Clinical Observation of Bevacizumab Combined with S-1 in the Treatment of Pretreated Advanced Esophageal Carcinoma

Objective To investigate the clinical effects and safety of bevacizumab combined with S-1 as the second-line treatment of recurrent and/or metastatic esophageal cancer after chemoradiation. Methods Patients with recurrent or metastatic esophageal cancer after chemoradiation were treated with bevacizumab and S-1. Bevacizumab was used by intravenous infusion, 7.5mg/kg body weight on day 1; S-1 was used by oral at 80mg/m^2·d on day 1-14, 21 days as a cycle of treatment and repeated until either progressive disease or intolerable toxicity occurred. Chest CT were performed and RECIST 1.1 was used for response evaluation. Kaplan-Meier method was used for survival analysis. Side effects were recorded and analyzed. Results Totally 78 patients were enrolled in the study, including 67 squamous cell carcinoma and 11 adenocarcinoma histologically. The overall response(CR+PR) rate was 22.4%(17/76) and disease control(CR+PR+SD) rate was 61.8%(47/76) respectively. The median follow-up time was 20 months(range from 9 to 44 months). The median progression-free survival(PFS) was 4.9 months(95% CI 4.4-5.5) and the median overall survival(OS) was 8.1 months(95% CI 7.6-9.2). The median PFS and OS of patients with metastasis diseases were 6.2 months(95% CI 3.3 to 6.3) and 8.5 months(95% CI 5.8 to 11.2), where PFS was longer than that of patients with local regional recurrence(median 5.0 months, 95% CI 3.0 to 5.5, P=0.017) and OS was longer than that of patients with regional disease and metastasis(median 8.0 months, 95% CI 4.6 to 9.5, P=0.010). The common adverse effects were mild to moderate neutropenia(84.2%), grade Ⅰ -Ⅱ hand and foot syndrome(51.3%), grade Ⅰ -Ⅱ nausea(48.7%), mild epistaxis(30.1%) and mild vomiting(14.5%). Esophageal bleeding occurred in 7.9% of patients. One patient(1.3%) died from massive bleeding which was caused by esophageal perforation. Conclusion Bevacizumab combined with S-1 was effective and safe for esophageal cancer patients who had recurrent or metastatic diseases after chemoradiation.

Sorafenib in Liver Function Impaired Advanced Hepatocellular Carcinoma

Objective To explore the efficacy and safty of sorafenib in Child-Pugh class B to class C hepatocellular carcinoma （HCC）. Methods In this three-center open-label study from November 2011 to May 2013, we randomly assigned 189 patients with advanced Child-Pugh class B or C HCC patients into two groups, one group with 95 patient to receive sorafenib （400 mga time, twice a day） and the other group with 94 patients to receive best supportive care. The primary end points were progression-free survival and overall survival. Results The median progression-free survival was 2.2 months and 1.9 months in the sorafenib group and best supportive care group respectively （Hazard ratio in the sorafenib group, 0.55; 95% confidence interval, 0.40-0.75; P=O.O02）. The median overall survival was 4.0 months and 3.5 months in the sorafenib group and best supportive care group respectively （Hazard ratio in the sorafenib group, 0.48; 95% confidence interval, 0.35-0.68; P〈0.001）. The main adverse effect of sorafenib was rash and ache of the skin （in 51.7% patients）. The incidences of severe rash, diarrhea, and dry skin were 5.6%, 5.6%, and 2.2% in the sorafenib group. One patient reached partial response in the sorafenib group. Conclusions Sorafenib is safe in patients with liver function impaired advanced HCC. It is effective in terms of progression-free survival and overall survival compared with best supportive care. Liver functions are the important predictive factors.

New Understanding on the Memory Effect of Crystallized iPP

In this study, recovery processes of isotactic polypropylene （iPP） melted spherulites at 135 ℃ after melting at higher temperatures （170 ℃-176 ℃） were investigated with polarized optical microscopy and Fourier transform infrared spectroscopy. The recovery temperature was fixed to exclude the interference from heterogeneous nuclei. After melting at temperatures between 170 ℃ and 174 ℃, the melted spherulite could recover back to the origin spberulite at low temperatures. Interestingly, a distinct infrared spectrum from iPP melt and crystal was observed in the early stage of recovery process after melting at low temperatures, where only IR bands resulting from short helices with 12 monomers or less can be seen, which indicates that the presence of crystal residues is not the necessary condition for the polymer memory effect. Avrami analysis further indicated that crystallization mainly took place in melted lamellae. After melting at higher temperatures, melted spherulite cannot recover. Based on above findings, it is proposed that the memory effect can be mainly ascribed to melted lamellae, during which crystalline order is lost but conformational order still exists. These conformational ordered segments formed aggregates, which can play as nucleation precursors at low temperatures.

Icotinib plus osimertinib overcome epidermal growth factor receptor 19del/T790 M/C797S/V834L quadruplet resistance mutation in a patient with non-small cell lung cancer

To the Editor:A 66-year-old woman presented with a severe cough and was admitted into hospital in April 2014.Positron emission tomography/computed tomography (PET/CT) scan showed a 2.0 cm×2.0 cm node located on the lower lobe of left lung,multi-mediastinal lymph nodes enlargement and pleural effusion [Figure 1A].

AZD9291-induced Acute Interstitial Lung Disease

To the Editor： A 32-year-old Chinese male patient with 1 week cough and dyspnea on exertion was presented to hospital. He was a metastatic lung adenocarcinoma patient with 3 years treatment history. In October 2012, the patient complained cough, short of breath, and thoracic computerized axial tomography scan （CAT-scan） revealed left lung hilum mass with the right lung multismall patches or opacities. Core needle biopsy on supraclavicular lymph nodes was performed and diagnosis of Stage IV （T3N3MIa） lung adenocarcinoma was made by radiologist, pathologist, and oncologist.

Successful Treatment of Erlotinib on Metastatic Adenoid Cystic Carcinoma of the Lacrimal Gland

To the Editor： A 32-year-old Chinese woman, complained diplopia, exophthalmos, and upper-right orbital pain and was admitted into the hospital in July 2009. Computerized tomography （CT） scan showed an upper-right orbital mass, measured 25 mm × 14 mm [Figure 1a], Extensive surgical resection of the tumor was done on January 14, 2010.

Crizotinib plus erlotinib overcomes osimertinib resistance in a seriously-ill non-small cell lung cancer patient with acquiredamplification

To the Editor:A 59-year-old Chinese man who presented with a severe cough and short of breath was admitted into hospital in October,2018.Computed tomography scan showed a 4.0 cm2.0 cm tumor located on the lower lobe of right lung[Figure 1A]and multi-bone lesions,core needle biopsy was performed and adenocarcinoma was confirmed by pathologists.Diagnosis of metastatic lung adenocarcinomawithT4N3M1cin stage IVB was made by oncologists and pathologists.Next generation sequencing(NGS)with the biopsied tumor was done,and epidermal growth factor receptor(EGFR)exon 21 L858R mutation with mutant allele fractions(MAF)of 24.8%was found.Icotinib(Betta Pharmaceuticals Co.,Ltd,Hangzhou,China),a firstgeneration EGFR tyrosine kinase inhibitor(TKI),at a dose of 125mg orally,three times a day was administered.The patient got a partial response(PR)after 5 months according to the Response Evaluation Criteria in Solid Tumors 1.1[Figure 1B].