Professor Liu Lian: "Three -pronged approach" may bring new breakthroughs to the clinical treatment of lung squamous carcinoma!

*For medical professionals for reading reference

Immune+chemotherapy+antiovascular generation drugs bring new treatment options

Lung cancer is the largest cancer in my country. The incidence and mortality rate ranks first in my country's malignant tumor [1,2], of which 85%are non -small cell lung cancer (NSCLC), and NSCLC can be further divided into lung adenocarcinoma. Subsidal types such as lung squamous carcinoma, large cell lung cancer [3]. Patients with pulmonary adenocarcinoma have been greatly improved due to the high rate of driving genetic mutation and the continuous development of targeted therapy; but the survival benefits of patients with squamous carcinoma are often relatively low [4].

At present, a number of studies have proved that immune combined therapy can bring greater survival benefits to patients with lung cancer. At the same time, Professor Liu Lian, a Department of Internal Medicine of Qilu Hospital of Shandong University, is undergoing an Evolipumab combined with chemotherapy and chemotherapy and chemotherapy Reorganized human vascular endothelial inhibitoryin to treat advanced lung squamous carcinoma (NCT05243355). On this opportunity, the "medical community" specially invited Professor Liu Lian to analyze and discuss the current status of the joint treatment of lung squamous carcinoma and this study.

1

Clinical diagnosis and treatment of lung squamous carcinoma

There are still many needs that need to be met urgently

Professor Liu Lian pointed out that lung squamous carcinoma accounts for about 20%-30%of NSCLC. Patients are often older, late, and complications during diagnosis. Most of the tumors are in the center. About 30%shorter than other subtype patients [5].

In terms of targeted therapy, if patients with epidermal growth factor receptor (EGFR), intermediary lymphoma kinase (ALK) such as epidermal growth factor receptor (EGFR), intercoufened lymphoma kinase (ALK) can often obtain better results after receiving the corresponding targeted drug treatment. However, the rate of mutation in common driving genes in lung & lung carcinoma is very low, so only a few patients have the opportunity to receive targeted therapy [6].

Chemotherapy is still the cornerstone of the treatment of advanced lung squamous carcinoma [6], but the 5 -year survival rate is very low [7], and it is urgent to find more effective treatment plans. Although previous studies have shown that combined with anti -vascular production treatment can play a better anti -tumor role [8], unfortunately, an early study found that 9%of patients in the Bevarzumab group occurred. Severe hemoptysis may be a risk factor for severe hemoptysis. Therefore, the safety of antibronoma -generating drugs to treat lung squamous carcinoma is still controversial.

In recent years, immunotherapy has opened a new door for lung -based carcinoma treatment [4]. A number of studies such as Keynote-407 Research, Rationale 307 Research, and Camel-SQ Studies have shown that compared with simple chemotherapy, immune combined chemotherapy can significantly improve the benefits of patients [11-14]. Even so, clinically need to further explore new solutions for lung squamous carcinoma treatment.

2

Envolimab

Joint reorganization of human vascular endothelial inhibitin and chemotherapy scheme

Combining the trend, born of the response

The research conducted by Professor Liu Lian this time is a forward -looking, single -arm, multi -centered phase II study, which aims to evaluate the advanced stage of the first -line treatment of Platinum dual -based chemotherapy and reorganized human vascular endothelial inhibitory programs (IIIB-IV) The effectiveness and security of the scale NSCLC (NCT05243355). The main endpoint of the study is the 1 -year PFS rate, and the secondary endpoint is an objective relief rate (ORR), the duration of duration (DOR), the non -progressive survival period (PFS), and the overall survival period (OS).

Earlier studies have proven that immunotherapy combined chemotherapy is expected to become a standard treatment for patients with advanced lung squamous carcinoma. According to the current status of the clinical treatment of tumor therapy and advanced development of tumor treatment and advanced development of tumor treatment, Professor Liu Lian said that the design ideas of the study can be described as "adapting to the trend and emerging."

Professor Liu Lian emphasized that Evol Mippling, as a PD-L1 monoclonal resistance, has the advantages of good effect and safety, and at the same time, it has the characteristics of small molecular weight, high affinity, good stability, and convenient subcutaneous injection administration. Therefore Select it as an immunotherapy drug for this study. In addition, although large -molecular drugs such as Bevarzumab are used to treat controversy in the treatment of lung squamous carcinoma, this does not affect the attempts of other types of antemiciane -generated treatment drugs in such patients.

A published by domestic scholars, exploring the reorganized human vascular endothelial inhibitoryin combined with chemotherapy and the treatment of advanced lung squamous carcinoma and safety META analysis [15] shows that compared with simple chemotherapy, reorganized human vascular endothelial inhibitoryin combined with advanced lung treatment The efficiency (RR) and the disease control rate (DCR) of squamous carcinoma are better, and there is no risk of adverse events. Therefore, in the research here, it is hoped that the "three -tube approach" plan can be achieved through immunochemical combined chemotherapy and antiovascular generation treatment.

Professor Liu Lian introduced the progress of the current research: "The research plan was incorporated into 46 patients, and 9 patients have been incorporated, of which 5 patients have completed at least 1 efficacy assessment, all reaching partial relief (PR). This is a one The result of Xiang's great potential has given us great research confidence. In the future, we will further accelerate the progress of the research, and hope that the research results can be reported as soon as possible to provide evidence -based evidence for the clinical treatment of lung squamous carcinoma. "

3

Anti -vascular treatment is not just a "or may" existence

Immunohistochemical point inhibitors are mainly combined with the PD-L1 expressed by tumor cells by inhibiting the PD-1 of T cells to achieve the effect of antitumor [16]; while antemlodia production drugs can inhibit blood vessel regeneration, normalize blood vessels, improve the reconstruction of blood vessels, improve it The effect of chemotherapy and radiotherapy is more likely to improve the immune response of anti -tumor [17]. Therefore, the combined application of antibody generic drugs and PD-1/PD-L1 inhibitors can play a synergistic antitumor effect of "1+1> 2" [17,18].

Professor Liu Lian believes that anti -vascular production therapy is very important for clinical treatment of lung squamous carcinoma. A secondary analysis conducted by the team [19] The results show that it is treated with the treatment of immune combined chemotherapy, anti -vascular production combined chemotherapy and other schemes. Compared with patients, patients receiving immune combined chemotherapy and anti -vascular generation treatment plan have a longer survival period, which can reach 19.5 months. Although there is no significant difference in the 1 -year survival rate of patients, patients who have received the plan for the plan are significantly better. The Asian group analysis shows that patients with squamous carcinoma receiving immunotherapy are 15.1 months, and non -squamous carcinoma patients can reach 19.3 months.

In this regard, Professor Liu Lian said that although other treatment plans, immune combined chemotherapy and antiovascular generation treatment plan did not significantly improve the 1 -year survival rate of patients, but with the extension of time, its advantages became more obvious. It is speculated that in the future, when observing patients' 3 -year survival rate and 5 -year survival rate, immune combined chemotherapy and antiovascular generation treatment plans may bring more obvious survival benefits to patients.

Expert Introduction

Professor Liu Lian

Doctor of Oncology, Shandong University, Doctor of Immunology, Professor of Shandong University

Director of the Department of Internal Medicine of Qilu Hospital of Shandong University, chief physician, doctoral supervisor

Chairman of the Shandong Immunization Society of Tumor Molecular Make and targeted therapy

Chairman of the Shandong Clinical Oncology Society of Immunotherapy Society

CSCO immunotherapy/thyroid cancer/tumor nutritional therapy expert committee

Member of the Internal Science Group of the China Anti -Cancer Association Stomach Cancer Professional Committee (CGCA)

Standing Committee Member of the China Pharmaceutical Education Society's difficult tumor committee committee

Director of Shandong Immunization Society

Deputy Chairman of the Shandong Physician Association Cancer Medicine Branch

Deputy Chairman of the Youth Committee of the Shandong Medical Association Puchao Medical Branch

Member of the Chemotherapy Branch and Standing Committee of the Youth Committee of the Shandong Anti -Cancer Association

Deputy Chairman of Shandong Pharmaceutical Biotechnology Society Cell Therapy Technology and Standard Committee Special Committee

Deputy Chairman of the Science Education Committee of Shandong Immunization Society

Deputy Chairman of the Shandong Pharmaceutical Education Society

Deputy Chairman of the Shandong Research Hospital Society of Tumor Transfer Specialty Committee

Deputy Chairman of the Shandong Pain Medical Association Tumor Integration Medical Committee

Shandong Physician Association Cancer Precision Medical Branch, Standing Committee Member of the Tumor MDT Special Committee

Data Inspector of the New Medicine Review Center of the State Food and Drug Administration

National Phone Graduation Thesis Evaluation Expert of the Ministry of Education's Degree Center

Shandong Science and Technology Expert Library Fund Evaluation Expert

references

[1] SUNG H, Ferlay J, Siegel Rl, et al. Global Cancer Statistics 2020: Globocan Estimates of Incidence and Mortality WORDWIDE For 36 Cancers in 185 (J]. -249.

[2] Chen W, Zheng R, Baade PD, et al. Cancer Statistics in China, 2015 [J]. Ca Cancer J clin, 2016, 66 (2): 115-132.

[3] Duma N, Santan-Davila R, Molina Jr. Non-Small Cell LUNG CANCER: EPIDEMIOLOGY, Screening, Diagnosis, and Treatment [J]. Mayo Clin Proc. 2019, 94 (8): 1623-1640.

[4] Zhao Lili, Feng Qingqing, Zhao Wenfei, Zhao Wenwen, Zhang Xue, Jing Wenjun, Wei Hongmei. Endu joint immune examination point inhibitor to treat the efficacy and safety observation of advanced lung squamous carcinoma [J]. 36 (06): 556-561.

[5] Gao Xue, Li Zhi, Shao Xinyi, etc. The prognosis of the prognosis of lung squamous carcinoma is available [J]. Chinese Oncology Magazine, 2021,43 (05): 569-573.

[6] Gao Ming, Zhou Qing. Progress of the treatment of lung squamous squamous carcinoma in advanced stage [J]. Chinese lung cancer magazine, 2020,23 (10): 866-874.

[7] Yang X, Peng P, zhang L. Multiline Treatment of Advanced Squamous Cell Carcinoma of the LUNG: A CASE Review and Review of the LITERATURE [J]. WORLD J CLIN CASES. [8] Herbst RS, onn A, Sandler A. Angiogenesis and LUNG CANCER: Prognostic and therapeutic Implication [J]. J clin oncol, 2005, 23 (14): 3243-3256.

[9]Johnson DH, Fehrenbacher L, Novotny WF, et al. Randomized phase II trial comparing bevacizumab plus carboplatin and paclitaxel with carbonplatin and paclitaxel alone in previously untreated locally advanced or metastatic non-small-cell lung cancer [J]. J Clin Oncol, 2004, 22 (11): 2184-2191.

[10] Cheng Gang, tension. Bevarzab's anti-treatment principles and treatment principles for treating non-small cell lung cancer [J]. Chinese lung cancer magazine, 2010,13 (06): 563-567.

[11]Paz-Ares L, Vicente D, Tafreshi A, et al. A Randomized, Placebo-Controlled Trial of Pembrolizumab Plus Chemotherapy in Patients With Metastatic Squamous NSCLC: Protocol-Specified Final Analysis of KEYNOTE-407[J]. J Thorac Oncol. 2020. 15 (10): 1657-1669.

[12]Wang J, Lu S, Yu X, et al. Tislelizumab Plus Chemotherapy vs Chemotherapy Alone as First-line Treatment for Advanced Squamous Non-Small-Cell Lung Cancer: A Phase 3 Randomized Clinical Trial[J]. JAMA Oncol. 2021, 7 (5): 709-717.

[13]C. Zhou, Y. Cheng, J. Chen, et al. First-line camrelizumab plus carboplatin and paclitaxel for advanced squamous non-small cell lung cancer: Updated overall survival results from the phase III CameL-sq trial. 2022 ELCC, abstract 3Mo.

[14]Zhou C, Wu L, Fan Y, et al. Sintilimab Plus Platinum and Gemcitabine as First-Line Treatment for Advanced or Metastatic Squamous NSCLC: Results From a Randomized, Double-Blind, Phase 3 Trial (ORIENT-12) [ J]. J Thorac oncol. 2021, 16 (9): 1501-1511.

[15] FENG L, Wang Z, Jing L, et al. Recombinant Human Endostatin Combined with Chemotherapy for Advanced Squamous Cell LUNG CANCER: A meta -analysis [j]. World j Surg Oncol. 2021);64. [16] Zhu Xiaodong, Chen Siyuan. Inhibitors of immune examination point inhibitors: from mechanism to clinical [J]. China Cancer Magazine, 2020, 30 (12): 969-976.

[17] Fukumura D, Kloepper J, Amoozgar Z, et al. Enhancing Cancer Immunotherapy USINGIOGENICS: Opportunities and Challenges [J]. Nat Rev Clin Oncol.

[18] Pinter M, Jain RK, DUDA DG. The Current Landscape of Immune Checkpoint Blockde in Hepatocellular CarCinoma: A Review [J]. 2021,7 (1): 113-123.

on integrated analysis [j]. Front Immunol. 2022, 5 (13): 764643.

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