Lung cancer, the number one cancer in China in terms of incidence and mortality rate, is still increasing at a rate of 4 to 45% per year. According to experts from Beijing Cancer Control Office, the incidence rate of lung cancer in Beijing has increased by 43% in 10 years, and the age of lung cancer tends to be younger. November 2015 is the 15th “Global Lung Cancer Awareness Month”, so I have taken this opportunity to take stock of the major research progress in the field of lung cancer in recent years.
Equipment when going out
In hazy days, the respiratory system is in frequent contact with the environment and has a large surface area, resulting in hundreds of atmospheric particles that can directly enter and adhere to the upper and lower respiratory tracts and lung lobes, most of which are inhaled by the human body; in addition, hazy weather leads to a weakening of ultraviolet light in the near-earth layer, which easily makes the activity of airborne germs increase, and fine particles can carry bacteria and viruses to the depths of the respiratory system, causing infection, so that haze increases The incidence of lung cancer is increased.
Lung cancer, the number one cancer in China in terms of incidence and mortality rate, is still increasing at a rate of 4 or 45% per year. The incidence rate of lung cancer in China in 2014 was 5 per 10,000 and the mortality rate was 4 per 10,000, which is the highest among all malignant tumors. November 2015 is the 15th “Global Lung Cancer Awareness Month”, and I take this opportunity to take stock of the major research advances in the field of lung cancer in recent years.
Causes of lung cancer
The main causes of lung cancer are smoking, environmental pollution, occupational exposure, chronic lung diseases and genetic susceptibility. Most lung cancers are caused by “gas”. Smoke, decoration pollution, air pollution and other “gas” are the main factors that cause cancer, and people with high risk of lung cancer should be screened early and early diagnosis and treatment are recommended. Recently, the State Key Laboratory of Membrane Biology, Institute of Animal Science, Chinese Academy of Sciences released the scientific article “The key role of inflammatory factor CXCL13 in lung cancer caused by environmental pollution”.
Lung cancer screening: 1.
1.Molecular genetic testing
Research in the medical journal The Lancet reports on how this test, which measures the activity of 14 genes in cancerous tissue, can improve the accuracy of prognosis and thus help guide the treatment of patients with the most common form of lung cancer, non-squamous non-small cell lung cancer. This new molecular assay can better identify patients at high risk of early death after surgery and therefore could be a more effective guide for considering the use of early chemotherapy.
2. Tumor Mutation Detection
On October 27, AgenaBioscience and DiatechPharmacogenetics jointly announced an action plan to launch a tumor mutation test with the CE-IVD mark of approval in the treatment of colon cancer, lung cancer and melanoma.
3. Low-dose CT screening for lung cancer
The results of the U.S. National Lung Cancer Screening Trial (NLST) showed that low-dose spiral CT (LDCT) screening can reduce lung cancer mortality by 20%. One of the advantages of low-dose CT is that it is very sensitive. Although low-dose CT lung cancer screening is effective in reducing lung cancer-related mortality, this screening method is limited by “high false positive rates, overdiagnosis, radiation exposure and cost.
In August, GE Healthcare announced that it had received FDA approval for its low-dose computed tomography (LDCT) lung cancer screening solution (LCS), the first FDA-approved low-dose CT solution for screening high-risk groups for lung cancer. This approval also marks the first time that the FDA has approved a CT device for disease screening.
4.FDGPET/CT, Dynamic PET-CT and Dual Energy CT System Screening
Studies have demonstrated the high sensitivity and specificity of FDGPET/CT in identifying benign and malignant isolated pulmonary nodules. However, this specificity is significantly reduced in areas with particularly high rates of lung infection or granulomatous lung disease (approximately 40%) and is considered an unreliable technique. Dynamic PET-CT or DualEnergyCT system (DualEnergyCT) may be a useful tool to better identify isolated lung nodules and further studies are needed to determine thresholds and standardize screening procedures.
5.Lung cancer biomarker screening
Biomarkers generally refer to some characteristic biochemical indicators of a common physiological or pathological or therapeutic process that can be objectively measured and evaluated, and through its measurement, the current biological process of the organism can be known. The examination of lung cancer biomarkers can enable the identification, early diagnosis, prevention and monitoring of the disease treatment process. The main biomarkers for non-small cell lung cancer (NSCLC) are tumor-associated antigens (CEA, SCC, CYFRA21-1, CA125, etc.), enzymes (EGFR, NSE, GST-π, AHH, telomerase, etc.), and molecular biomarkers (p53, KRAS, p16).
Of course, an integrated screening approach (combined biomarkers and imaging) can achieve sufficiently high statistical efficacy, easy access, ease of use, non-invasiveness and high acceptance rate, and cost effectiveness.
6.Breath diagnosis technology for lung cancer
Tumor markers can be detected in exhaled gas, and the concentration of tumor markers is closely related to the presence of tumor can directly obtain the physiological and non-physiological parameters of the tested person. Lung cancer gas markers originate from the metabolism of cancer cells and tumor microenvironment, and are often associated with free radical-induced lipid oxidation. The detection of VOCs in exhaled gas has significant potential for early cancer detection and can be used for lung cancer recurrence monitoring.
7.Lung cancer blood detection technology
Imperial College of Science and Technology (UK) released that by identifying cancer-related genetic variant features in deoxyribonucleic acid (DNA) to determine whether a patient has cancer. This newly developed blood test technology can achieve more efficient diagnosis of lung cancer in experiments, and the whole testing process is simpler and cheaper than traditional methods, which will help cancer prevention and treatment if put into use.
8.Liquid biopsy
The advantages of liquid biopsy with blood cfDNA as the test object: the collection of samples is non-invasive or minimally invasive; it can be sampled at any time to achieve real-time mastery of lesion-related Biomarker, which solves the heterogeneity of tumor in time dimension; the cfDNA within blood can comprehensively reflect the overall tumor situation and exclude the heterogeneity in space.
Immune cell therapy
1.PD-1/PD-L1
Bristol-Myers Squibb’s (BMS) PD-1 immunotherapy Opdivo (nivolumab) was approved by the European Union for patients with previously treated locally advanced or metastatic squamous (SQ) non-small cell lung cancer (NSCLC). This approval marks the first major therapeutic advance in squamous non-small cell lung cancer (SQ-NSCLC) in more than 10 years, and the first and only PD-1 immunotherapy to demonstrate overall survival (OS) benefit in the previously treated metastatic SQ-NSCLC population.
The FDA approved Agilent’s Dako’s novel companion diagnostic technology for Merck’s non-small cell lung cancer lung cancer test. pD-L1IHC22C3pharmDx’s companion diagnostic technology is commonly used to determine whether patients with malignant non-small cell lung cancer are responding to Merck’s anti-PD-1 therapy, Keytruda (pembrolizumab) which is now FDA-approved for the treatment of patients with metastatic non-small cell lung cancer whose tumor cells express PD-L1, as well as for patients whose disease has progressed or who have undergone platinum chemotherapy.
Targeted therapies for lung cancer
1. ID proteins
ID is a class of transcription factors that inhibit DNA binding/differentiation. ID proteins are able to dimerize and bind regulatory E proteins to suppress the expression of tumor suppressor genes. Previous studies have found that ID family proteins are highly expressed in various cancer cell types, however, the specific role of ID protein overexpression in cancer cells is not clear. To address this issue, Professor Xiaojun Li’s group from Nanjing University investigated the physiological significance of ID3 gene overexpression in the A549 cancer cell line, and the related results were published in the journal naturegenetherapy. The authors concluded that they have discovered the mechanism of ID3 tumor suppression and could be a target molecule for diagnosis and treatment of tumor progression.
2. HM61713
Boehringer Ingelheim and Hanmi Pharmaceuticals announced an exclusive license agreement for the development and global commercialization of HM61713, a novel third-generation, orally active, irreversible, selective, epidermal growth factor receptor mutation-targeting complexine kinase inhibitor (TKI) for the treatment of epidermal growth factor receptor-positive lung cancer. kinase inhibitor (TKI) with oral activity. This compound is currently in Phase II clinical development in patients with non-small cell lung cancer who have developed resistance to previous epidermal growth factor receptor-targeted therapies and carry a T790M mutation, with a Phase III trial scheduled to begin in 2016.
3. Iressa
FDA approved Iressa as an orphan drug designated for the treatment of EGFR mutation-positive metastatic non-small cell lung cancer. Iressa is a kinase inhibitor, which promotes the development of cancer cells with EGFR mutations. This inhibitor can be used to treat most tumor types that express an EGFR mutation (exon 19 deletion or exon 21 L858R substitution mutation). therascreenEGFRRGQPCR kit, which was approved concurrently, can be used to test to determine if a tumor patient has an EGFR mutation to determine which patients can be treated with Iressa. treatment. “Iressa provides another effective option for the first-line treatment of patients with lung cancer. This approval provides further support for targeted therapies for cancer treatment,” said Richard Pazdur, MD, PhD, director of the Office of Hematology and Immunology Products, FDA’s Center for Drug Evaluation and Research.
Lung Cancer Prevention
To prevent lung cancer, you must have good lifestyle habits. For example, you should have a regular work and rest schedule, maintain sufficient sleep and a good state of mind, quit smoking and drinking, actively participate in exercise to enhance physical fitness, and eat more vegetables and fruits, especially foods rich in vitamin C and vitamin E, in order to facilitate the nutrition of lung cells, and drink more water, especially for those who are often in a smoking environment, which can accelerate the discharge of harmful substances from the body. Try to stay away from smoke, radon gas, car exhaust, haze, kitchen fumes and other harmful gases. If you cannot avoid contact with these gases, please bring a good mask for protection, and wash your face, rinse your mouth and clean your nasal cavity in time, which is good for washing off the tiny particles.