*For medical professionals only
The 7th Zhongshan Lung Cancer Forum is about to open, come and participate!
From October 8 to 10, 2021, the 7th Zhongshan Lung Cancer Forum and Tracheoscopic Interventional Diagnosis and Treatment New Technology Workshop will be held in Shanghai, focusing on the comprehensive diagnosis and treatment of lung cancer under the multidisciplinary model - what is the progress of early screening and diagnosis of lung cancer? How can tracheoscopic interventional techniques play a greater role in lung lesions? Professor Zhang Xin of Zhongshan Hospital Affiliated to Fudan University, specially invited by the medical community, shared the accurate diagnosis and treatment of lung cancer and the highlights and characteristics of the conference.
Targeted therapy gene testing is required
"Case-by-case analysis"
Under the background of precision medicine and classification and treatment, genetic testing has high clinical significance and value for patients with advanced lung cancer who are initially treated or relapsed, guiding treatment plans, predicting and monitoring efficacy, and genetic testing has played a certain role.
Professor Zhang Xin said: "Targeted therapy for lung cancer is a typical embodiment of precision therapy, in addition to the EGFR and ALK targets that are well known to clinicians and patients, there are rare targets with low mutations such as ROS1, MET, RET, NTRK and so on. The survival benefits of EGFR and ALK corresponding targeted drugs to lung cancer patients have been 'self-evident', and with the continuous progress of research and drug research and development, drugs for rare mutations such as MET 14 exon jump mutation, NTRK fusion, and RET have also emerged. ”
The 2020 National Comprehensive Cancer Network (NCCN) First Edition of the Non-Small Cell Lung Cancer Guidelines recommends that lung cancer patients should be tested on targets such as EGFR, ALK, ROS1, BRAF, NTRK, PD-L1 and emerging targets MET, RET, HER2, and tumor mutation burden (TMB).
The scope of genetic testing and the choice of means should be based on the patient's underlying condition and individualized decision-making, such as lung cancer patients with a small probability of complex mutations, usually choose to detect common genes such as EGFR, and because of the cost and cycle of testing, the detection method does not have to choose NGS (second-generation sequencing), the choice of PCR detection can be.
But if it is a lung cancer patient who develops secondary resistance after treatment with a first- and second-generation EGFR inhibitor, the need for NGS testing is highlighted – because NGS testing is more extensive and can detect multiple genes at once. Through NGS test results, clinicians are able to identify the mechanism of drug resistance in patients, so that the drug regimen can be adjusted so that patients can receive the best and most accurate treatment.
The era of "more precise" immunotherapy is still exploring
In addition to targeted therapy, the application of immunotherapy in major cancers such as lung cancer is also becoming more and more extensive, "For screening the applicable population of immunotherapy, I often say that there are two 'half' relatively mature biomarkers, one is the expression state of PD-(L)1." In the case of pambolizumab, PD-L1 expression testing [Tumor Ratio Score (TPS) ≥1%] is a concomitant diagnosis and a necessary condition in the U.S. Food and Drug Administration (FDA)-approved indications for single-drug first-line therapy in the NSCLC field.
TMB can be counted as 'half', and patients with high TMB may be more likely to benefit from immunotherapy; the last is that there are no mutations in the common sensitive driver genes, but this does not mean that patients are ineffective in receiving immunotherapy, but when receiving monotherapy, targeted drugs will be more effective than immunotherapy. Professor Zhang Xin explained.
In addition, Professor Zhang Xin pointed out that many combinations of immunotherapy drugs and chemotherapy have been approved for NSCLC first-line treatment indications, but when chemotherapy and immunization are combined, what is the predictive value of the expression status of previously confirmed biomarkers such as PD-L1? New research and new data are urgently needed to clarify.
Tracheoscopic intervention technology continues to develop,
"Diagnosis" and "treatment" fly in tandem
Professor Zhang Xin introduced: "The 7th Zhongshan Lung Cancer Forum is jointly organized by multiple disciplines including respiratory, thoracic surgery, pathology, radiology and other disciplines, which is also one of the major features of this forum. It is worth mentioning that this Zhongshan Lung Cancer Forum is also a new technology workshop for tracheoscopic interventional diagnosis and treatment. ”
The clinical application of tracheoscopic interventional techniques can be divided into two aspects - diagnosis and treatment. The narrowing of the airways and central airways caused by various causes is limited, and interventional techniques can be re-passed by ablation or stent implantation, thus breaking the "shackles" of traditional treatment. In addition to simple airway stenosis, refractory asthma caused by hyperplasia of smooth muscle can also be intervened by tracheoscopy, so that the contraction response of the small and medium airways is weakened, so as to achieve the purpose of treatment.
The mainstay of treatment for early-stage lung cancer is surgery, however, many patients are unable to operate for a variety of reasons and choose alternative therapy, and transbronchoscopic interventional techniques are viable because they are less invasive and have more treatment options. Professor Zhang Xin introduced that lung nodules, radiofrequency ablation of multiple foci of advanced/metastatic lung cancer, treatment of peripheral lung cancer through airway intervention, photodynamic therapy, cryoablation technology, etc. are all more and more widely used models in clinical practice.
In the early years, the positive rate of biopsy of peripheral lesions in the lungs was low, and patients also needed to undergo additional examinations for serious complications such as major bleeding and pneumothorax such as percutaneous lung puncture, but with the continuous development of the operation technology and related instruments of tracheoscopic intervention, tracheoscopic interventional technology has been widely used in the pathological diagnosis of lung cancer and the differential diagnosis of lung lesions. Ultrasound bronchoscopy (EBUS) clearly shows the relationship between extra airway, intrastinal vascular lymph nodes, and mass lesions by ultrasound localization of the specific location of extrabronchial lesions. Transbronchiallung biopsy (TBLB) has been carried out for many years, the development of various navigation and ultrasound confirmation technologies, the positive rate of peripheral lung lesion diagnosis continues to increase, but due to equipment limitations including X-ray fluoroscopy, the popularity of high-level TBLB in China still needs to be improved.
"In addition, there are some difficult diseases including infections that can be solved by tracheoscopic interventional technology, and it can be said that the diagnosis of tracheoscopic interventional technology has reached the full coverage of lung lesions." At present, the positive rate of peripheral pulmonary nodular tracheoscopy biopsy in our center is between 75% and 80%, and we are constantly optimizing the process, such as carrying out rapid pathological evaluation on the spot, thereby improving the positive rate of biopsy, and when the pathology is considered to be lung adenocarcinoma, the driver gene can be detected as soon as possible, thereby saving time. Professor Zhang Xin said. The Zhongshan Lung Cancer Forum and Tracheoscopic Interventional Diagnosis and Treatment New Technology Workshop will also showcase surgical demonstrations, theoretical lectures, hand-to-hand teaching and other aspects.
At the forefront, how is the intestinal flora related to immunotherapy for lung cancer?
Professor Zhang Xin will bring a wonderful report entitled "Intestinal Flora and Immunotherapy for Lung Cancer" on the second day of the Zhongshan Lung Cancer Forum, that is, October 9. Differences in the efficacy of immunotherapy can be attributed to different types of tumors and individual differences in patients, and in recent years, the participation of intestinal flora in regulating immunotherapy and potential molecular mechanisms has also become a hot topic.
Nature Medicine has published a study in which specific gut flora has been found in patients with high adverse effects of dual immunotherapy, which means that in the future, it may be possible to treat immunotherapy toxicity by manipulating the gut microbiota while maintaining a strong response to combination therapy. Coincidentally, Science has published results on fecal microbiota transplantation (FMT) to overcome the resistance of melanoma patients to anti-PD-1 treatment, and relevant studies published in leading journals have confirmed the value of intestinal microbiota in predicting and even intervening in immunotherapy efficacy.
"In addition to research in tumor treatment, the mechanism of intestinal microbiota in Alzheimer's disease, pediatric ADHD and other aspects has gradually been discovered and confirmed." Professor Zhang Xin said, "In the past, every year at the Zhongshan Lung Cancer Forum, I would sort out cutting-edge and clinically valuable content to share with you, which was also the original intention and purpose of the conference. In this conference, I will also bring together the efficacy of intestinal microbiota and lung cancer immunotherapy, adverse reactions, application prospects, clinical decision-making strategies, etc. to share and introduce. It is expected that the clinical research related to intestinal flora and immunotherapy jointly initiated by our department and gastroenterology has also passed the hospital ethics review and will soon begin to start. ”
From October 8th to October 10th, the 7th Zhongshan Lung Cancer Forum will be held in Shanghai to further discuss the progress of multidisciplinary diagnosis and treatment of lung cancer and individualized treatment, Professor Zhang Xin said: "Although only half an hour of conference lectures may take 10-20 hours to sort out the relevant content, as long as it is helpful to the academics, I am still willing to share with you, the 7th Zhongshan Lung Cancer Forum, look forward to your participation." ”
Forum Schedule
Expert Profiles
Professor Zhang Xin
Chief Physician, M.D
Deputy Director of the Department of Respiratory Medicine, Zhongshan Hospital, Fudan University
Director of the Department of Lung Tumor and Respiratory Interventions
Member of the Interventional Science Group of the Respiratory Branch of the Chinese Medical Association
Member of the Standing Committee of the Lung Tumor Committee of the China Medical Education Association
Standing Director of the Asia-Pacific Society of Medical Bioimmunology
Vice Chairman of respiratory tumor intervention committee of Shanghai Anti-Cancer Association
Vice Chairman of the Lung Cancer Molecular Targeting and Immunotherapy Committee of Shanghai Anti-Cancer Association
Member of the editorial board of Shanghai Pharmaceutical Magazine
He has been engaged in respiratory and lung cancer diagnosis and treatment for 29 years, and has successively engaged in research work such as lung cancer gene diagnosis and gene therapy, combined application of targeted and chemotherapy, lung cancer liquid biopsy, magnetic navigation guided lung biopsy, etc., and participated in a number of international clinical trials as a sub-center PI. He has edited 6 monographs such as "Practical Internal Medicine" and published more than 30 papers.
*This article is only used to provide scientific information to medical personnel and does not represent the views of this platform
