Is there a place for optimizing thoracic radiotherapy in limited-stage small cell lung cancer after twenty years?

Thoracic radiotherapy(TRT)is one of the main treatments in limited-stage small cell lung cancer(LS-SCLC).Hyperfractionated TRT(45 Gy,1.5 Gy twice daily)has been the standard of care(SOC)since Turrisi and colleagues published the results of their clinical trial in 1999.Two meta-analyses have demonstrated the benefits of concurrent chemotherapy and TRT in terms of intrathoracic disease control at 2 years and 3-year overall survival(OS).The phase 2 trial by Grønberg et al(2016)comparing once-daily hypofractionated TRT to twice-daily hyperfractionated TRT in LS-SCLC found similar outcomes in both groups in terms of response rate,progression-free survival(PFS),grade 3-4 adverse effects,and OS.The CONVERT trial,published in 2017,failed to demonstrate the superiority of the conventional scheme(once-daily TRT)vs twice-daily radiotherapy,despite the application of modern radiotherapy techniques and a quality assurance programme,thus confirming the twice-daily hyperfractionated regimen as the SOC.At the 2020 American Society of Clinical Oncology(ASCO)annual meeting,Grønberg et al reported preliminary findings from a phase 2 trial comparing two different TRT dose regimens(45 Gy vs 60 Gy),both administered twice daily.Those data demonstrated a marked improvement in 2-year survival rates in the high dose arm(70.2%vs 46.1%,P=0.002),despite similar objective response rates and PFS outcomes.Those findings provide a new treatment alternative to consider:Hyperfractionated,high-dose TRT.However,the results of that trial will need to be validated in a large,randomized phase 3 study.The results of the phase 2 CALCG 30610 trial will help to clarify the optimal dose and regimen.The potential role of upfront immunotherapy,which early data suggest may improve OS,also needs to be determined.

Docetaxel as salvage chemotherapy in patients with advanced non-small cell lung cancer after failure of cytotoxic agents and gefitinib treatment

Objective： We conducted a prospective phase II trial of single-agent salvage chemotherapy with docetaxel in patients with advanced non-small cell lung cancer （NSCLC） after failure of chemotherapy and gefitinib to assess the efficacy and toxicity of docetaxel in this setting. Methods： Patients with histologically confirmed NSCLC who were failure of chemotherapy and gefitinib were given docetaxel 75 mg/m^2 intravenously for 30 rain every 3 weeks until the toxicity was unacceptable or disease progressed. The response evaluation criteria in solid tumors （RECIST） guidelines were used for the evaluation of an- titumor activity. Toxicity was graded according to the National Cancer Institute Common Toxicity Criteria version 2.0. Results： In total, 31 patients were enrolled in this phase II trial between February 2004 and December 2006, and 84 cycles （average 2.7 cycles） were given. We observed 4 partial responses （PRs） and 10 stable disease （SD） states in 31 eligible patients. The objective response rate was 12.9%, and the disease control rate was 45.2%. The median survival time （MST） was 10 months （95% CI, 5.05-15.08 months）. The 1-year survival rate was 40.6%. The most common toxicities were neutropenia, anemia, and peripheral neuropathy that occurred as follows： 45% of the patients experienced grade 3 or 4 neutropenia, 29% experienced grade 3 anemia, and 25.8% had grade 3 peripheral neuropathy. No patient terminated docetaxel chemotherapy due to toxicity. Conclusion： Docetaxel is beneficial as salvage chemotherapy in patients with advanced NSCLC after failure of cytotoxic agents and gefitinib.

Evaluation of conventional radiotherapy vs. conformal radiotherapy in the treatment of non-small-cell lung cancer after surgical resection

Objective： To compare the survival fractions and radiation-induced complications of conventional radiotherapy （CV） vs. conformal radiotherapy （CF） for non-small-cell lung cancer （NSCLC） after surgical resection. Methods： Between 1990 and 2002, 167 patients underwent post-radiotherapy either CV （n = 90） or CF （n = 77） for pathological IliA NSCLC at the University of Texas M.D. Anderson Cancer Center. Patients and tumor charactedstics were balanced in the two treatment groups. Surgical resection mainly consisted of Iobectomy and mediastinal lymph node dissection. In the CV group, postoperative radiotherapy was delivered to 54.3 Gy （range 22-69.6 Gy） in 27 fractions （range 11-58 f） for 5-6 weeks, while the CF group with RT to 53.9 Gy （range 50-63 Gy） in 26 fractions （range 25-33 f） for 5-6 weeks. Overall survival, disease-free survival, local control and distant metastasis-free survival were calculated using the Kaplan-Meier method. The complications of radiotherapy were also compared between the two groups. The median follow-up duration was 36 months in the CV group while 24 months in the CF group. Results： No statistically significant differences were found in terms of disease-free survival, local-regional control and distant metastasis-free survival in the two treatment groups. However, the overall survival was found statistically significant different in the two groups （P = 0.014）. Postoperative radiotherapy complications such as weight loss, skin reaction, dysphagia, and cardiac related complication were similar in the two groups although the lung fibrosis, cardiac complications and hematologic complications were significantly different, and 8 cases of death in the CV group associated with cardiac complications while none was observed in the CF group. Conclusion： The treatment of stage IliA NSCLC using either CV or CF postoperative radiotherapy resulted in similar outcomes in terms of local control, disease-free survival and most of complications. However, CF could achieve better overall survival and less complications such as lung fibrosis, cardiac complications and hematologic complications. The advantage is worth further observation.

Successful resection of colonic metastasis of lung cancer after colonic stent placement:A case report and review of the literature

BACKGROUND Lung cancer is the leading cause of cancer deaths worldwide.Although lung cancer can metastasize to various organs such as the liver,lymph nodes,adrenal gland,bone,and brain,metastases to the digestive organs,especially the colon,are rare.CASE SUMMARY An 83-year-old man diagnosed with lung cancer received radiation and chemoimmunotherapy,resulting in a complete clinical response.One year after the initial lung cancer diagnosis,the patient presented with obstructive ileus caused by a tumor in the descending colon.An elective left hemicolectomy was successfully performed after the endoscopic placement of a self-expandable metallic stent(SEMS).Pathologically,the tumor of the descending colon was diagnosed as lung cancer metastasis.The postoperative course was uneventful,and the patient is in good condition 13 mo after surgery,with no signs of recurrence.The previous 23 cases of surgical resection of colonic metastasis from lung cancer were reviewed using PubMed to characterize their clinicopathological features and outcomes.CONCLUSION SEMS is useful for obstructive colonic metastasis as a bridge to surgery to avoid emergency operations.

Application Problems and Countermeasures of External Diaphragm Pacer in Elderly Patients with Lung Cancer after Surgery

This article summarized the nursing problems and corresponding nursing strategies of 18 cases of external diaphragm pacemakers in the application of elderly patients with lung cancer after thoracic surgery. Timely psychological care, correct operation, close observation and infection prevention during treatment can effectively optimize the use of external diaphragm pacemakers, improve respiratory muscle function, and the quality of life after lung cancer surgery in elderly patients.

Prognostic factors in patients with bone metastasis of lung cancer after immune checkpoint inhibitors:A retrospective study

BACKGROUND Accurate data on the prognosis of bone metastases are necessary for appropriate treatment.Immune checkpoint inhibitors(ICIs)are widely used in the treatment of gene mutation-negative non-small cell lung cancer(GMN-NSCLC).AIM To investigate the prognostic factors in patients with bone metastases from GMNNSCLC following ICI use.METHODS This retrospective cohort study included 45 patients with GMN-NSCLC who were treated for bone metastases from 2017 to 2022 and received chemotherapy after diagnosis.Using Kaplan–Meier curves and Cox proportional hazards models,we evaluated the association between overall survival(OS)and clinical parameters,including serum biochemical concentrations and blood cell count.RESULTS Univariate analysis showed that Eastern Cooperative Oncology Group performance status≤1 and the use of ICIs and bone-modifying agents after bone metastasis diagnosis were significantly associated with a favorable OS.Multivariate analysis revealed that ICI use after bone metastasis diagnosis was signi
cantly associated with a favorable OS.CONCLUSION ICI use after bone metastasis diagnosis may be a favorable prognostic factor in patients with bone metastases of GMN-NSCLC.Consideration of ICI treatment for bone metastasis and GMN-NSCLC is warranted to establish a more accurate predictive nomogram for patients with bone metastasis.

Enhanced recovery after surgery in elderly patients with non-small cell lung cancer who underwent video-assisted thoracic surgery

BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.

Returning from the afterlife?Sotorasib treatment for advanced KRAS mutant lung cancer:A case report

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.

Spontaneous coronary artery rupture after lung cancer surgery:A case report and review of literature

BACKGROUND Spontaneous coronary artery rupture(SCAR)is a rare and life-threatening complication after lung cancer surgery.We present a case of SCAR following left upper lobectomy,successfully managed through emergency thoracotomy and coronary artery ligation.CASE SUMMARY A 61-year-old male patient underwent left upper lobectomy and mediastinal lymph node dissection for lung cancer.The surgery was performed using singleport video-assisted thoracoscopic surgery,and there were no observed complications during the procedure.However,19 h after surgery,the patient experienced chest discomfort and subsequently developed severe symptoms,including nausea,vomiting,and a drop in blood pressure.Urgent measures were taken,leading to the diagnosis of SCAR.The patient underwent emergency thoracotomy and coronary artery ligation,successfully stopping the bleeding and stabilizing the condition.Despite postoperative complications,the patient made a successful recovery and was discharged from the hospital.CONCLUSION SCAR is a rare but life-threatening complication following lung cancer surgery.Immediate thoracotomy has been shown to be a life-saving measure,while stenting is not the preferred initial approach.

Predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa squamous cell lung cancer:A retrospective analysis

BACKGROUND Lung cancer(LC)is a global medical,social and economic problem and is one of the most common cancers and the leading cause of mortality from malignant neoplasms.LC is characterized by an aggressive course,and in the presence of disease recurrence risk factors,patients,even at an early stage,may be indicated for adjuvant therapy to improve survival.However,combined treatment does not always guarantee a favorable prognosis.In this regard,establishing predictors of LC recurrence is highly important both for determining the optimal treatment plan for the patients and for evaluating its effectiveness.AIM To establish predictors of disease recurrence after radical resection and adjuvant chemotherapy in patients with stage IIb-IIIa lung squamous cell carcinoma(LSCC).METHODS A retrospective case-control cohort study included 69 patients with LSCC who underwent radical surgery at the Orenburg Regional Clinical Oncology Center from 2009 to 2018.Postoperatively,all patients received adjuvant chemotherapy.Histological samples of the resected lung were stained with Mayer's hematoxylin and eosin and examined under a light microscope.Univariate and multivariate analyses were used to identify predictors associated with the risk of disease recurrence.Receiver operating characteristic curves were constructed to discriminate between patients with a high risk of disease recurrence and those with a low risk of disease recurrence.Survival was analyzed using the Kaplan-Meier method.The log-rank test was used to compare survival curves between patient subgroups.Differences were considered to be significant at P<0.05.RESULTS The following predictors of a high risk of disease recurrence in patients with stage IIb-IIa LSCC were established:a low degree of tumor differentiation[odds ratio(OR)=7.94,95%CI=1.08-135.81,P=0.049];metastases in regional lymph nodes(OR=5.67,95%CI=1.09-36.54,P=0.048);the presence of loose,fine-fiber connective tissue in the tumor stroma(OR=21.70,95%CI=4.27-110.38,P=0.0002);and fragmentation of the tumor solid component(OR=2.53,95%CI=1.01-12.23,P=0.049).The area under the curve of the predictive model was 0.846(95%CI=0.73-0.96,P<0.0001).The sensitivity,accuracy and specificity of the method were 91.8%,86.9%and 75.0%,respectively.In the group of patients with a low risk of LSCC recurrence,the 1-,2-and 5-year disease-free survival(DFS)rates were 84.2%,84.2%and 75.8%,respectively,while in the group with a high risk of LSCC recurrence the DFS rates were 71.7%,40.1%and 8.2%,respectively(P<0.00001).Accordingly,in the first group of patients,the 1-,2-and 5-year overall survival(OS)rates were 94.7%,82.5%and 82.5%,respectively,while in the second group of patients,the OS rates were 89.8%,80.1%and 10.3%,respectively(P<0.00001).CONCLUSION The developed method allows us to identify a group of patients at high risk of disease recurrence and to adjust to ongoing treatment.

Prognostic Impact of Histopathologic Response after Neoadjuvant Chemotherapy in Stage Ⅲ_A Non-small Cell Lung Cancer

Objective： To investigate prognostic impact of histopathologic response induced by neoadjuvant chemotherapy in patients with stage ⅢA non-small cell lung cancer （NSCLC）. Methods： Forty patients with stage ⅢA NSCLC underwent two cycles of neoadjuvant chemotherapy with mitomycin, vindosine, and cisplatin followed by surgery. Histopathologic response in resection of the tumor was examined after surgery. Tumor regression was classified as grade Ⅳ, grade Ⅲ, grade Ⅱ, and grade Ⅰ according to the extent of tumor necrosis and the extent of the vital tumor tissues. The tumor regression grading was correlated with the survival time of the patients. Results： After two cycles of chemotherapy, 19 （47.5%） of 40 patients had objective response （2 complete and 17 partial response）. In 40 resected tumor specimens, 2 （5%） were classified as regression grade Ⅳ, 16 （40%） as regression grade Ⅲ, 18 （45%） as regression gradeⅡ, and 4 （10%） as regression grade Ⅰ. The rate of complete surgical resection was significantly higher in patients with tumor regression grade Ⅲ-Ⅳ （〈10% vital tumor tissue）（P〈0.05）. The median survival time in patients classified as having tumor regression grade Ⅲ-Ⅳ was significantly longer than that in patients who had regression grade Ⅰ-Ⅱ （P〈0.05）. The 3-year survival rate in patients with regression grade Ⅲ-Ⅳ was markedly higher than that in patients who had regression grade Ⅰ-Ⅱ （P〈0.05）. Conclusion： The extent of tumor regression induced by neoadjuvant chemotherapy is a critical issue for successful therapeutic approach in patients with stage ⅢA NSCLC. In resected specimens of tumors after chemotherapy, the presence of marked tumor regression （regression grade Ⅲ-Ⅳ） is predictive for superior survival time.

Secondary metabolites of mulberry leaves exert anti-lung cancer activity through regulating the PD-L1/PD-1 signaling pathway

Lung cancer ranks the top of malignancies that cause cancer-related deaths worldwide.The leaves of Morus alba L are traditional Chinese medicine widely applied in respiratory diseases.Our previous work has demonstrated the anti-lung cancer effect of secondary metabolites of mulberry leaf,but their mechanism of action has still not fully elucidated.We synthesized Moracin N(MAN)-Probe conjugated with alkyne to label lung cancer cells and identified protein targets by chemical proteomic analysis.MAN and its probe exerted similar growth-inhibitory effect on human lung cancer cells.Chemical proteomic results showed that MAN targeted the programmed death ligand 1(PD-L1)checkpoint pathway and T cell receptor(TCR)signaling pathway,indicating its immune-regulatory function.Cell-free surface plasmon resonance(SPR)results showed the direct interaction of MAN with PD-L1 protein.Molecular docking analysis demonstrated that MAN bound to E158 residue of PD-L1 protein.MAN downregulated the expression levels of PD-L1 in a time-and dose-dependent manner and disrupted the PD-L1/programmed death 1(PD-1)binding,including other secondary metabolites of mulberry leaves Guangsangon E(GSE)and Chalcomoracin(CMR).Human peripheral blood mononuclear cells(PBMCs)co-cultured with MAN-treated A549 cells,resulting in the increase of CD8^(+)GZMB^(+)T cells and the decrease of CD8^(+)PD-1^(+)T cells.It suggested that MAN exerts anti-cancer effect through blocking the PD-L1/PD-1 signaling.In vivo,MAN combined with anti-PD-1 antibody significantly inhibited lung cancer development and metastasis,indicating their synergistic effect.Taken together,secondary metabolites of mulberry leaves target the PD-L1/PD-1 signaling,enhance T cell-mediated immunity and inhibit the tumorigenesis of lung cancer.Their modulatory effect on tumor microenvironment makes them able to enhance the therapeutic efficacy of immune checkpoint inhibitors in lung cancer.

Multilevel Attention Unet Segmentation Algorithmfor Lung Cancer Based on CT Images

Lung cancer is a malady of the lungs that gravely jeopardizes human health.Therefore,early detection and treatment are paramount for the preservation of human life.Lung computed tomography(CT)image sequences can explicitly delineate the pathological condition of the lungs.To meet the imperative for accurate diagnosis by physicians,expeditious segmentation of the region harboring lung cancer is of utmost significance.We utilize computer-aided methods to emulate the diagnostic process in which physicians concentrate on lung cancer in a sequential manner,erect an interpretable model,and attain segmentation of lung cancer.The specific advancements can be encapsulated as follows:1)Concentration on the lung parenchyma region:Based on 16-bit CT image capturing and the luminance characteristics of lung cancer,we proffer an intercept histogram algorithm.2)Focus on the specific locus of lung malignancy:Utilizing the spatial interrelation of lung cancer,we propose a memory-based Unet architecture and incorporate skip connections.3)Data Imbalance:In accordance with the prevalent situation of an overabundance of negative samples and a paucity of positive samples,we scrutinize the existing loss function and suggest a mixed loss function.Experimental results with pre-existing publicly available datasets and assembled datasets demonstrate that the segmentation efficacy,measured as Area Overlap Measure(AOM)is superior to 0.81,which markedly ameliorates in comparison with conventional algorithms,thereby facilitating physicians in diagnosis.

Influence of initial check, information exchange, final accuracy check, reaction information nursing on the psychology of elderly with lung cancer

BACKGROUND As one of the fatal diseases with high incidence,lung cancer has seriously endangered public health and safety.Elderly patients usually have poor self-care and are more likely to show a series of psychological problems.AIM To investigate the effectiveness of the initial check,information exchange,final accuracy check,reaction(IIFAR)information care model on the mental health status of elderly patients with lung cancer.METHODS This study is a single-centre study.We randomly recruited 60 elderly patients with lung cancer who attended our hospital from January 2021 to January 2022.These elderly patients with lung cancer were randomly divided into two groups,with the control group taking the conventional propaganda and education and the observation group taking the IIFAR information care model based on the conventional care protocol.The differences in psychological distress,anxiety and depression,life quality,fatigue,and the locus of control in psychology were compared between these two groups,and the causes of psychological distress were analyzed.RESULTS After the intervention,Distress Thermometer,Hospital Anxiety and Depression Scale(HADS)for anxiety and the HADS for depression,Revised Piper’s Fatigue Scale,and Chance Health Locus of Control scores were lower in the observation group compared to the pre-intervention period in the same group and were significantly lower in the observation group compared to those of the control group(P<0.05).After the intervention,Quality of Life Questionnaire Core 30(QLQ-C30),Internal Health Locus of Control,and Powerful Others Health Locus of Control scores were significantly higher in the observation and the control groups compared to the pre-intervention period in their same group,and QLQ-C30 scores were significantly higher in the observation group compared to those of the control group(P<0.05).CONCLUSION The IIFAR information care model can help elderly patients with lung cancer by reducing their anxiety and depression,psychological distress,and fatigue,improving their tendencies on the locus of control in psychology,and enhancing their life qualities.

Imbalance of Circulating Follicular Regulatory and Follicular Helper T Cell Subpopulations Is Associated with Disease Progression and Serum CYFRA 21-1 Levels in Patients with Non-small Cell Lung Cancer

Objective This study aimed to investigate the changes of follicular helper T(TFH)and follicular regulatory T(TFR)cell subpopulations in patients with non-small cell lung cancer(NSCLC)and their significance.Methods Peripheral blood was collected from 58 NSCLC patients at different stages and 38 healthy controls.Flow cytometry was used to detect TFH cell subpopulation based on programmed death 1(PD-1)and inducible co-stimulator(ICOS),and TFR cell subpopulation based on cluster determinant 45RA(CD45RA)and forkhead box protein P3(FoxP3).The levels of interleukin-10(IL-10),interleukin-17a(IL-17a),interleukin-21(IL-21),and transforming growth factor-β(TGF-β)in the plasma were measured,and changes in circulating B cell subsets and plasma IgG levels were also analyzed.The correlation between serum cytokeratin fragment antigen 21-1(CYFRA 21-1)levels and TFH,TFR,or B cell subpopulations was further explored.Results The TFR/TFH ratio increased significantly in NSCLC patients.The CD45RA^(+)FoxP3^(int) TFR subsets were increased,with their proportions increasing in stages Ⅱ to Ⅲ and decreasing in stage IV.PD-1^(+)ICOS+TFH cells showed a downward trend with increasing stages.Plasma IL-21 and TGF-β concentrations were increased in NSCLC patients compared with healthy controls.Plasmablasts,plasma IgG levels,and CD45RA^(+)FoxP3^(int) TFR cells showed similar trends.TFH numbers and plasmablasts were positively correlated with CYFRA 21-1 in stages Ⅰ-Ⅲ and negatively correlated with CYFRA 21-1 in stage IV.Conclusion Circulating TFH and TFR cell subpopulations and plasmablasts dynamically change in different stages of NSCLC,which is associated with serum CYFRA 21-1 levels and reflects disease progression.

Nursing effect of narrative nursing intervention on postoperative patients with severe lung cancer

BACKGROUND Lung cancer is a common disease with high mortality,and psychological support is very important in the diagnosis and treatment of postoperative patients with cancer pain.AIM To explore the application effect of the narrative nursing method in postoperative lung cancer patients in the intensive care unit.METHODS A total of 120 patients diagnosed with lung cancer and experiencing cancer-related pain were randomly allocated into two groups:an observation group and a control group,each consisting of 60 cases.The control group was given routine analgesic and psychological care,while the research group applied the five-step narrative nursing method based on routine care,comparing the visual analogue scale scores,sleep status,anxiety and depression status,and quality of life of the two groups of patients before and after the intervention.RESULTS The pain scores,anxiety scores,and depression scores of the study group were lower than those of the control group after the intervention using the narrative nursing method,and the difference was statistically significant(P<0.05).CONCLUSION Using narrative nursing methods to intervene in patients with lung cancer combined with cancerous pain can help patients to correctly recognize their disease,adjust their mentality,establish confidence,alleviate patients'subjective pain feelings,and improve their adverse emotions.

Changes of activated circulating endothelial cells and survivin in patients with non-small cell lung cancer after antiangiogenesis therapy

Background Although antiangiogenesis therapy plays an important role in anti-neoplastic treatment with its recognized efficacy and slight adverse effect, there is no prospective clinical trial to define ideal markers for predicting efficacy of antiangiogenic therapy. This study was undertaken to investigate the changes of activated circulating endothelial cells （aCECs） and survivin after anti-angiogenesis therapy and their significance in predicting the efficacy of the therapy. Methods Patients of non-small cell lung cancer （NSCLC） treated with chemotherapy with or without Endostar were observed. The amount of activated CECs was detected by flow cytometry, and the expression of survivin mRNA was determined by real-time polymerase chain reaction （PCR）. Results After treatment, the amount of activated CECs decreased significantly in clinical benefit cases （P=0.021 in chemotherapy alone, P=0.001 in chemotherapy plus Endostar）, increased in disease progressive cases （P=0.015 in chemotherapy alone, but P=0.293 in chemotherapy with Endotatar）. After therapy, the expression of survivin mRNA decreased in clinical benefit cases （P=0.001） and increased in disease progressive cases （P=0.018）. A positive correlation was found between activated CECs and survivin in the chemotherapy group pre- and post-therapy （P=0.001 and 0.021, respectively）, but only in the chemotherapy with Endostar group pre-therapy （P=0.030） rather than post-therapy. A positive correlation was found between the decreased activated CECs after therapy and time to progression （TTP） （r=0.322, P=0.012）; a negative correlation was found between the amount of survivin mRNA in serum post-therapy and -l-I-P（r= -0.291, P=0.048）. Conclusions Activated CECs and survivin may be ideal markers forecasting efficacy and prognosis of NSCLC. The former can reflect more sensitively antiangiogenic efficacy and the latter is more sensitive to shrinkage or swelling of tumors. Their combination can evaluate more accurately the efficacy of antiangiogenic therapy of NSCLC.

Efficacy and safety of icotinib in Chinese patients with advanced non-small cell lung cancer after failure of chemotherapy

Background The preclinical experiments and several clinical studies showed icotinib,an oral epidermal growth factor receptor （EGFR） tyrosine kinase inhibitor,in Chinese patients with advanced non-small cell lung cancer （NSCLC） who failed previous chemotherapy.We performed a retrospective study of the efficacy and safety of icotinib monotherapy in a different and more recent sample of Chinese patients.Methods The clinical data of 149 patients with advanced NSCLC who were admitted to Zhejiang Cancer Hospital from August 1,2011 to July 31,2012 were retrospectively analyzed.All patients were given icotinib treatment after the failure of previous chemotherapy.Univariate and multivariate analyses were conducted based on the Kaplan Meier method and Cox proportional hazards model.Results The objective response rate was 33/149 and disease control rate was 105/149.No complete response occurred.Median progression free survival （PFS） with icotinib treatment was 5.03 months （95％ CI：3.51 to 6.55）.Median overall survival was 12.3 months （95％ CI：10.68 to 13.92）.Multivariate analysis showed that the mutation of EGFR and one regimen of prior chemotherapy were significantly associated with longer PFS.At least one drug related adverse event was observed in 65.8％ （98/149） of patients,but mostly grade 1 or 2 and reversible and none grade 4 toxicity.Conclusions lcotinib monotherapy is an effective and well tolerated regimen for Chinese patients with NSCLC after the failure of chemotherapy.It is a promising agent and further study with icotinib in properly conducted trials with larger patient samples and other ethnic groups is warranted.

China National Medical Products Administration approval summary:anlotinib for the treatment of advanced non-small cell lung cancer after two lines of chemotherapy

Background:On May 8,2018,the China National Medical Products Administration(NMPA)approved anlotinib,an orally administered anti-angiogenesis inhibitor,for the treatment of patients with advanced non-small cell lung can-cer(NSCLC)who have progressed after treatment with two or more lines of prior systemic chemotherapy.Main body of the abstract:China NMPA reviewed and inspected a regional double-blinded,placebo-controlled,Phase III trial comparing the overall survival(OS)of NSCLC patients between the anlotinib and placebo arms.A total of 437 patients were randomized(2:1)to receive either anlotinib(n=294)or placebo(n=143)once daily on a 2-week on and 1-week off schedule.Patients with epidermal growth factor receptor(EGFR)or activating anaplastic lymphoma kinase(ALK)genomic tumor aberrations should have disease progression on NMPA-approved therapy.Anlotinib is the first NMPA-approved drug for patients with advanced NSCLC who have progressed on at least two lines of prior systemic chemotherapies in China.The approval was based on a statistically and clinically significant improvement in median OS with anlotinib(9.46 months)compared with placebo[6.37 months;hazard ratio(HR])=0.70,95%confidence interval(CI)=0.55-0.89;two-sided log-rank P=0.002].The confirmed objective response rate(ORR)was 9.2%in the anlotinib arm and 0.7%in the placebo arm.The median duration of response(DoR)was 4.83 months,with a 95%CI of 3.31-6.97 months.The toxicity profile of anlotinib was consistent with that of known anti-angiogenesis inhibitors.Common adverse drug reactions(ADRs)in anlotinib-treated patients included hypertension(67.4%),hand-foot syndrome(43.9%),hemoptysis(14.0%),thyroid stimulating hormone(TSH)elevation(46.6%),and corrected QT interval(QTc)prolongation(26.2%).Short conclusion:Anlotinib demonstrated a clinically significant OS prolongation as a novel therapeutic option for advanced or metastatic NSCLC following at least two lines of chemotherapy.

Erlotinib as a salvage treatment for patients with advanced non-small cell lung cancer after failure of gefitinib treatment

Background Several clinical trials showed that erlotinib was effective after the failure of gefitinib in advanced non-small cell lung cancer （NSCLC）. The aim of this study was to evaluate the feasibility of erlotinib treatment after the failure of gefitinib based on the data from our hospital. Methods The clinical data of 20 patients with advanced NSCLC who were admitted to Shanghai Chest Hospital from August 2007 to December 2008 were retrospectively analyzed. All of the patients were given erlotinib treatment after the failure of gefitinib. Survival analysis was made by Kaplan-Meier method. The Cox regression model was performed to analyze the relationship between the influential factors and the erlotinib progression-free survival （PFS）. Results Five patients had a partial response （PR）, nine patients had stable disease （SD） and six patients had progressive disease （PD） with gefitinib treatment. The median PFS was 277 days （95% CI 0-566）. No patient had a PR, seven had SD and fourteen PD with the erlotinib therapy. The median PFS was 31 days （95% CI 9.1-52.9）. The response rate （RR） was 0, and the disease control rate （DCR） was 35% （7/20）. Cox regression analysis demonstrated that sex （P=0.96）, age （P=0.89）, smoking history （P=0.78）, performance status （PS） （P=0.98）, gefitinib efficacy （P=-0.90） and whether chemotherapy was applied between using the two drugs （P=-0.45） had no significant correlation with erlotinib PFS. Fifteen patients had epidermal growth factor receptor （EGFR） mutation status determined. There were five cases got SD with the erlotinib treatment in ten mutation negative （wild-type） patients. No SD was recorded in the five mutation positive patients. Conclusions The efficacy of erlotinib treatment after gefitinib failure was limited. However, the patients who are EGFR mutation negative can probably benefit from erlotinib treatment after gefitinib failure.