Advanced lung cancer PFS up to 3 years, the treatment plan is...

time:2022-10-07 05:26:35source:monlittlebaby.com author:Make one's mouth water
Advanced lung cancer PFS up to 3 years, the treatment plan is...

*Only for medical professionals to read and reference In the past 20 years, targeted therapy has brought earth-shaking changes to the diagnosis and treatment of lung cancer. Survival for advanced lung cancer increased from a few months to 39 months. For patients with advanced lung cancer who are negative for driver genes, immunotherapy can provide a survival benefit. Professor Yu Hui from Fudan University Affiliated Cancer Hospital shared a case of driver gene-negative advanced lung cancer. After treatment, the progression-free survival period reached 3 years. The Medical Oncology Channel specially organizes the treatment process for readers. 1. Basic information of the case The patient, female, 54 years old, was admitted to the hospital in November 2018 due to aggravation of back pain and discomfort in January. History of present illness: PET-CT in another hospital in 2018.12 showed that the posterior segment of the upper lobe of the left lung occupied space, and the FDG metabolism was increased. Considering peripheral lung cancer with multiple lymph node metastases in the left upper lobe and mediastinum, and multiple bone metastases. 2018.12.21 Chest CT: mass in the upper lobe of the left lung, mediastinal lymph node metastasis, and bilateral multiple ribs. Slight inflammation in the lower lobe of the right lung. Past history: The patient was in good health in the past, and there was no history of water-infestation in the epidemic-free area. Personal history: no history of smoking and drinking, no family history of hereditary tumors. Physical examination: ECOG 1 score, NRS score 3, clear, superficial lymph nodes not palpable, clear breath sounds in both lungs, no dry or wet rales, heart rate 80 beats/min, regular rhythm, no pathological murmurs , The abdomen was flat and soft, the liver and spleen were not reached under the ribs, and the obvious mass was not palpable. Auxiliary examination: 1. (left lung puncture) non-small cell carcinoma, consistent with poorly differentiated lung adenocarcinoma. Immunohistochemistry TTF-1 (+), P40 (-), ALK-Ventana (-), PD-L1 22C3 TPS about 90%. 2. Genetic testing: EGFR, KRAS, ALK, ROS1, MET were all negative. 3. Brain MR and abdominal CT showed no abnormality. Clinical diagnosis: left lung adenocarcinoma with bone metastases, negative for genetic testing, PD-L1 22C3 TPS 90%. 2. After the treatment, the patients voluntarily participated in the CheckMate227 clinical trial. On January 23, 2019, the patient received ipilimumab 49mg q6w + nivolumab 147mg q2w. Treatment ended on November 24, 2020. After treatment, the patient's response was evaluated as PR. Imaging changes during treatment During treatment, the patient developed a 1° oral ulcer, a second-degree increase in lipase, and a first-degree increase in thyroid function, which may be related to drug side effects, not immune reactions. The follow-up CT showed that in November 2019, the original tumor foci changed from hollow to solid. Does this mean that the disease progresses after using the double-immunity regimen? 3. Case Discussion In recent years, immunotherapy has greatly changed the pattern of lung cancer diagnosis and treatment. However, immunotherapy faces the problems of suboptimal response in some patients and a high ratio of primary/adaptive drug resistance. Therefore, the exploration of immune combination regimens with higher efficacy has become a hot spot in the field of lung cancer. Nivolumab and ipilimumab, known as "immune twins", have performed well in various cancer types. The CheckMate 227 study showed that, regardless of PD-L1 expression status, ipilimumab + nivolumab resulted in better objective response rate (ORR) and duration of response (DOR) than chemotherapy. In lung cancer patients with different PD-L1 expression levels, nivolumab + ipilimumab achieved ORR and DOR. In terms of safety, the incidence of adverse events during the dual-immunity regimen was lower, and no new immune-related adverse reactions occurred. Are you impatient in front of the screen? ↓Come and watch the class↓【The "miracle" case collection of tumor growth and survival】
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