Clinical Observation on Treatment of NonParvicellular Carcinoma of the Lung with Jin Fu Kang Oral Liquid

Jin Fu Kang Oral Liquid ([symbol: see text]), made of traditional Chinese drugs for supplementing qi and nourishing yin, was developed according to the common symptoms in lung carcinoma with deficiency of both qi and yin. Of the 96 cases in the Jin Fu Kang group, 1 case got complete remission (CR) after treatment, 8 cases partial remission (PR), 52 cases no change (NC), PR + NC covering 63.5%. Of the 52 cases in the group of Jin Fu Kang plus chemotherapy, 11 cases got PR after treatment, 26 cases NC, PR + NC covering 71.2%. Of the 25 cases in the chemotherapy group, 4 cases got PR after treatment, 11 cases NC, PR + NC covering 60.0%. The results show that the therapeutic effectiveness in the Jin Fu Kang group and the group of Jin Fu Kang plus chemotherapy was better than that in the chemotherapy group. The one-year survival rate and the two-year survival rate after treatment in the Jin Fu Kang group were 67.3% and 67.3% respectively; 66.7% and 66.7% in the group of Jin Fu Kang plus chemotherapy; and 40.3% and 0.0% in the chemotherapy group. The improvement of clinical symptoms, increase of body weight and improvement of health situation (KPS marks) after treatment in both the Jin Fu Kang group and the group of Jin Fu Kang plus chemotherapy were better than that in the chemotherapy group. Some indicators of immunology and hemogram after treatment were greatly improved in the Jin Fu Kang group, worse in the chemotherapy group, but no obvious improvement in the group of Jin Fu Kang plus chemotherapy.

Advances in adjuvant systemic therapy for non-small-cell lung cancer

Non-small-cell lung cancer remains a leading cause of death around the world. For most cases, the only chance of cure comes from resection for localised disease, however relapse rates remain high following surgery. Data has emerged over recent years regarding the utility of adjuvant chemotherapy for improving disease-free and overall survival of patients following curative resection. This paper reviews the clinical trials that have been conducted in this area along with the studies integrating radiation therapy in the adjuvant setting. The role of prognostic gene signatures are reviewed as well as ongoing clinical trials including those incorporating biological or targeted therapies.

Unresectable stage Ⅲ non-small-cell lung cancer: Have we made any progress?

Lung cancer is responsible for the most cancer deaths worldwide with an incidence that is still rising. One third of patients have unresectable stage ⅢA or stage ⅢB disease. The standard of care for locally advanceddisease in patients with good performance status consists of combined modality therapy in particular concurrent chemoradiotherapy. But despite a lot of efforts done in the past, local control and survival of patients with unresectable stage Ⅲ non-small-cell lung cancer(NSCLC) remains poor. Improving outcomes for patients with unresectable stage Ⅲ NSCLC has therefore been an area of ongoing research. Research has focused on improving systemic therapy, improving radiation therapy or adding a maintenance therapy to consolidate the initial therapy. Also implementation of newer targeted therapies and immunotherapy has been investigated as well as the option of prophylactic cranial irradiation. This article reviews the latest literature on improving local control and preventing distant metastases. It seems that we have reached a plateau with conventional chemotherapy. Radiotherapy dose escalation did not improve outcome although increasing radiation dose-intensity with new radiotherapy techniques and the use of newer agents, e.g., immunotherapy might be promising. In the future well-designed clinical trials are necessary to prove those promising results.

The Therapeutic Effects of the Radiotherapy Plus TCM Treatment Observed in Senile Non-Parvicellular Lung Cancer Patients at the Late Stage

47 senile non-parvicellular lung cancer patients at stage Ⅲ or Ⅳ were randomly divided into a treatment group (26 cases) treated by radiotherapy plus traditional Chinese medicine (TCM) and a control group (21 cases) treated only by radiotherapy for observation of the therapeutic effects.The patients in the treatment group orally took Chinese medicine during and after the radiotherapy.There was no obvious difference in short-term therapeutic effects between the two groups,but the long-term curative effects in the treatment group was obviously superior to that in the control group (P<0.05 or P<0.01).Conclusion:radiotherapy plus TCM can prolong the survival period for senile non-parvicellular lung cancer patients.

Molecular Mechanisms Contributing to Resistance to Tyrosine Kinase-Targeted Therapy for Non-Small Cell Lung Cancer

One of the most important pathways in non-small cell lung cancer(NSCLC) is the epidermal growth factor receptor(EGFR) pathway. This pathway affects several crucial processes in tumor development and progression,including tumor cell proliferation,apoptosis regulation,angiogenesis,and metastatic invasion.Targeting EGFR is currently being intensely explored.We are witnessing the development of a number of potential molecular-inhibiting treatments for application in clinical oncology.In the last decade,the tyrosine kinase(TK) domain of the EGFR was identified in NSCLC patients,and it has responded very well with a dramatic clinical improvement to TK inhibitors such are gefitinib and erlotinib.Unfortunately,there were primary and/or secondary resistance to these treatments,as shown by clinical trials.Subsequent molecular biology studies provided some explanations for the drug resistance phenomenon.The molecular mechanisms of resistance need to be clarified.An in-depth understanding of these targeted-therapy resistance may help us explore new strategies for overcoming or reversing the resistance to these inhibitors for the future of NSCLC treatment.

奥希替尼在老年非小细胞肺癌患者靶向治疗中的应用效果及对T细胞水平的影响

目的 探讨奥西替尼在老年非小细胞肺癌患者靶向治疗中的效果及对免疫水平的影响。方法 回顾性选择2018年1月至2020年12月老年非小细胞肺癌患者116例研究,根据治疗方法不同分为2组,各58例。对照组采用常规放化疗治疗,观察组在对照组基础上联合奥西替尼治疗,3个月治疗后评估患者效果,比较2组总有效率、T细胞水平(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、肿瘤标志物水平、不良反应发生率。结果 观察组治疗3个月总有效率为44.8%高于对照组25.9%(P<0.05);2组治疗后3个月CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均低于治疗前(P<0.05);CD8^(+)水平高于治疗前(P<0.05);观察组治疗后3个月CD3^(+)(58.95±4.21)%、CD4^(+)(32.59±3.11)%、CD4^(+)/CD8^(+)(1.21±0.22)高于对照组(P<0.05);CD8^(+)(26.81±3.32)%低于对照组(P<0.05);观察组干预3个月后CA125(91±8)U/ml、CYFRA21-1(1.26±0.24)μg/L及癌胚抗原(CEA)水平(34±5)μg/L均低于对照组(P<0.05);2组不良反应发生率差异无统计学意义(P>0.05)。结论 奥西替尼用于老年非小细胞肺癌患者靶向治疗中,能获得较好的总有效率,对患者T细胞水平影响较小,可降低肿瘤标志物水平,未增加不良反应发生率,值得临床推广应用。

程序性死亡蛋白-1抑制剂单药治疗老年晚期非小细胞肺癌患者的疗效及安全性研究

背景以程序性死亡蛋白-1(PD-1)抑制剂为代表的免疫治疗近年来逐步成为晚期非小细胞肺癌(NSCLC)的标准治疗方案,改变了该病的治疗格局。大部分PD-1抑制剂相关研究排除了70或75岁以上的老年晚期NSCLC患者,使得老年患者使用PD-1抑制剂治疗的疗效及安全性数据相对较少。目的本研究旨在探讨PD-1抑制剂在老年晚期NSCLC患者中的疗效及安全性。方法选取2018年10月至2021年11月在甘肃中医药大学第四附属医院胸外科和肿瘤科接受PD-1抑制剂单药治疗的65岁及以上的晚期NSCLC患者,最终纳入符合标准的患者63例。本研究中PD-1抑制剂均为已经在中国获批上市的PD-1抑制剂单抗,包括卡瑞利珠单抗、信迪利单抗和帕博利珠单抗。通过医院电子病历系统整理患者接受治疗后的疗效及安全性数据,并对患者进行定期随访获取长期生存数据,随访至2022-03-15,收集患者PD-1抑制剂的疗效资料、老年晚期NSCLC患者的预后情况和接受PD-1抑制剂治疗的毒副作用情况,采用Cox比例风险模型探讨老年晚期NSCLC患者预后的影响因素。结果63例老年晚期NSCLC患者的中位年龄为71(65,89)岁。接受PD-1抑制剂治疗期间的最佳疗效评估结果显示无患者完全缓解,14例患者获得部分缓解,21例患者疾病稳定,28例患者疾病进展。PD-1抑制剂单药治疗晚期NSCLC患者的客观缓解率(ORR)为22.2%(14/63),疾病控制率(DCR)为66.7%(14/21)。预后数据提示63例老年晚期NSCLC患者的中位无进展生存期(PFS)为3.3(2.0,4.6)个月。中位OS为10.2(6.1,14.3)个月。接受PD-1单药治疗期间,63例老年晚期NSCLC中46例患者出现了治疗相关的毒副作用(73.0%),其中3级以上的毒副作用发生率为14.3%(9/63)。常见的毒副作用类型有乏力、腹泻、皮疹和肝功能异常,发生率分别为23.8%(15/63)、19.1%(12/63)、15.9%(10/63)和14.3%(9/63)。Cox比例风险回归分析结果显示,东部肿瘤协作组(ECOG)体质状态评分和转移病灶数目是老年晚期NSCLC患者接受PD-1抑制剂后PFS的独立影响因素(HR=0.56、0.48)。结论PD-1抑制剂单药在老年晚期NSCLC患者中具有初步的疗效和可耐受的安全性。ECOG体质状态评分和转移病灶数目可能是影响该类患者PFS的潜在风险因素。

化学治疗Ⅲ期肺鳞状细胞癌及肺腺癌后患者骨密度变化

目的观察化学治疗(化疗)Ⅲ期肺鳞状细胞癌(鳞癌)及肺腺癌后患者骨密度(BMD)变化。方法回顾性分析经病理确诊并接受规律化疗的44例Ⅲ期肺鳞癌(鳞癌组)和47例Ⅲ期肺腺癌(腺癌组),以定量CT(QCT)测量其化疗前日(基线期)及第1、2、3个周期后1周内L1~L2 BMD;比较组间基线资料,观察不同时间点组间及组内BMD差异。结果组间基线资料差异均无统计学意义(P均>0.05)。鳞癌组第3个化疗周期后BMD较腺癌组降低(t=-2.572,P=0.011),其余时间点组间BMD差异均无统计学意义(P均>0.05)。相比基线期,鳞癌组第2、3个化疗周期后BMD均显著降低(P均<0.01),其余不同时间点BMD差异均无统计学意义(P均>0.05);腺癌组化疗前、后BMD差异无统计学意义(F=0.331,P=0.803)。结论3个周期化疗后Ⅲ期肺鳞癌患者BMD降低,而腺癌患者BMD未见明显变化。

Advancements in next-generation sequencing for diagnosis and treatment of non-small-cell lung cancer

In recent years, lung cancer has been the most commonly diagnosed cancer globally; 1.6 million people died of lung cancer in 2012 globally, making lung cancer the leading cause of cancer-related deaths.1,2 Lung cancer can be mainly histologically classified into two types: non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC), ac-counting for approximately 85% and 15% of cases, respectively.3 NSCLC can be further classified as squamous cell carcinoma, adenocarcinoma, and large-cell lung carcinoma, among which lung adenocarci-noma is the most common primary malignant tumor. Unfortunately, most NSCLC cases are diagnosed at a late stage when the survival rate is low; the 5-year survival rate is approximately 16%.

非小细胞肺癌患者靶向治疗服药依从性及影响因素分析

目的:调查非小细胞肺癌患者口服靶向药的服药依从性,并分析其影响因素,为提高患者靶向治疗依从性提供参考。方法:采用便利抽样法,选取2021年2月至7月208例接受口服靶向药治疗的非小细胞肺癌患者作为调查对象,采用一般资料调查表、服药依从性量表、出院患者药物素养调查问卷和社会支持评定量表进行调查。结果:肺癌患者靶向治疗依从性得分为(4.52±1.58)分,高依从性占2.9%,中依从性占18.3%,低依从性占78.8%。多因素回归分析显示,影响肺癌患者靶向治疗依从性的主要因素为药物素养、社会支持、年龄、居住地及居住方式。结论:非小细胞肺癌患者口服靶向药治疗依从性较低。医护人员应鼓励家属给予患者更多的关注和支持,同时积极为肺癌患者搭建沟通交流的平台,增进患者间的支持,并进一步发展延续性护理,发挥自身专业优势,为院外患者提供用药指导和咨询,帮助患者提高药物素养,从而提高患者服药依从性。

不同联合化疗方案治疗晚期非小细胞肺癌的临床观察

背景与目的:已证实以铂类为基础的联合化疗对晚期非小细胞肺癌患者有益,但近十年来对化疗方案选择仍有争论。本研究观察比较MIP方案(MMC+IFO+DDP)、TP方案(泰素+DDP)和DP方案(泰索帝+DDP)联合治疗晚期非小细胞肺癌的近期疗效和耐受性。方法∶92例晚期非小细胞肺癌分为3组,分别接受3种不同化疗方案治疗,MIP组32例,TP组30例,DP组30例;除DP组Ⅳ期病例较多并有复治病人外,3组病人其它因素均具有可比性。结果:MIP组有效率为43.8%,中位生存期为11个月,1年生存率为46%;TP组有效率为40.0%,中位生存期为10个月,1年生存率为40%;DP组有效率为46.7%,中位生存期为12个月,1年生存率为50%。3组有效率相似,主要不良反应为骨髓抑制、恶心呕吐和脱发。结论:本研究表明,3种化疗方案均对晚期非小细胞肺癌有相似的疗效,不良反应可耐受,但泰索帝每周方案骨髓抑制相对较少。

中晚期非小细胞肺癌联合治疗进展

肺癌是全球常见的恶性肿瘤之一,严重威胁着人们的身体健康,近年其发病率和病死率均有明显上升趋势。很多患者确诊时多已达到晚期,出现转移,错过手术时机。近年来临床应用多种治疗手段治疗中晚期肺癌,其有效治疗依赖于放疗、化疗、消融、免疫治疗等多种方法的有效配合。本文就目前临床常用的各种中晚期非小细胞肺癌联合治疗手段做一综述。

艾迪注射液联合GP化疗治疗老年晚期非小细胞肺癌的临床疗效评价

目的:观察单纯GP方案和艾迪注射液联合GP(吉西他滨+顺铂)化疗方案治疗老年晚期非小细胞肺癌(NSCLC)的效果,阐明艾迪注射液对老年晚期NSCLC化疗的效果。方法:将68例60岁以上晚期NSCLC患者按住院号奇偶数随机分为联合治疗组和单纯GP组(每组各34例)。治疗组给予艾迪注射液+GP方案,对照组给予单纯GP方案,至少2个化疗周期后评价临床疗效。结果:2组近期疗效比较差异无统计学意义(P>0.05);2组患者生活质量Karnofsky评分提高比较,治疗组明显高于对照组(P<0.05);治疗组白细胞减少明显低于对照组(P<0.05);治疗组消化道反应(恶心、呕吐)及肝、肾功能损害发生率低于对照组,但差异无统计学意义(P>0.05)。结论:艾迪注射液联合GP化疗治疗NSCLC较单纯GP化疗在改善生活质量及减少化疗毒副作用方面效果更好。

埃克替尼一线治疗EGFR敏感性突变的晚期非小细胞肺癌的疗效观察

目的探讨盐酸埃克替尼一线治疗EGFR敏感性突变的晚期NSCLC的疗效及安全性。方法回顾性分析51例使用埃克替尼治疗的EGFR敏感性突变的晚期非小细胞肺癌患者,口服埃克替尼125 mg,3次/d,持续至疾病进展或不良反应无法耐受,计算有效率、疾病控制率、中位生存期、无进展生存期以及不良反应。结果 51例患者中19外显子缺失突变29例,21外显子错义突变22例,有效率为70.6%,疾病控制率88.2%;中位生存期为29.0月,无进展生存期为10.5月;主要不良反应是皮疹和腹泻,多为Ⅰ~Ⅱ级。结论埃克替尼一线治疗EGFR敏感性突变的晚期非小细胞肺癌有较好的疗效,不良反应较轻,为一线治疗EGFR敏感性突变的晚期非小细胞肺癌的新选择。

单药多西他赛治疗老年晚期非小细胞肺癌每周方案与每三周方案的疗效及毒性比较

为了分析单药多西他赛治疗老年晚期非小细胞肺癌（non small cell lungcancer，NSCI．C）每3周方案与每周方案疗效与毒性的关系，对72例老年晚期NSCLC患者，其中40例（治疗组）接受每周方案，30～35mg／m^3，持续静脉滴入3h，d1、d8、d15休2周，为1个周期；32例（对照组）接受每3周方案，70mg／m^2，持续静脉滴入3h，每3周1次，为1个周期。结果治疗组CR、PR、SD、PD率、总有效率及1年生存率分别为2．5％（1／40）、37．5％（15／40）、32．5％（13／40）、27．5％（11／40）、40．0％（16／40）和47．5％（19／40），对照组分别为3．1％（1／32）、34．4％（11／32）、37．5％（12／32）、25．0％（8／32）、37．5％（12／32）和43．8％（14／32）。两者之间有效率和1年生存率差异无统计学意义，P=0．9920；P=0．6500；治疗组Ⅲ度以上骨髓抑制、消化道反应、口腔黏膜炎分别为3（7．5％）、6（15．0％）和7例（17．5％），而对照组分别为13（40．6％）、15（46．9％）和20例（62．5％）。两组之间差异有统计学意义，P〈0．05。初步研究结果显示，多西他赛单药每周方案治疗老年晚期NSCLC疗效与每3周方案大致相同，但不良反应轻微，更易被耐受。

VIP方案治疗小细胞肺癌的初步研究

目的：探索高剂量强度的化疗方案ＶＩＰ（ＶＰ１６，ＩＦＯ，ＰＤＤ）能否提高小细胞肺癌的疗效，以及在小剂量ＧＣＳＦ支持下能否保证其剂量强度。方法：１９例小细胞肺癌患者，接受高剂量强度的ＶＩＰ方案化疗：ＶＰ１６１００ｍｇ／ｍ２ｉｖｄ１～５，ＩＦＯ１．５ｇ／ｍ２ｉｖｄ１～５，Ｍｅｓｎａ０．４ｇｉｖ，于ＩＦＯ注射后０、４、８ｈ各一次；ＤＤＰ２０ｍｇ／ｍ２ｉｖｄ１～５；于ｄ７开始应用ＧＣＳＦ２～３μｇ／ｋｇ·ｄ，皮下注射直至血白细胞＞５×１０９／Ｌ时停药。每３周重复，共４～６疗程，局限期病人进行辅助胸部放疗。结果：初治的１６例中，ＣＲ７例（４４８％）、ＰＲ９例（５６２％），ＣＲ＋ＰＲ为１００％。４例ＰＲ的局限期病例中，通过放射治疗又有２例获得ＣＲ，３例复治病例亦有２例ＰＲ。相对剂量强度为９２８％。初治的病例，中位生存期１１个月，范围为５～３６个月，２例ＣＲ的病例获得了２年无病生存。主要的不良反应为骨髓抑制及恶心、呕吐。结论：高剂量强度的ＶＩＰ方案化疗能获得较高的有效率及完全缓解率，毒性能耐受。

长春瑞滨联合顺铂方案治疗非小细胞肺癌的临床观察

目的 :观察抗肿瘤国产新药长春瑞滨 (盖诺 )和顺铂联合化疗治疗晚期非小细胞肺癌的疗效。方法 :采用NP方案治疗晚期非小细胞肺癌 (NSCLC) 2 5例 ,男 19例 ,女 6例。病理类型以腺癌为主 15例。Ⅲ期 13例 ,Ⅳ期 12例 ;初治 14例 ,复治 11例。结果 :部分缓解 (PR) 11例 ,稳定 (SD) 10例 ,进展 (PD) 4例 ,总有效率为 4 4 %。每周盖诺≥ 2 5mg/m2 的毒性主要为骨髓抑制 ,白细胞数下降为 88% ,Ⅲ度、Ⅳ度为 2 0 % ,局部静脉炎发生率为 5 2 % ,高于进口药诺维本 (NVB)。结论 :国产长春瑞滨—盖诺替代进口NVB +顺铂 (NP)治疗晚期NSCLC可行 ;其疗效 ,毒副反应与NVB相近。

乐铂单药治疗42例原发性支气管肺癌

评价德国ASTA药物公司研制的新化疗药物乐铂对小细胞及非小细胞肺癌的治疗效果和不良反应。方法 :治疗原发性支气管肺癌 42例 ,初治 2 5例 ,复治 17例 ;小细胞肺癌 34例 ,非小细胞肺癌 8例。单用乐铂5 0mg m2 静脉滴注 ,共 2个周期 ,2个周期间隔 2 1天。结果 :总有效率 30 9% ,其中部分缓解 (PR) 13例 ;小肺癌有效率 38 2 % ,非小细胞肺癌均无效。该药的剂量限制性毒性为骨髓抑制 ,白细胞、血色素下降轻微 ,Ⅲ—Ⅳ度血小板下降 (周期数 ,下同 )为 4 6 % (1例因血小板下降死亡 ) ,Ⅰ—Ⅱ度下降为 11 8% ,恶心、呕吐发生率 6 4 3% ,均为Ⅰ—Ⅱ度 ,无Ⅲ—Ⅳ度。结论 :乐铂单药治疗对小细胞肺癌疗效较好 ,毒副反应轻 ,主要毒性为血小板降低 ,肾脏毒性不明显 。

温下方对Lewis肺癌的抑制作用及对细胞周期的影响

目的:观察温下方对Lewis肺癌的抑制作用及对细胞周期的影响。方法:C57BL/6小鼠皮下接种Lewis肺癌,随机分组,口服给药后计算抑瘤率、脾及胸腺指数;流式细胞技术分析肿瘤细胞周期变化及凋亡百分率。结果:温下方质量分数在生药2.8、5.57和11g/(kg.d)时,对小鼠Lewis肺癌的抑制率分别为31.0%、34.3%和37.6%;肺癌细胞凋亡率增加至(11.13±4.52)%、(16.31±6.12)%和(20.08±5.13)%;G0/G1期细胞比例增加至(50.40±5.37)%、(56.01±5.91)%和(62.38±5.22)%,呈明显的剂量依赖关系。结论:温下方抑制肿瘤生长的机制可能与阻滞细胞周期、诱导细胞凋亡有关。

吉西他滨联合奥沙利铂或顺铂治疗晚期非小细胞肺癌的随机对照研究

目的:评价吉西他滨联合奥沙利铂(GO组)与吉西他滨联合顺铂(GP组)治疗晚期非小细胞肺癌(NSCLC)的疗效及毒副反应。方法:121例经病理或细胞学确诊的Ⅲ~Ⅳ期NSCLC,随机分为GO组61例,GP组60例。GO组:吉西他滨1000mg/m2,溶入0.9%NS 100mL,30min静脉滴入,d1、d8;奥沙利铂135 mg/m2,加入5%葡萄糖500mL中,静脉滴入2h,d2。GP组:吉西他滨1000mg/m2,溶入0.9%NS 100mL,30min静脉滴入,d1、d8;DDP 25mg/m2,静脉滴入,d1~d3。以上方案均每21d为1个周期,2个周期评估疗效。结果:GO组:部分缓解24例,稳定25例,总有效率为39.3%。初治有效率为45.7%,复治有效率20.0%。GP组:完全缓解1例,部分缓解21例,稳定24例,总有效率为36.7%。初治有效率为41.7%,复治有效率16.7%。两组近期疗效比较差异无统计学意义,χ2=0.190,P=0.663。最常见的不良反应为骨髓抑制、消化道反应、肾功能损害及神经毒性等,其中GP组Ⅲ~Ⅳ度白细胞下降、胃肠道反应和肾毒性高于GO组;周围神经炎发生率GP组低于G...