotherapy is increasingly widely used in clinical practice，which not only brings survival benefits but also increases the incidence of pneumonitis. The occurrence of pneumonitis affects the subsequent immunotherapy and can be life-threatening in severe cases. The occurrence and severity of pneumonitis after combination therapy depends on a variety of factors，including patient's age，physical strength，pulmonary function，race，combination therapy mode，radiotherapy dose parameters，type of immune checkpoint inhibitor，history of checkpoint inhibitor-related pneumonitis or radiation pneumonitis，serum indexes and so on. At present，further research is needed to find out the influencing factors of the occurrence and severity of pneumonitis attributed to combined therapy，so as to better avoid，predict，identify and treat related pneumonitis in clinical practice. References | Related Articles | Metrics

Application of CT-based radiomics analysis in predicting and identifying of treatment-associated pneumonitis Cao Xiaohui, Yu Hong, Li Wanhu 2023, 50 (2):  107-111.  doi: 10.3760/cma.j.cn371439-20220726-00022 Abstract ( 135 )   HTML ( 3 )   PDF (718KB) ( 108 )   Save As a non-invasive image analysis method，radiomics can deeply explore the clinical information hidden behind medical images，and has been widely used in medicine in recent years. Consolidation immunotherapy after concurrent chemoradiotherapy has become the standard treatment for locally advanced non-small cell lung cancer. The prediction and identification of treatment-associated adverse events radiation pneumonitis （RP） and immune checkpoint inhibitor-related pneumonitis （CIP） are of vital importance for the formulation of treatment plan and the selection of subsequent treatment. CT-based radiomics analysis shows great potential in predicting and identifying RP and CIP. References | Related Articles | Metrics

Progress in the study of predictors of tumor regression grade after neoadjuvant chemotherapy for gastric cancer Fan Shanlin, Wang Pinxiu, Kong Fei, Zhou Yujie, Yuan Wenzhen 2023, 50 (2):  112-116.  doi: 10.3760/cma.j.cn371439-20220624-00023 Abstract ( 158 )   HTML ( 5 )   PDF (719KB) ( 116 )   Save The overall efficacy of neoadjuvant chemotherapy for locally advanced gastric cancer has been recognized. However，neoadjuvant chemotherapy is ineffective in a subset of patients due to tumor heterogeneity. The tumor regression grade （TRG） has unique advantages in assessing the efficacy of neoadjuvant chemotherapy for gastric cancer. Nonetheless，since TRG is dependent on postoperative pathology，it becomes a significant topic today to mine TRG predictors to more accurately select appropriate patients for neoadjuvant chemotherapy. Therefore，to understand the relevant research progress and current research challenges of TRG predictors after neoadjuvant chemotherapy for gastric cancer from the aspects of biomarkers，immunity，inflammatory indicators，body composition，imaging indicators，etc.，is conducive to further clinical research and practice. References | Related Articles | Metrics

Effect of anesthesia on the recurrence and metastasis of hepatocellular carcinoma Ma Peihan, Zhang Lingming, Lu Ning, Zhang Mingxin 2023, 50 (2):  117-121.  doi: 10.3760/cma.j.cn371439-20221027-00024 Abstract ( 99 )   HTML ( 3 )   PDF (714KB) ( 52 )   Save Hepatocellular carcinoma （HCC） is one of the leading causes of cancer death. There is a high risk of recurrence and metastasis after surgery. Anesthesia methods，anesthesia-related drugs and intraoperative anesthesia management can affect the biological behavior of HCC cells or the body's immunity，thus affecting the recurrence and metastasis of HCC. Paying attention to the effect of anesthesia on recurrence and metastasis of HCC and optimizing anesthesia management are expected to improve the long-term survival of patients. References | Related Articles | Metrics

Research status and application prospect of a novel immune checkpoint TIGIT in the immunotherapy of multiple myeloma Zhang Yuxiao, Zhang Liansheng, Li Lijuan 2023, 50 (2):  122-125.  doi: 10.3760/cma.j.cn371439-20221024-00025 Abstract ( 130 )   HTML ( 4 )   PDF (701KB) ( 75 )   Save T cell immunoglobulin and immunoreceptor tyrosine-based inhibitory motif domain （TIGIT） is a new immune checkpoint protein. Studies have shown that TIGIT can cause dysfunction of immune cells，weaken the anti-tumor effect，thus leading to tumor immune tolerance and immune escape. Blocking TIGIT can reverse immune cell failure and exert anti-tumor effect，which is expected to become a new therapeutic target for multiple myeloma. References | Related Articles | Metrics