BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)and endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)are highly sensitive for diagnosing and staging lung cancer.In...BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)and endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)are highly sensitive for diagnosing and staging lung cancer.In recent years,targeted therapy has shown great significance in the treatment of non-small cell lung carcinoma(NSCLC).Using these minimally invasive techniques to obtain specimens for molecular testing will provide patients with a more convenient diagnostic approach.AIM To evaluate the feasibility and accuracy of tissue samples obtained using EUSFNA and EBUS-TBNA for molecular diagnosis of NSCLC.METHODS A total of 83 patients with NSCLC underwent molecular testing using tissues obtained from EUS-FNA or EBUS-TBNA at the Tianjin Medical University Cancer Hospital from January 2017 to June 2019.All enrolled patients underwent chest computed tomography or positron emission tomography/computed tomography prior to puncture.We detected abnormal expression of EGFR,KRAS,MET,HER2,ROS1 and anaplastic lymphoma kinase protein.Two patients failed to complete molecular testing due to insufficient tumor tissue.The clinical features,puncture records,molecular testing results and targeted treatment in the remaining 81 patients were summarized.RESULTS In a total of 99 tissue samples obtained from 83 patients,molecular testing was successfully completed in 93 samples with a sample adequacy ratio of 93.9%(93/99).Biopsy samples from two patients failed to provide test results due to insufficient tumor tissue.In the remaining 81 patients,62 cases(76.5%)were found to have adenocarcinoma,11 cases(13.6%)had squamous cell carcinoma,3 cases(3.7%)had adenosquamous carcinoma and 5 cases(6.2%)had NSCLC-not otherwise specified.The results of molecular testing showed EGFR mutations in 21 cases(25.9%),KRAS mutations in 9 cases(11.1%),ROS-1 rearrangement in 1 case(1.2%)and anaplastic lymphoma kinase-positive in 5 cases(6.2%).Twentyfour patients with positive results received targeted therapy.The total effectiveness rate of targeted therapy was 66.7%(16/24),and the disease control rate was 83.3%(20/24).CONCLUSION Tissue samples obtained by EUS-FNA or EBUS-TBNA are feasible for the molecular diagnosis of NSCLC and can provide reliable evidence for clinical diagnosis and treatment.展开更多
BACKGROUND Lung cancer is increasing in incidence worldwide,and targeted therapies are developing at a rapid pace.Furthermore,the KRAS specific gene is strongly associated with non-small cell lung cancer(NSCLC).Adult ...BACKGROUND Lung cancer is increasing in incidence worldwide,and targeted therapies are developing at a rapid pace.Furthermore,the KRAS specific gene is strongly associated with non-small cell lung cancer(NSCLC).Adult patients with locally advanced or metastatic NSCLC who have tested positive for the KRAS G12C mutation and have progressed after at least one systemic treatment are treated with sotorasib.CASE SUMMARY In this study,we report on an advanced NSCLC with a KRAS G12C mutation.The histological diagnosis indicates stage IVB left lung adenocarcinoma with pelvic and bone metastases,identified as cT4N2bM1c.Using circulating tumor DNA analysis,it was possible to determine the mutation abundance of the KRAS gene exon 2,c.34G>Tp.G12C,which was 32.3%.The patient was advised to take sotorasib as part of their treatment.The imaging data were compared before and after treatment.Furthermore,clinical reassessments and regular serial blood testing were conducted.We found that the patient’s clinical symptoms significantly improved after receiving sotorasib medication,and there were no notable side effects,such as liver toxicity,during the treatment.CONCLUSION Sotorasib has shown promising clinical efficacy in patients with the KRAS G12c mutation and has no apparent toxic side effects.展开更多
Lung cancer is one of the most common human cancers and the number one cancer killer in the United States.In general,lung cancer includes small cell lung cancer(SCLC)and non-small cell lung cancer(NSCLC),but NSCLC acc...Lung cancer is one of the most common human cancers and the number one cancer killer in the United States.In general,lung cancer includes small cell lung cancer(SCLC)and non-small cell lung cancer(NSCLC),but NSCLC accounts for approximately 90%of lung cancer.The early diagnosis and therapy of lung cancer still presents a big challenge because validated screening tools,which can improve current early detection to reduce mortality from lung cancer,do not exist.Over the last decade,molecular genetic abnormalities have been described in NSCLC,including chromosomal aberrations,overexpression of oncogenes,and deletion and/or muta-tions in tumor suppressor genes.These molecular markers in NSCLC demonstrated close associations with the development of lung cancer such as Ras,the epidermal growth factor receptor(EGFR,or c-erbB-1),HER2(c-erbB-2),c-Met,and Bcl-2.Therefore,this information may be applied for early cancer detection,classification,novel targeted therapy,and prognosis in NSCLC.Recent clinical data have revealed that targeted therapy might be the second-line therapy as an alternative approach.Currently,the targeted therapies are mainly focused on two lung cancer pathways,the EGFR and the vascular endothelial growth factor(VEGF)pathways.Some clinical trials are very encouraging,but some of them are not.However,these trials have not identified a subgroup of NSCLC with biomarkers.Therefore,it is very important to select NSCLC patients with biomarkers to match targeted agents so that we can further identify effectiveness of targeted therapy in the future.展开更多
目的:对中医专病专方联合化疗治疗Ⅲ～Ⅳ期非小细胞肺癌患者的疗效和安全性进行Meta分析。方法:检索中国生物医学文献数据库(Chinese Biomedical Literature Database,CBM)、中国知识基础设施(China National Knowledge Infrastructure,...目的:对中医专病专方联合化疗治疗Ⅲ～Ⅳ期非小细胞肺癌患者的疗效和安全性进行Meta分析。方法:检索中国生物医学文献数据库(Chinese Biomedical Literature Database,CBM)、中国知识基础设施(China National Knowledge Infrastructure,CNKI)数据库和维普中文科技期刊数据库中1993—2012年发表的有关中医专病专方联合化疗治疗Ⅲ～Ⅳ期非小细胞肺癌患者的临床随机对照研究。应用RevMan5.2.3软件对符合纳入标准的研究进行质量评价和Meta分析。结果:共纳入17项随机对照研究,患者共计1163例。Meta分析结果表明,与单纯化疗相比,中医专病专方联合化疗治疗Ⅲ～Ⅳ期非小细胞肺癌患者可提高治疗有效率,改善生活质量,减少不良反应。治疗有效率优势比(odds ratio,OR)为1.44,95%可信区间(confidence interval,CI)为1.12～1.85;生活质量改善OR为3.36,95%CI为2.45～4.59;不良反应发生率OR为0.23,95%CI为0.18～0.28。结论:本次Meta分析结果表明,中医专病专方联合化疗治疗Ⅲ～Ⅳ期非小细胞肺癌患者较单纯化疗更具优势,但因纳入的随机对照研究文献质量普遍不高,因此今后有待开展更多大样本、多中心的高质量随机对照研究进行验证。展开更多
基金Supported by National Natural Science Foundation of China,No.81903055Tumor Translational Medicine Seed Fund of Tianjin Medical University Cancer Institute and Hospital,No.1709.
文摘BACKGROUND Endoscopic ultrasonography-guided fine-needle aspiration(EUS-FNA)and endobronchial ultrasound-guided transbronchial needle aspiration(EBUS-TBNA)are highly sensitive for diagnosing and staging lung cancer.In recent years,targeted therapy has shown great significance in the treatment of non-small cell lung carcinoma(NSCLC).Using these minimally invasive techniques to obtain specimens for molecular testing will provide patients with a more convenient diagnostic approach.AIM To evaluate the feasibility and accuracy of tissue samples obtained using EUSFNA and EBUS-TBNA for molecular diagnosis of NSCLC.METHODS A total of 83 patients with NSCLC underwent molecular testing using tissues obtained from EUS-FNA or EBUS-TBNA at the Tianjin Medical University Cancer Hospital from January 2017 to June 2019.All enrolled patients underwent chest computed tomography or positron emission tomography/computed tomography prior to puncture.We detected abnormal expression of EGFR,KRAS,MET,HER2,ROS1 and anaplastic lymphoma kinase protein.Two patients failed to complete molecular testing due to insufficient tumor tissue.The clinical features,puncture records,molecular testing results and targeted treatment in the remaining 81 patients were summarized.RESULTS In a total of 99 tissue samples obtained from 83 patients,molecular testing was successfully completed in 93 samples with a sample adequacy ratio of 93.9%(93/99).Biopsy samples from two patients failed to provide test results due to insufficient tumor tissue.In the remaining 81 patients,62 cases(76.5%)were found to have adenocarcinoma,11 cases(13.6%)had squamous cell carcinoma,3 cases(3.7%)had adenosquamous carcinoma and 5 cases(6.2%)had NSCLC-not otherwise specified.The results of molecular testing showed EGFR mutations in 21 cases(25.9%),KRAS mutations in 9 cases(11.1%),ROS-1 rearrangement in 1 case(1.2%)and anaplastic lymphoma kinase-positive in 5 cases(6.2%).Twentyfour patients with positive results received targeted therapy.The total effectiveness rate of targeted therapy was 66.7%(16/24),and the disease control rate was 83.3%(20/24).CONCLUSION Tissue samples obtained by EUS-FNA or EBUS-TBNA are feasible for the molecular diagnosis of NSCLC and can provide reliable evidence for clinical diagnosis and treatment.
文摘BACKGROUND Lung cancer is increasing in incidence worldwide,and targeted therapies are developing at a rapid pace.Furthermore,the KRAS specific gene is strongly associated with non-small cell lung cancer(NSCLC).Adult patients with locally advanced or metastatic NSCLC who have tested positive for the KRAS G12C mutation and have progressed after at least one systemic treatment are treated with sotorasib.CASE SUMMARY In this study,we report on an advanced NSCLC with a KRAS G12C mutation.The histological diagnosis indicates stage IVB left lung adenocarcinoma with pelvic and bone metastases,identified as cT4N2bM1c.Using circulating tumor DNA analysis,it was possible to determine the mutation abundance of the KRAS gene exon 2,c.34G>Tp.G12C,which was 32.3%.The patient was advised to take sotorasib as part of their treatment.The imaging data were compared before and after treatment.Furthermore,clinical reassessments and regular serial blood testing were conducted.We found that the patient’s clinical symptoms significantly improved after receiving sotorasib medication,and there were no notable side effects,such as liver toxicity,during the treatment.CONCLUSION Sotorasib has shown promising clinical efficacy in patients with the KRAS G12c mutation and has no apparent toxic side effects.
文摘Lung cancer is one of the most common human cancers and the number one cancer killer in the United States.In general,lung cancer includes small cell lung cancer(SCLC)and non-small cell lung cancer(NSCLC),but NSCLC accounts for approximately 90%of lung cancer.The early diagnosis and therapy of lung cancer still presents a big challenge because validated screening tools,which can improve current early detection to reduce mortality from lung cancer,do not exist.Over the last decade,molecular genetic abnormalities have been described in NSCLC,including chromosomal aberrations,overexpression of oncogenes,and deletion and/or muta-tions in tumor suppressor genes.These molecular markers in NSCLC demonstrated close associations with the development of lung cancer such as Ras,the epidermal growth factor receptor(EGFR,or c-erbB-1),HER2(c-erbB-2),c-Met,and Bcl-2.Therefore,this information may be applied for early cancer detection,classification,novel targeted therapy,and prognosis in NSCLC.Recent clinical data have revealed that targeted therapy might be the second-line therapy as an alternative approach.Currently,the targeted therapies are mainly focused on two lung cancer pathways,the EGFR and the vascular endothelial growth factor(VEGF)pathways.Some clinical trials are very encouraging,but some of them are not.However,these trials have not identified a subgroup of NSCLC with biomarkers.Therefore,it is very important to select NSCLC patients with biomarkers to match targeted agents so that we can further identify effectiveness of targeted therapy in the future.
文摘目的:对中医专病专方联合化疗治疗Ⅲ～Ⅳ期非小细胞肺癌患者的疗效和安全性进行Meta分析。方法:检索中国生物医学文献数据库(Chinese Biomedical Literature Database,CBM)、中国知识基础设施(China National Knowledge Infrastructure,CNKI)数据库和维普中文科技期刊数据库中1993—2012年发表的有关中医专病专方联合化疗治疗Ⅲ～Ⅳ期非小细胞肺癌患者的临床随机对照研究。应用RevMan5.2.3软件对符合纳入标准的研究进行质量评价和Meta分析。结果:共纳入17项随机对照研究,患者共计1163例。Meta分析结果表明,与单纯化疗相比,中医专病专方联合化疗治疗Ⅲ～Ⅳ期非小细胞肺癌患者可提高治疗有效率,改善生活质量,减少不良反应。治疗有效率优势比(odds ratio,OR)为1.44,95%可信区间(confidence interval,CI)为1.12～1.85;生活质量改善OR为3.36,95%CI为2.45～4.59;不良反应发生率OR为0.23,95%CI为0.18～0.28。结论:本次Meta分析结果表明,中医专病专方联合化疗治疗Ⅲ～Ⅳ期非小细胞肺癌患者较单纯化疗更具优势,但因纳入的随机对照研究文献质量普遍不高,因此今后有待开展更多大样本、多中心的高质量随机对照研究进行验证。
