Benefits throughout the entire process, guarding new students: Disumab provides another one-dimensional guarantee of efficacy for patients with lung cancer and bone metastases!

*Only for medical professionals' reference.
Disumab has a rapid onset of action and relieves bone pain.
It can be combined with local radiotherapy or targeted drugs to better control lung cancer bone metastasis
.

Lung cancer has metastasis as the main malignant sign and feature, and it is also considered to be the main cause of treatment failure and patient death.
Among them, the most common metastatic cancer of advanced lung cancer is bone metastasis [1]
.

In the past, one of the basic methods for the treatment of bone metastases in Chinese patients was bisphosphonate drugs, but with the update of the clinical research data of desulumab, desulumab provides patients with a safe and effective new treatment option
.

This case was provided by Professor Wang Ting from Shanghai Changzheng Hospital.
This patient had multiple bone metastases after lung cancer surgery.
After anti-tumor treatment and anti-bone metastasis treatment with desulzumab, the bone pain was relieved, and sensorimotor was significantly restored.
Osteogenesis changes, alkaline phosphatase is significantly reduced
.

Brief medical history: A 75-year-old female patient with no history of smoking, drinking, and family history of tumors
.

2016.
03 because of "left lung nodule" underwent wedge resection of lung, postoperative pathology showed: lung adenocarcinoma, considered as carcinoma in situ, no further treatment after operation; 2017.
04 again due to "right lung nodule" underwent wedge resection, postoperative Pathological findings: lung adenocarcinoma, considered as carcinoma in situ, and no further treatment after surgery; 2021.
01.
02 sudden chest and back pain, sensory dyskinesia in both lower limbs, unable to walk; 2021.
01.
05 full spine MRI showed: chest 6 -7 Metastases with obvious compression of the dural sac; PET-CT examination on January 06, 2020 showed that there were multiple bone metastases after lung cancer surgery; on January 08, 2020, he went to our clinic
.

X-ray: Scoliosis caused by pain, kyphotic deformity caused by vertebral compression
.

Figure 1.
MRI results of X-ray examination: abnormal signal of thoracic 5-9 vertebral body, compression fracture of T7 vertebral body, occupying space in T4-8 spinal canal
.

Figure 2.
MRI results CT: obvious osteoporosis
.

Figure 3.
CT examination results PET-CT: multiple spine metastases, lung tumor activity remains Figure 3.
PET-CT examination results case characteristics summary of elderly women, osteoporosis with a history of lung adenocarcinoma, have undergone surgery, no chemotherapy , Targeting, radiotherapy and other multiple spine metastases, focusing on chest 6-7, thoracic 7 vertebral body instability or thoracic spine tumor destruction, resulting in thoracic back pain, thoracic 4-8 spinal nerve compression, resulting in insufficiency of the lower limbs diagnosis 1.
Tumors of thoracic 6-7 vertebral body appendages with incomplete paralysis of both lower extremities 2.
Multiple bone metastases throughout the body after lung cancer surgery 3.
Osteoporosis treatment to prevent the problem-disulfumab is used before surgery, considering the use of disulfan during the perioperative period Antibodies may have the effects of inhibiting bone destruction, improving pain, and reducing intraoperative bleeding.
On January 9, 2021, the patient was given a subcutaneous injection of 120 mg of disulumab.
On January 13, 2021, the patient was treated with a posterior thoracic spine tumor resection under general anesthesia.
Reconstructive internal fixation (separation surgery)
.

Postoperative X-ray: thoracic 7 vertebral body resection, titanium mesh support, local packing of bone cement; thoracic grade 4-6 and thoracic 8 vertebrae were injected with bone cement
.

Figure 4.
Postoperative X-ray examination results.
The patient felt pain relieved after the operation, and the sensory movement of both lower limbs was significantly restored.
The patient went to the ground 2 weeks after the operation
.

Riding the victory and pursuing the battle-after the three-pronged combination of dishu, radiotherapy, and targeting, the patient was treated with comprehensive treatment, and continued to use disumab therapy (120mg subcutaneous injection q4w), and radiotherapy at the surgical site of the thoracic spine (2Gy) 1 month after the operation × 20 times), and started gefitinib treatment 3 weeks after surgery
.

2021.
07.
15 CT: Osteogenic changes at the surgical site, no obvious tumor recurrence
.

Figure 5.
CT examination results half a year after surgery.
Figure 6.
Comparison of patients' CT examination results.
After using desulumab, the patient's blood calcium decreased transiently and returned to normal after calcium supplementation.
The patient showed a significant decrease in alkaline phosphatase.

.

Figure 7.
Summary of laboratory indicators before and after the treatment with desulumab and thoughts.
This patient had multiple bone metastases after lung cancer surgery, chest and back pain on admission, sensory dyskinesia in both lower limbs, and unable to walk
.

The patient was given desulumab once and undergoing surgical treatment.
The patient felt pain was relieved, and the sensory movement of both lower limbs was significantly restored.
After the operation, the patient was treated with desulumab, combined with local radiotherapy and targeted therapy, and the imaging examination revealed the surgical site.
Osteogenic changes, no obvious tumor recurrence, and a significant decrease in alkaline phosphatase
.

The above review results suggest that the comprehensive treatment plan for this patient has been successful
.

This case suggests that when a patient has bone metastases, preoperative application of desulumab may reduce intraoperative bleeding, the use of desulumab can significantly reduce the incidence of bone events in lung cancer patients with bone metastases, and desulumab can improve Local pain caused by bone destruction or vertebral body instability; the low side effects of desulzumab make it safer to be used in combination with surgery, radiotherapy, systemic drug therapy, etc.
, and it is combined with local radiotherapy or targeted drugs The combined use of, may better control the progress of bone metastasis
.

Expert profile Dr.
Wang Ting, Department of Orthopedic Oncology, Shanghai Changzheng Hospital, Attending Physician, Doctor of Medicine under the supervision of Professor Xiao Jianru, a famous spine and bone tumor surgeon in China, and Dean of Orthopedic Hospital, specializing in clinical and basic research on primary bone tumors and spinal metastases 1 National Natural Science Foundation of China Youth Project, 1 General Project, 14 SCI papers published by the first and corresponding author, 1 authorized invention patent, 6 utility model patents, and 6 expert comments that the incidence of lung cancer in China has been increasing year by year, and it has become the most common One of the most common malignant tumors of advanced lung cancer is bone metastasis, which is more common in the spine, limb bones, iliac bones, etc.
It can show different degrees of local bone pain, dysfunction, etc.
, and can be complicated by a series of Bone-related events (SREs), such as pathological fractures and severe bone pain, severely reduce the quality of life of patients, and even lead to death [1]
.

Therefore, for patients with bone metastases from lung cancer, how to prevent and treat bone metastases and SREs is particularly important while actively treating the primary lesions
.

Disulumab is an osteoclast bone resorption inhibitor that binds to nuclear factor kappa B receptor activator ligand (RANKL) in a manner similar to natural bone protection factors, thereby preventing RANKL and nuclear factor kappa B receptor activating protein The interaction of (RANK) ultimately reduces the differentiation, activity and survival of osteoclasts, and inhibits bone resorption [2]
.

After subcutaneous injection, desulimab is rapidly absorbed, and it can be detected in the serum within 1 hour after administration, and it lasts as long as 9 months after a single administration [2]
.

A systematic review and meta-analysis [3] explored the most effective drug treatment for bone metastases from lung cancer, and found that compared with untreated patients, disulumab is better than azole in terms of overall survival (OS).
With ledronic acid, OS was estimated to be extended by an average of 3.
3 months (95% confidence interval 0.
3-6.
3) (P score = 89%), while zoledronic acid was only extended by 2.
1 months
.

In terms of the time to SRE, compared with untreated patients (P score=99%), the average number of SRE-free months for desulimab was 9.
1 months (95% CI 6.
7-11.
5), while zoledronic acid The average number of months without SRE is 4.
8 months (95% CI 3.
6-6.
1)
.

Therefore, in terms of the occurrence time of OS and SRE, disulumab is superior to zoledronic acid.
Disulumab can prolong the survival time of patients with lung cancer and bone metastases to a certain extent
.

A number of guidelines point out that bone-modulating drugs should be applied immediately after bone metastasis is found on imaging.
Regardless of whether there are related clinical symptoms, desulumab can be used to treat patients with advanced tumor bone metastases [4-5]
.

 It is expected that Disumab can play a greater role in clinical practice, and continue to advance relevant clinical research, so that more patients with tumor bone metastases can benefit from it
.

Expert profile Professor Zhipeng Wu, deputy chief physician and associate professor of orthopedic tumor surgery, Changzheng Hospital, and master's tutor of doctor of medicine.
Currently serving as a young member of the Orthopedic Professional Committee of the PLA.
He has written more than 20 SCI papers as the first author and corresponding author.
Obtained invention patents and utility model patents.
More than 10 projects were led by the National Natural Science Foundation of China as the project leader, and 2 projects were awarded the Shanghai Science and Technology Progress First Prize as the main completer of the project.
2 references: [1] Zhao Guangzong, Zhang Longqiang, Fang Jun, Li Huazhuang, Liang Zhiyong, Wang Shantao.
The effect of ledronic acid on the serum levels of bone loss markers in patients with lung cancer spinal metastases.
China Practical Medicine, 2020,15(28):57-59.
[2] Chinese Anti-Cancer Association Urinary and Male Reproductive Tumor Professional Committee, Ye Dingwei , Shi Benkang, Xing Jinchun, Zhu Gang, Qi Jun, Li Changling, Li Ningchen, He Zhisong, Zhou Fangjian, Yao Xin, Guo Jun, Xie Xiaodong, Wei Qiang, Wei Shaozhong.
Clinical application of disumab in prostate cancer patients with bone metastases.
Oncology.
Electronic Journal of Comprehensive Therapy, 2021, 7(3): 17-21.
[3] Bozzo A, Deng J, Abbas U, et al.
Which Bone-Modifying Agent is Associated with Better Outcomes in Patients with Skeletal Metastases from Lung Cancer? A Systematic Review and Network Meta-analysis.
Clin Orthop Relat Res.
2021;479(9):2047-2057.
doi:10.
1097/CORR.
0000000000001749[4]Coleman R, Body JJ, Aapro M, Hadji P, Herrstedt J; ESMO Guidelines Working Group.
Bone health in cancer patients: ESMO Clinical Practice Guidelines.
Ann Oncol.
2014;25 Suppl 3:iii124-iii137.
doi:10.
1093/annonc/mdu103[5]Van Poznak CH, Von Roenn JH, Temin S.
American society of clinical oncology clinical practice guideline update: recommendations on the role of bone-modifying agents in metastatic breast cancer.
J Oncol Pract.
2011;7 (2):117-121.
doi:10.
1200/JOP.
2011.
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