Text/Yangcheng Evening News all-media reporter Zhang Hua
Photo/Visual China
Lung cancer has the highest incidence and mortality rate of malignancy worldwide. In the past decade, genotyping-based molecularly targeted therapies have revolutionized the treatment of patients with advanced non-small cell lung cancer.
On February 18, at the expert media salon meeting of "ROS1 Target Grasp Every Point Possible", Professor Yang Gengji, director of the Cancer Center of Guangdong Provincial People's Hospital, pointed out that about 800,000 new lung cancer patients in the mainland every year, including patients with gene variants such as EGFR, ALK, ROS1, and HER2, can be treated with targeted drugs. Through the whole process of management, every lung cancer patient can get precise treatment, and finally achieve a survival period of more than 5 years, or even more than 10 years, so as to truly turn advanced lung cancer into a chronic disease.
About 1 in every 7 lung cancer patients is positive for a rare target
Lung cancer is the leading cause of cancer-related deaths worldwide, with a global 5-year survival rate of just 17.8%, well below the survival rate of other major cancers. According to statistics, among lung cancer patients, non-small cell lung cancer is common, accounting for about 80%-85% of the proportion. In the past decade, genotyping-based molecularly targeted therapies have revolutionized the treatment of patients with advanced non-small cell lung cancer.
Professor Yang Gengji, director of the Cancer Center of Guangdong Provincial People's Hospital, said that with the deepening of lung cancer research, more and more genetic mutation targets are clinically recognized, and EGFR mutations are the most frequent, accounting for more than 50%; ALK rearrangement is the second driver gene, accounting for 5%-7%; ROS1, HER2 and other gene variants account for 1%-2% each, which the medical community calls rare events. Although the incidence of mutations in a single tumor driver gene is less than 5%, rare targets have a large overall presence, accounting for about 15% of all lung cancers.
That is, about 1 in every 7 lung cancer patients is positive for a rare target. Counting down, there are more than 800,000 new lung cancer patients in the mainland every year, and the proportion of 1% is that more than 8,000 patients have ROS1 gene fusion.
Therefore, for lung cancer doctors, the task they face is to implement precision treatment and full management for each patient with a special stage of sub-disease, even if only 1% of patients with ROS1 gene fusion, in the hope of turning lung cancer patients with small probability events into a chronic disease that can survive for a long time.
Lung cancer genetic testing should be "willing to do its best" to provide adequate options
After years of exploration and accumulation of clinical experience, the diagnosis and treatment of lung cancer with rare targets has achieved a certain degree of development, and patients have gained more hope for survival. However, on the whole, the awareness of rare targets of lung cancer is still low compared with common targets, and it faces problems such as low clinical admission rate, irregular choice of treatment plan, and limited diagnosis and treatment options.
Professor Long Hao, chief expert of lung cancer at the Affiliated Cancer Hospital of Sun Yat-sen University and director of the Institute of Lung Cancer of Sun Yat-sen University, said in an interview with reporters that clinically, the patient's tumor lesion tissue or body fluids, blood, etc. can be genetically tested. Theoretically, all lung cancer patients should achieve full genetic testing, because this affects the doctor's treatment choice, it can be said that there is no precision treatment without testing. However, in fact, due to price, hospital management and other reasons, a considerable number of patients have not done genetic testing, which greatly reduces the treatment effect.
"The detection rate and targeted therapy rate of rare targets are lower than those of common targets. Taking ROS1 as an example, in patients with non-small cell lung cancer, the detection rate of ROS1 gene is only 38%, which is lower than the detection rate of EGFR and ALK. Professor Tang Kejing, deputy director of the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Sun Yat-sen University, introduced that such patients with such targets are often younger, have a history of non-smoking or mild smoking, and advanced adenocarcinoma.
Fortunately, in Dongguan City, due to the genetic testing of lung cancer patients, it has been included in medical insurance, which has greatly improved the acceptance of patients. Professor Jia Yun, director of the Cancer Prevention and Control Center of Dongguan Hospital (Dongguan People's Hospital) affiliated to Southern Medical University, introduced, "In our hospital, 9 gene testing packages for lung cancer, including EGFR, ALK, ROS1, etc. require 6615 yuan, our medical insurance can reimburse 80%, and patients only need more than 1,000 yuan at their own expense. ”
According to the reporter's understanding, the current genetic testing of lung cancer includes a variety of methods such as enhanced immunohistochemistry and second-generation sequencing. Experts said that genetic testing should run through the whole process of lung cancer management, so as to guide doctors to accurately use drugs.
Targeted drugs prolong the survival of lung cancer patients
The survival of lung cancer patients is significantly prolonged by using targeted drugs, such as cretinib for the treatment of advanced non-small cell lung cancer. In the latest update to the study data, the median overall survival reached 51.4 months, which was surprisingly effective.
Of course, targeted drug therapies also face the challenge of drug resistance, and this situation is inevitable. How should patients and doctors face drug resistance? Professor Yang Gengji said that when patients with ROS1 gene fusion use a generation of drug TKI drug resistance, we can use the third generation or even the fourth generation of TKI drugs, follow-up new drugs continue to emerge, if the sequence is combined, the patient is likely to break through the 5-year survival period.
If there is a bypass or histological transformation, we can use the corresponding chemotherapy or combination of targeted drugs, or chemotherapy combined with anti-angiogenesis, or even combined with immunotherapy, which can greatly prolong the survival of patients.
"There are still many ways." Professor Yang Gangji said that in real-world research, it can be seen that through precise targeted drug therapy, the median survival of patients with ROS1-positive advanced non-small cell lung cancer has reached more than 7 and a half years, which is better than the treatment effect of patients with EGFR and ALK gene mutations. So is advanced lung cancer still far from being a chronic disease? Not too far away! (For more news, please pay attention to Yangcheng Pie pai.ycwb.com)
Source | Yangcheng Evening News Yangcheng Pie
Editor-in-charge | Cui Wencan