Prognostic significance of combined fibrinogen concentration and neutrophil-to-lymphocyte ratio in patients with resectable non-small cell lung cancer

Objective:Cancer-associated inflammation and coagulation cascades play vital roles in cancer progression and survival.In this study,we investigated the significance of the combination of preoperative fibrinogen and the neutrophil-to-lymphocyte ratio(NLR)in predicting the survival of patients with non-small cell lung cancer(NSCLC).Methods:We retrospectively enrolled 589 patients with NSCLC who underwent surgery.The univariate and multivariate Cox survival analyses were used to evaluate the prognostic indicators,including the combination of fibrinogen and NLR(F-NLR).The cut-off values for fibrinogen,NLR,and clinical laboratory variables were defined by the receiver operating characteristic(ROC)curve analysis.According to the ROC curve,the recommended cut-off values for fibrinogen and the NLR were 3.48 g/L and 2.30,respectively.Patients with both a high NLR(≥2.30)and hyperfibrinogenemia(≥3.48 g/L)were given a score of 2,whereas those with one or neither were scored as 1 or 0,respectively.Results:Our results showed that F-NLR was an independent prognostic indicator for disease-free survival(DFS)[hazard ratio(HR),1.466;95%confidence interval(CI),1.243–1.730;P<0.001]and overall survival(OS)(HR,1.512;95%CI,1.283–1.783;P<0.001).The five-year OS rates were 66.1%,53.5%,and 33.3%for the F-NLR=0,F-NLR=1,and F-NLR=2,respectively(P<0.001).Correspondingly,their five-year DFS rates were 62.2%,50.3%,and 30.4%,respectively(P<0.001).In the subgroup analyses of the pathological stages,the F-NLR level was significantly correlated with DFS and OS in stage I and IIIA cancers.Conclusions:Preoperative F-NLR score can be used as a valuable prognostic marker for patients with resectable early-stage NSCLC.

Combined Double Sleeve Lobectomy and Superior Vena Cava Resection for Non-small Cell Lung Cancer with Persistent Left Superior Vena Cava

A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department.Bronchoscopy displayed complete obstruction of right upper lobe bronchus and infiltration of the bronchus intermedius with tumor.Chest contrast computed tomography revealed the tumor invaded right pulmonary artery,superior vena cava,and the persistant left superior vena cava flowed into the coronary sinus.The tumor was successfully removed by means of bronchial and pulmonary artery sleeve resection of the right upper and middle lobes combined with resection and reconstruction of superior vena cava(SVC)utilizing ringed polytetrafluoroethylene graft.To the best of our knowledge,this was the first report of complete resection of locally advanced lung cancer involving superior vena cava,right pulmonary artery trunk and main bronchus with persistant left superior vena cava.

Targeting carnitine palmitoyl transferase 1A(CPT1A)induces ferroptosis and synergizes with immunotherapy in lungg cancer

Despite the successful application of immune checkpoint therapy,no response or recurrence is typical in lung cancer.Cancer stem cells(CSCs)have been identified as a crucial player in immunotherapy-related resistance.Ferroptosis,a form of cell death driven by iron-dependent lipid peroxidation,is highly regulated by cellular metabolism remolding and has been shown to have synergistic effects when combined with immunotherapy.Metabolic adaption of CsCs drives tumor resistance,yet the mechanisms of their ferroptosis defense in tumor immune evasion remain elusive.Here,through metabolomics,transcriptomics,a lung epithelialspecific Cptla-knockout mouse model,and clinical analysis,we demonstrate that CPT1A,a key rate-limiting enzyme of fatty acid oxidation,acts with L-carnitine,derived from tumor-associated macrophages to drive ferroptosis-resistance and CD8^(+)T cells inactivation in lung cancer.Mechanistically,CPT1A restrains ubiquitination and degradation of c-Myc,while c-Myc transcriptionally activates CPT1A expression.The CPT1A/c-Myc positive feedback loop further enhances the cellular antioxidant capacity by activating the NRF2/GPX4 system and reduces the amount of phospholipid polyunsaturated fatty acids through ACSL4 downregulating,thereby suppressing ferroptosis in CSCs.Significantly,targeting CPT1A enhances immune checkpoint blockadeinduced anti-tumor immunity and tumoral ferroptosis in tumor-bearing mice.The results illustrate the potential of a mechanismguided therapeutic strategy by targeting a metabolic vulnerability in the ferroptosis of CsCs to improve the efficacy of lung cancer immunotherapy.

Outcome comparison of pyrotinib with current standard of care in the second/third line setting in advanced non-small cell lung cancer patients with HER2 mutation

To the Editor:In recent years,impressive outcomes have been achieved in patients harboring human epidermal growth factor receptor 2(HER2)mutations,which accounts for 1%to 4%of cases in non-small cell lung cancer(NSCLC).

Individualized Chemotherapy in Advanced NSCLC Patients Based on mRNA Levels of BRCA1 and RRM1

Objective： Experimental evidence suggests that the overexpression of breast cancer-specific tumor suppressor protein 1 （BRCA1） gene enhances sensitivity to docetaxel and resistance to cisplatin and ribonucleotide reductase M1 （RRM1） gene overexpression enhances resistance to gemcitabine. To further examine the effect of BRCA1 and RRM1 mRNA levels on outcome in advanced non-small cell lung cancer （NSCLC）, we performed this non-randomized phase II clinical trial which tested the hypothesis that customized therapy would confer improved outcome over non-customized therapy. Methods： RNA was isolated from fresh tumor tissue. Patients received chemotherapy regimen based on their BRCA1 and RRM1 mRNA levels： both low-cisplatin plus gemcitabine （GP）; both high-vinorelbine plus cisplatin （NP）; BRCA1 low and RRM1 high-cisplatin plus docetaxel （TP）; BRCA1 high and RRM1 low-vinorelbine plus gemcitabine （GN）. Results： From Dec 2005 to Nov 2008, 94 metastatic and locally advanced NSCLC patients from our institute were enrolled in this study. The median age was 58 years old. Among them, 21 patients received GP, 30 patients received TP and 43 patients received NP chemotherapy. GP group had a higher response rate, and longer median time to progression （TTP） and median overall survival （OS） time than the other 2 groups. The response rates in the GP, TP and NP groups were 42.9%, 36.7% and 27.9%, respectively （P=0.568）. The median TTP was 5.6, 5.0, 4.8 months （P=0.975）, respectively, and the median OS time was 12.5, 11.0, 9.7 months （P=0.808）, respectively. Conclusion： Chemotherapy customized according to BRCA1 and RRM1 expression levels is associated with higher response rate and longer TTP and OS time in the GP group. This suggests that BRCA1 and RRM1 mRNA levels could be used as biomarkers in individual therapy in NSCLC.

Uncommon EGFR mutations in a cohort of Chinese NSCLC patients and outcomes of first-line EGFR-TKIs and platinum-based chemotherapy

Objective： Data on the clinical activity of epidermal growth factor receptor （EGFR） tyrosine kinase inhibitors （TKIs） in patients with non-small-cell lung cancer （NSCLC） and uncommon EGFR mutations remain insufficient. This study aimed to investigate the effect of first-line EGFR-TKIs or platinum-based chemotherapy in NSCLC patients with uncommon EGFR mutations. Methods： We retrospectively enrolled 504 patients with EGFR-mutant NSCLC. The clinical characteristics and treatment outcomes were collected and compared between patients with common and uncommon EGFR-mutant NSCLC. Results： Seventy patients （13.9%） harboring uncommon EGFR mutations were included. Thirty of these patients received EGFR-TKIs and 40 received platinum-based chemotherapy as first-line therapy. The objective response rate （ORR） and median progression-free survival （mPFS） of patients treated with TKIs in the uncommon mutation group was significantly inferior to that in the common mutation group （ORR： 23.3% vs. 51.8%, P=0.003; mPFS： 7.1 vs. 10.9 months, P〈0.001）. In the uncommon group, mPFS was similar between first-line EGFR-TKIs treatment and platinum-based chemotherapy （7.1 vs. 6.1 months, P=0.893）. In patients with EGFR G719X or L861Q mutations, the mPFS was longer in the first-line EGFR-TKIs treatment group than in the chemotherapy group, but the difference was not statistically significant （G719X： 8.2 vs. 5.8 months, P=0.061; L861Q： 7.6 vs. 4.1 months, P=0.872）. Multivariate analyses identified adenocarcinoma （P=0.003） as the independent predictive factor for PFS in patients with uncommon EGFR mutations who were treated with first-line EGFR-TKIs. Conclusions： The current study demonstrated that the effect of first-line EGFR-TKIs was similar to that of platinum-based chemotherapy in patients with uncommon EGFR-mutant NSCLC. Adenocarcinoma was the independent predictive factor for PFS in uncommon EGFR-mutant NSCLC patients treated with first-line EGFR- TKIs.

TGFb1 Receptor Kinase Inhibitor Inhibits Prostate Cancer Growth in Bone

Background and objective Bone metastases (BM) are the primary cause of morbidity and mortality of prostate cancer (PCa) and noeective therapy is currently available.

A nomogram-based immune-serum scoring system predicts overall survival in patients with lung adenocarcinoma

Objective:The immunoscore,which is used to quantify immune infiltrates,has greater relative prognostic value than tumor,node,and metastasis(TNM)stage and might serve as a new system for classification of colorectal cancer.However,a comparable immunoscore for predicting lung adenocarcinoma(LUAD)prognosis is currently lacking.Methods:We analyzed the expression of 18 immune features by immunohistochemistry in 171 specimens.The relationship of immune marker expression and clinicopathologic factors to the overall survival(OS)was analyzed with the Kaplan-Meier method.A nomogram was developed by using the optimal features selected by least absolute shrinkage and selection operator(LASSO)regression in the training cohort(n=111)and evaluated in the validation cohort(n=60).Results:The indicators integrated in the nomogram were TNM stage,neuron-specific enolase,carcino-embryonic antigen,CD8 center of tumor(CT),CD8 invasive margin(IM),Fox P3 CT,and CD45 ROCT.The calibration curve showed prominent agreement between the observed 2-and 5-year OS and that predicted by the nomogram.To simplify the nomogram,we developed a new immune-serum scoring system(I-SSS)based on the points awarded for each factor in the nomogram.Our I-SSS was able to stratify same-stage patients into different risk subgroups.The combination of I-SSS and TNM stage had better prognostic value than the TNM stage alone.Conclusions:Our new I-SSS can accurately and individually predict LUAD prognosis and may be used to supplement prognostication based on the TNM stage.

Preliminary Study of Local Immunotherapy with Autologous Cytokine-Induced Killer Cells for Glioma Patients

OBJECTIVE Cytokine-induced killer(CIK)cells are T-cells that display effective anti-tumor activity.In this study,we investigated the anti-tumor activity of CIK cells in vitro,and conducted a preliminary investigation using autologous CIK cells to treat glioma patients through local administration. METHODS The CIK cells were derived from peripheral blood monocytes(PBMCs)of the glioma patients.The anti-tumor activity of the CIK cells against human T98-G glioma cell was tested in vitro.In addition,the autologous CIK ceils were locally administrated into the tumor cavity in the malignant glioma patients through an Ommaya reservoir which was pre-inserted during tumor resection.The 4×10~8 CIK cells in a 5 ml suspension were injected once a week 2 times per cycle.Five hundreds KU of IL-2 was injected every other day. RESULTS(i)With incubation,the CIK cells showed dual staining of CD3^+CD56^+with a positive rate of 3.45% on day 10 and 55.2% on day 30.In vitro anti-tumor activity(against T98-G cells)of the CIK cells reached the highest level after 18 days of incubation with different effector/target(E:T)ratios.(ii) Six patients received autologous CIK cell treatment(10 cycles). Two patients showed no recurrence and are still alive(24 and 10 months),while 4 cases had a recurrence 3 of which have died.The mean survival time from the first CIK cell treatment to the end of follow-up was 12.5 months.The main side-effects of the local CIK cell treatment was brain edema,which was controlled by mannitol in most of the cases.However for one patient injection of CIK cells and IL-2 had to be discontinued. CONCLUSION In vitro CIK cells are effective anti-glioma T-cells.Local therapy with CIK cells has potential anti-glioma efficacy and tolerable side-effects.

Weekly gemcitabine as a radiosensitiser for the treatment of brain metastases in patients with non-small cell lung cancer:phase Ⅰ trial

Background Conventional treatment for non-small cell lung cancer （NSCLC） brain metastases （BM） is whole-brain radiotherapy （WBRT）. The efficacy is limited. It might be increased by a potent radiosensitizer such as gemcitabine, which is believed to cross the disrupted blood-brain barrier. The primary objective of this study was to determine the maximum tolerated dose （MTD） of weekly gemcitabine given concurrently with WBRT. Methods Patients with BM from NSCLC were included. The dose of WBRT was 3750 cGy （total 15 times, 3 weeks）. Gemcitabine was given concurrently with WBRT on days 1, 8 and 15. The starting dose was 400 mg/m^2, escalated by 100 mg/m^2 increments. At least three patients were included per level. Dose limiting toxicity （DLT） was defined as grade 4 hematological or grade 2 neurological toxicity. When two or more patients experience DLT, the MTD was reached. Results A total of 16 patients were included; 69% had a performance status （PS） 1 （Eastern Cooperative Oncology Group, ECOG）. A total of 69% had concurrent active extra cranial diseases. All had more than 3 BM. Up to 600 mg/m^2 （level 3） no neurology toxicity was observed. At 600 mg/m^2 two out of 9 patients developed grade 4 thrombocytopenia. One of the two patients＇ thrombocytopenia was confused with disseminated intravascular coagulation （DIC）. At 700 mg/m^2 two out of 4 patients developed neurotoxicities. One developed grade 3 seizure and cognitive disorder. Another patient developed suspected grade 2 muscle weakness. Conclusions The MTD was reached at a dose of 700 mg/m^2. The dose of 600 mg/m^2 would be considered for further study.

Expressions of CLDN1 and insulin-like growth factor 2 are associated with poor prognosis in stage N2 non-small cell lung cancer

Background Patients with single station mediastinal lymph node （N2） non-small call lung ccancer （NSCLC） have a better prognosis than those with multilevel N2.The molecular factors which are involved in disease progression remain largely unknown.The purpose of this study was to investigate gene expression differences between single station and multilevel N2 NSCLC and to identify the crucial molecular factors which are associated with progress and prognosis of stage N2 NSCLC.Methods Gene expression analysis was performed using Agilent 4x44K Whole Human Genome Oligo Microarray on 10 freshfrozen lymph node tissue samples from single station N2 and paired multilevel N2 NSCLC patients.Real-time reverse transcription （RT）-PCR was used to validate the differential expression of 14 genes selected by cDNA microarray of which four were confirmed.Immunohistochemical staining for these validated genes was performed on formalin-fixed,paraffinembedded tissue samples from 130 cases of stage N2 NSCLC arranged in a high-density tissue microarray.Results We identified a 14 gene expression signature by comparative analysis of gene expression.Expression of these genes strongly differed between single station and multilevel N2 NSCLC.Four genes （ADAM28,MUC4,CLDN1,and IGF2） correlated with the results of microarray and real-time RT-PCR analysis for the gene-expression data in samples from 56 NSCLC patients.Immunohistochemical staining for these genes in samples from 130 cases of stage N2 NSCLC demonstrated the expression of IGF2 and CLDN1 was negatively correlated with overall survival of stage N2 NSCLC.Conclusions Our results suggest that the expression of CLDN1 and IGF2 indicate a poor prognosis in stage N2 NSCLC.Further,CLDN1 and IGF2 may provide potential targeting opportunities in future therapies.

Osteopontin knockdown suppresses non-small cell lung cancer cell invasion and metastasis

Background Osteopontin （OPN） was identified as one of the leading genes that promote the metastasis of malignant tumor. However, the mechanism by which OPN mediates metastasis in non-small cell lung cancer （NSCLC） remains unknown. The aim of the study is to investigate the biological significance and the related molecular mechanism of OPN expression in lung cancer cell line. Methods Lentiviral-mediated RNA interference was applied to inhibit OPN expression in metastatic human NSCLC cell line （A549）, The invasion, proliferation, and metastasis were evaluated OPN-silenced in A549 cells in vitro and in vivo. The related mechanism was further investigated. Results Interestingly, OPN knockdown significantly suppressed the invasiveness of A549 cells, but had only a minor effect on the cellular migration and proliferation. Moreover, we demonstrated that OPN knockdown significantly reduced the levels of matrix metalloproteinase （MMP）-2 and urokinase plasminogen activator （uPA）, and led to an obvious inhibition of both in vitro invasion and in vivo lung metastasis ofA549 cells （P 〈0.001）. Conclusions Our data demonstrate that OPN contributes to A549 cell metastasis by stimulating cell invasion, independent of cellular migration and proliferation. OPN could be a new treatment target of NSCLC.

多药耐药细胞株A549/Gem及其亲代细胞A549之间的区别研究(英文)

Objective:To discuss the difference between multi-drug resistant cell line A549/Gem and its parental cell A549 on the basis of establishment of human gemcitabine-resistant cell line A549/Gem so as to elaborate the possible mechanisms of gemcitabine resistance.Methods:Human gemcitabine-resistant non-small cell lung cancer cell line A549/Gem was estab-lished by the method of repeated clinical serous peak concentration plus gradually increasing concentration of gemcitabine from its parental cell human lung adenocarcinoma cell line A549 which was sensitive to gemcitabine.During the course of inducement,we had monitored their morphology,checked their resistance indexes and resistant pedigree by MTT method,gathered their growth curves and calculated their doubling time,examined their DNA contents and cell cycles by FCM;at the same time,we had measured their expressions of P53,EGFR,Cerb-B-2,PTEN,PCNA,c-myc,VEGF,MDR-1,Bcl-2,nm23,MMP-9,TIMP-1,and CD44v6 proteins via immunocytochemistry staining,RRM1 and ERCC1 mRNA by real-time fluorescent quantitative-PCR.Results:The resistance index of A549/Gem' cells(the deputy of cells in the process of inducement) to gemcitabine was 163.228,and the cell line also exhibited cross-resistance to vinorelbine,taxotere,fluorouraci,etoposide and cisplatin,but kept sensitivity to paclitaxol and oxaliplatin.The doubling time of A549/Gem' was shorter and figures in G0-G1 phases were increased than A549 cells.Compared with A549 cells,A549/Gem' cells achieved EGFR and c-myc proteins expressions,nm23 protein expression enhanced,P53,Cerb-B-2 and Bcl-2 proteins expressions reduced,PTEN,PCNA and MDR-1 proteins expressions vanished,but those of MMP-9,VEGF,CD44v6 and TIMP-1 proteins changed trivially.Meanwhile,expressions of RRM1 and ERCC1 mRNA were augmented markedly.The resistance index of A549/Gem cells to gemcitabine was 129.783,and the cell line also held cross-resistance to vinorelbine,taxotere,etoposide,cisplatin and sensitivity to paclitaxol.But the resistance to fluorouracil and sensitivity to oxaliplatin vanished.And the expression of RRM1 and ERCC1 mRNA decreased visibly.The doubling time of A549/Gem cells was longer and figures in G0-G1 phases were decreased than A549/Gem' cells.In A549/Gem cells,expressions of P53,EGFR,PCNA and MDR-1 proteins was same to those of A549/Gem' cells.A549/Gem cells achieved TIMP-1 and PTEN proteins expressions,Cerb-B-2,MMP-9,c-myc and Bcl-2 proteins expressions enhanced,nm23 protein expressions vanished,but the expressions of VEGF and CD44v6 proteins changed trivially.Furthermore,Compared with its parental cell A549,A549/Gem cell was mixed with giant cells of different sizes and was larger and more irregular.Conclusion:The human gemcitabine-resistant non-small cell lung cancer cell line A549/Gem had achieved multi-drug resistance and great changes of biological characters compared with its parental cells A549.And these changes possibly participated in the formation of multidrug resistance.

实时荧光PCR法检测肺癌细胞系中吉西他滨耐药相关基因的表达(英文)

Objective: To explore the molecular mechanism of gemcitabine-resistance, the relative mRNA expression of five genes related to gemcitabine-resistance was detected in six lung cancer cell lines. Methods: The total RNA was extracted from six lung cancer cell lines GLC-82, NCI-H460, A549, 95-C, 95-D and QG56. Then the cDNA was amplified by real-time quantitative PCR method to quantify the gene expression of RRM1, PTEN, ERCC1, dCK and CDA. The cytotoxicity of gem- citabine to cell lines was tested by MTT method. Results: Among the detected six lung cancer cell lines, the mRNA level of RRM1, PTEN and ERCC1 in lung squamous cell line QG56 was highest, and the IC50 of gemcitabine to QG56 cell line was also highest. Conclusion: The mRNA expression of RRM1, PTEN and ERCC1 was correlated, and the high expression of RRM1 was related to gemcitabine resistance of lung cancer.

吉西他滨耐药细胞系H460/Gem及其亲代细胞NCI-H460之间的不同(英文)

Objective: To discuss the difference between multi-drug resistant cell line H460/Gem and its parental cell NCI-H460 on the basis of establishment of human gemcitabine-resistant cell line H460/Gem so as to elaborate the possible mech-anisms of gemcitabine resistance. Methods: Human gemcitabine-resistant non-small cell lung cancer cell line H460/Gem was established by 2/3 clinical serous peak concentration gemcitabine intermittent selection from its parental cell human large cell lung carcinoma cell line NCI-H460 which was sensitive to gemcitabine. During the course of inducement, we had monitored their morphology, checked their resistance indexes and resistant pedigree by MTT method, gathered their growth curves and calculated their doubling time, examined their DNA contents and cell cycles by FCM; at the same time, we had measured its expressions of P53, EGFR, c-erb-B-2, PTEN, PCNA, c-myc, VEGF, MDR-1, Bcl-2, nm23, MMP-9, TIMP-1, CD44v6 proteins via immunocytochemistry staining, RRM1 and ERCC1 mRNA by real-time fluorescent quantitative-PCR. Results: The resis-tance index of H460/Gem' cells (the deputy of cells in the process of inducement) to gemcitabine was 1.201, and the cell line also exhibited cross-resistance to paclitaxol, fluorouraci, etoposide, cisplatin and oxaliplatin, but kept sensitivity to vinorelbine and taxotere. The doubling time of H460/Gem' cells was longer and figures in G0-G1 phase was decreased than that of NCI-H460 cells. Compared with NCI-H460 cells, H460/Gem' cells had achieved TIMP-1 protein expression emerged, nm23 protein expression enhanced, VEGF and MMP-9 protein expressions reduced, and CD44v6, P53 protein expressions van-ished, but expressions of EGFR, c-erb-B-2, PTEN, PCNA, c-myc, MDR-1, Bcl-2 proteins and RRM1, ERCC1 mRNA changed trivially. The resistance index of H460/Gem cells to gemcitabine was 1.644, and the cell line also exhibited cross-resistance to fluorouraci, cisplatin and oxaliplatin, but kept sensitivity to paclitaxol, vinorelbine, taxotere, and etoposide. The doubling time of H460/Gem cells was longer and figures in G0-G1 phase was decreased than those of NCI-H460 cells. The farther studies indicated that, compared with NCI-H460 cells, the expressions of MDR-1, nm23 and Bcl-2 proteins in H460/Gem cells had been enhanced, c-erb-B-2 protein expression emerged, P53, MMP-9 and VEGR protein expression had been weakened, but the changes of PTEN, PCNA, c-myc, TIMP-1, EGFR, CD44v6 protein, RRM1 mRNA and ERCC1 mRNA expressions were trivial. Furthermore, compared with its parental cells, H460/Gem cells were mixed with giant cells of different sizes that were larger and more irregular. Conclusion: The human gemcitabine-resistant non-small cell lung cancer cell line H460/Gem had achieved multi-drug resistance and great changes of biological characters compared with its parental cells. And these changes possibly participated in the formation of multidrug resistance.

层粘连蛋白5高表达可能是肺癌患者吉非替尼疗效差的预测因子(英文)

Objective: To investigate whether laminin 5 (LN5) might be a predictor in lung cancer patient treated with gefitinib and estimate the underlying mechanisms. Methods: LN5 and epidermal growth factor receptor (EGFR) mRNA expression level were detected in the tumor tissues of lung cancer patients who underwent surgery resection prior to gefitinib treatment. EGFR exon 19 and 21 mutation status was also detected in these specimens. The association between LN5, EGFR mRNA expression level, EGFR mutation and gefitinib treatment response were evaluated. In vitro study were carried by adding exog- enous LN5 and gefitinib to A549 lung cancer cell line, and Western-blotting was performed to investigate the phosphorylation level of EGFR,Ak, and Erk. Results: The disease control rate according to LN5 mRNA level was 52.9% for the below cut- point group, and 17.6% for the above cut-point (P = 0.009). The in vitro study showed that exogenous LN5 can neutralize the inhibition of phosphor-Akt by gefitinib. Conclusion: Patients with lower LN5 mRNA level would likely benefit from gefitinib. In vitro study indicated that the inhibition of Akt induced by gefitinib might be reversed by LN5. These results provide important insights into the molecular mechanisms underlying sensitivity to gefitinib in lung cancer patients.

Research trends of cancer metabolism:analysis from a Chinese perspective

1 INTRODUCTION Association between aberrant metabolism and tumor progression has been discovered and studied for a long period of time,and reprogramming of metabolism has become one of the key characteristics of cancer cells[1,2].Numerous studies showed that metabolic disorders are closely related to cancer risk and cancer-related deaths[3].According to the reports by the International Agency for Research on Cancer(IARC)and World Cancer Research Fund(WCRF),besides smoking,obesity and alcohol have become the most important risk factors of cancer worldwide[4].

Sintilimab versus docetaxel as second-line treatment in advanced or metastatic squamous non-small-cell lung cancer:an open-label,randomized controlled phase 3 trial(ORIENT-3)

Background:Treatment options for Chinese patients with locally advanced or metastatic squamous-cell non-small-cell lung cancer(sqNSCLC)after failure of first-line chemotherapy are limited.This study(ORIENT-3)aimed to evaluate the efficacy and safety of sintilimab versus docetaxel as second-line treatment in patients with locally advanced or metastatic sqNSCLC.Methods:ORIENT-3 was an open-label,multicenter,randomized controlled phase 3 trial that recruited patients with stage IIIB/IIIC/IV sqNSCLC after failure with first-line platinum-based chemotherapy.Patients were randomized in a 1:1 ratio to receive either 200 mg of sintilimab or 75 mg/m^(2) of docetaxel intravenously every 3 weeks,stratified by the Eastern Cooperative Oncology Group performance status.The primary endpoint was overall survival(OS)in the full analysis set(FAS).Secondary endpoints included progression-free survival(PFS),objective response rate(ORR),disease control rate(DCR),duration of response(DoR)and safety.Results:Between August 25,2017,and November 7,2018,290 patients were randomized.For FAS,10 patients fromthe docetaxel armwere excluded.Themedian OS was 11.79(n=145;95%confidence interval[CI],10.28-15.57)months with sintilimab versus 8.25(n=135;95%CI,6.47-9.82)months with docetaxel(hazard ratio[HR]:0.74;95%CI,0.56-0.96;P=0.025).Sintilimab treatment significantly prolonged PFS(median 4.30 vs.2.79 months;HR:0.52;95%CI,0.39-0.68;P<0.001)and showed higher ORR(25.50%vs.2.20%,P<0.001)and DCR(65.50%vs.37.80%,P<0.001)than the docetaxel arm.The median DoRwas 12.45(95%CI,4.86-25.33)months in the sintilimab arm and 4.14(95%CI,1.41-7.23)months in the docetaxel arm(P=0.045).Treatment-related adverse events of grade≥3were reported in 26(18.1%)patients in the sintilimab arm and 47(36.2%)patients in the docetaxel arm.Exploratory biomarker analysis showed potential predictive values of expression levels of two transcription factors,including OVOL2(HR:0.35;P<0.001)and CTCF(HR:3.50;P<0.001),for sintilimab treatment.Conclusions:Compared with docetaxel,sintilimab significantly improved the OS,PFS,and ORR of Chinese patients with previously treated locally advanced or metastatic sqNSCLC.

Tobacco carcinogen induces tryptophan metabolism and immune suppression via induction of indoleamine 2,3-dioxygenase 1

Indoleamine 2,3-dioxygenase 1(IDO1),the enzyme that catabolizes tryptophan(Trp)metabolism to promote regulatory T cells(Tregs)and suppress CD8+T cells,is regulated by several intrinsic signaling pathways.Here,we found that tobacco smoke,a major public health concern that kills 8 million people each year worldwide,induced IDO1 in normal and malignant lung epithelial cells in vitro and in vivo.The carcinogen nicotine-derived nitrosaminoketone(NNK)was the tobacco compound that upregulated IDO1 via activation of the transcription factor c-Jun,which has a binding site for the IDO1 promoter.The NNK receptorα7 nicotinic acetylcholine receptor(α7nAChR)was required for NNK-induced c-Jun activation and IDO1 upregulation.In A/J mice,NNK reduced CD8+T cells and increased Tregs.Clinically,smoker patients with non-small-cell lung cancer(NSCLC)exhibited high IDO1 levels and low Trp/kynurenine(Kyn)ratios.In NSCLC patients,smokers with lower IDO1 responded better to anti-PD1 antibody treatment than those with higher IDO1.These data indicate that tobacco smoke induces IDO1 to catabolize Trp metabolism and immune suppression to promote carcinogenesis,and lower IDO1 might be a potential biomarker for anti-PD1 antibodies in smoker patients,whereas IDO1-high smoker patients might benefit from IDO1 inhibitors in combination with anti-PD1 antibodies.