Interpretation of problems in tumor immunotherapy
The "13th Five-Year Plan for the Development of Strategic Emerging Industries" will develop cancer immunotherapy technology as a strategic industry. However, there are still many problems in the clinical transformation and practice of tumor immunotherapy. For this reason, the author focused on the safety of clinical treatment and tumor immunotherapy combined with immunological checkpoint inhibitors. The author interviewed the Cancer Research Institute of Tongji University Medical College. Chang, Professor Zhou Caicun, Director of Oncology, Shanghai Pulmonary Hospital.
Author: Thank you very much for participating in the 2017 Cancer Immunity + Seminar sponsored by the author. We know that PD-1 antibodies have made outstanding progress in the treatment of non-small cell lung cancer and have been recommended as first-line treatment by the 2017 NCCN. Please talk about the clinical treatment of lung cancer using immunological checkpoint inhibitors in China.
Answer: At present, immunological checkpoint inhibitors are still in clinical research stage in China, and several international companies such as BMS, Roche, AstraKen and Merck and other PD-1 or PD-L1 inhibitors are completing or undergoing second-line treatment. Clinical research; some companies are exploring the first line of treatment.
Most domestic companies' products are in Phase I clinical trials, with only 1-2 products entering Phase II or Phase III clinical studies. Therefore, most doctors have insufficient clinical experience in immunological checkpoint suppression points.
Author: Lung cancer patients treated with PD-1 antibody, even if the gene detection of PD-L1 expression exceeds 50%, but the clinical response rate is only about 20%, which means that only some patients benefit. What do you think about this issue?
Answer: The molecular markers for predicting the efficacy of lung cancer checkpoint inhibitors have not yet been determined. Some studies have explored the relationship between PD-L1 expression levels, mutation load, TILs and other immunological checkpoint inhibitors, and found that these factors are related to efficacy. Patients with high PD-L1 expression had high remission rates, long OS, etc., but PD-L1 did not express patients, and some of them obtained disease remission and improved overall survival. The Keynote 026 study compared the efficacy and safety of the PD-1 inhibitor Keytruda with the standard platinum-containing dual-drug regimen in the treatment of patients with advanced NSLCLC with PD-L1 TPS ≥ 50%. It was found that Keytruda was significantly better than standard chemotherapy. The high reached 45%, the PFS was 10.3 months, and the safety was good. The study also found that the overall survival of the Keytruda group also improved. To this end, for patients with advanced NSCLC with high PD-L1 expression, Keytruda should be the standard first-line treatment if there is no EGFR mutation or ALK fusion gene.
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