Multidisciplinary management of hepatobiliary tumors in the era of precision medicine

Hepatobiliary tumor (HBT), one of the leading causes of cancer deaths globally, is more frequent in East Asia including China [1].HBTincludeslivercancer,cholangiocarcinomaandgallbladder cancer.HBTburdenvariesmarkedlybygenderandgeographic regionduetotheexposureofriskfactors.MajorityofthehepatocellularcarcinomasareassociatedwithhepatitisB-typevirus

A CLINICAL STUDY FOR EVALUATING EARLY RADIOTHERAPY EFFECT IN PATIENTS WITH BRAIN TUMOR USING ^(99)Tc^m-HL91 SPECT

Objective： The purpose of this study was to evaluate the early radiotherapy effect using ^99Tc^m-HL91 SPECT in patients with brain tumors. Methods： Twenty-one patients with brain tumors who were treated by radiotherapy were studied. KPS grade, tumor size on ^99Tc^m-HL91 SPECT, tumor size on MRI, and ratio of T/N （tumor counts/sec over normal brain tissue counts/sec） were investigated before ,during and after radiotherapy. Results： The average tumor size on ^99Tc^m-HL91 SPECT and MRI was 11.34±5.88 cm^2, 9.46±5.66 cm^2, respectively before radiotherapy. The tumor size on ^99Tc^m-HL91 SPECT was not in accordance with to that on MRI （P〈0.05）. KPS grade, tumor size on ^99Tc^m-HL91 SPECT and ratio of T/N had significance differences before, during and after radiotherapy （P〈0.05）, but the tumor size on MRI imaging had no significance differences before, during and after radiotherapy （P〉0.05）. The rate of symptom improvement was 80% during radiotherapy and 100% after radiotherapy. The rates of imaging remission based on the brain tumor size on ^99Tc^m-HL91 SPECT, MRI and T/N were 75%, 15%, and 80%, respectively during radiotherapy. The agreement rates between imaging remission diagnosed by those three methods and symptom improvement were 70%, 40%, and 60% respectively during radiotherapy. The rates of imaging remission based on the brain tumor sizes on ^99Tc^m-HL91 SPECT, MRI and T/N were 100%, 25%, and 95% respectively after radiotherapy. The agreement rates between imaging remission diagnosed by those three methods and symptoms improvement were 100%, 20%, and 95% respectively after radiotherapy. Conclusion： The tumor size on ^99Tc^m-HL91 SPECT is a valuable tool for evaluating early radiotherapy effect of brain tumor in process of radiotherapy. T/N is not a feasible method in evaluating radiotherapy effect of brain tumor because it may show elevation unrelated to the curative effect during radiotherapy.

Pembrolizumab combined with lenvatinib as non-first-line therapy in patients with refractory biliary tract carcinoma

Background:A therapeutic strategy involving combined treatment with lenvatinib plus pembrolizumab(LEP)has demonstrated a relatively high antitumor response in several solid tumors;however,the efficacy and safety of LEP in patients with refractory bile tract carcinoma(BTC)remains unknown.Methods:This is a single-arm study for a preliminary assessment of the efficacy and tolerability of LEP in patients who experienced progression from prior systemic treatments.Pre-treatment tumor tissues were collected to retrospectively evaluate the expression status of PDL1.Results:Thirty-two patients received second-line and above treatment with LEP.Overall,the objective response rate(ORR)was 25%,the disease control rate(DCR)was 78.1%,and the clinical benefit rate(CBR)was 40.5%.The median progression-free survival(PFS)was 4.9 months(95%CI:4.7–5.2 months),and the median overall survival(OS)was 11.0 months(95%CI:9.6–12.3 months).For tolerability,no grade 5 serious adverse events(AEs)were reported.All patients had any-grade AEs,and 59.3%of the patients experienced grade 3 AEs,while only 1 patient experienced a grade 4 AE of stomach bleeding.Fatigue was the most common AE,followed by hypertension and elevated aminotransferase levels.Retrospective analysis for PDL1 expression revealed that PDL1 positive tumor cells were associated with improved clinical benefits and survival outcomes.Conclusions:LEP is a promising alternative as a non-first-line therapeutic regimen for patients with refractory BTC.Furthermore,well-designed prospective clinical trials with a control arm are still needed to obtain more evidences to confirm the efficacy and safety of this particular regimen as well as the role of PDL1 expression.