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    Home > Active Ingredient News > Antitumor Therapy > Case case Shenghui | Unresectable locally advanced NSCLC adds a strong dose to the cornerstone of radiotherapy and chemotherapy

    Case case Shenghui | Unresectable locally advanced NSCLC adds a strong dose to the cornerstone of radiotherapy and chemotherapy

    • Last Update: 2021-06-01
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read for reference.
    The initial treatment of inoperable patients with locally advanced NSCLC was treated with recombinant human endostatin combined with radiotherapy and chemotherapy, and the lesions were significantly reduced.

    The treatment of inoperable locally advanced non-small cell lung cancer (NSCLC) has always been one of the focuses of academic research.

    Concurrent radiotherapy and chemotherapy is the standard treatment for inoperable locally advanced NSCLC, but the efficacy is not satisfactory.
    The 5-year survival rate is only 15%-25%, and the long-term survival rate data is rarely reported [1].

    Previous studies have shown that hypoxia in the tumor microenvironment helps tumor cells to resist chemotherapy and tumor metastasis [2,3]; tumor vascular abnormalities are one of the most common factors that cause hypoxia, and anti-angiogenesis therapy can promote Normalization of tumor blood vessels, reduce tumor hypoxia, and increase tumor sensitivity to radiotherapy [4,5].

    A number of studies have found [6,7] that the combination of recombinant human endostatin and other anti-angiogenic drugs with radiotherapy and chemotherapy has shown good efficacy and safety, and is expected to become a new treatment option for unresectable locally advanced NSCLC.

     In this issue, I will share a case of unresectable locally advanced NSCLC patient with TNM stage IIIC from Jiangnan University Affiliated Hospital.
    Recombinant human endostatin combined with chemotherapy was used for first-line treatment, and then combined with radiotherapy on this basis.
    The final efficacy evaluation For partial remission (PR).

    Basic information of the patient A 54-year-old male patient was admitted to the hospital on November 5, 2018 due to "intermittent cough for more than seven months and sputum and blood for more than one month".

    In April 2018, the patient had an irritating cough, no sputum, no chest tightness, and shortness of breath without obvious inducements, and he did not pay attention to it.

    In September 2018, the patient developed blood in his sputum, and occasionally experienced chest tightness and shortness of breath after the activity.

    CT examination of the chest and abdomen in October 2018: It showed that the right lower lung was occupying space, invading the main bronchus, and accompanied by mediastinal lymph node metastasis.

    Physical examination after admission: ECOG score of 1 point, no obvious abnormalities.

    Pathological examination: squamous cell carcinoma.

    CT examination of the chest and abdomen (2018-11-6): It showed that the right lung occupies a space, about 10*7.
    8cm in size, with mediastinal and right hilar lymph node metastasis (as shown in Figure 1).

    Figure 1.
    CT tumor marker examination of the chest and abdomen before treatment: squamous cell carcinoma antigen (SCC-Ag) at 8.
    60ng/ml, carcinoembryonic antigen (CEA) at 9.
    80ng/ml, neurospecific enolase (NSE) It is 22.
    86ng/ml, and the cytokeratin fragment is 23.
    03ng/ml.

     Diagnosis of right lung squamous cell carcinoma with mediastinal and right hilar lymph node metastasis (CT4N3M0, stage IIIC).

     After treatment on November 7, 2018 and December 2, 2018, the patients were given recombinant human endostatin 30mg×7d + docetaxel 140mg (75mg/㎡) + nedaplatin 140mg (75mg/㎡), respectively.
    After two courses of treatment, the patient's cough, blood sputum, and chest tightness alleviated.

    A re-examination of CT on December 29, 2018 showed that the size of the right lung lesion was about 6cm×5cm, and the lesion, mediastinum, and hilar metastatic lymph nodes were smaller than before (as shown in Figure 2), and the therapeutic effect was evaluated as PR.

    Figure 2.
    Chest and abdomen CT after two courses of treatment.
    On December 30, 2018, the patient underwent a course of recombinant human endostatin 30mg/d×7d + docetaxel + nedaplatin, and then on January 2019 From 17 to March 14, 2019, radiotherapy was given: right lung lesions and right hilar and mediastinal lymph node drainage area (PTV) 6Mv-xrayIMRTDT45Gy/20f, 2.
    25Gy/f.

    Re-examination of chest CT during treatment showed that the size of the right lung lesion was about 5.
    6cm×4.
    7cm, and the lung lesions and mediastinal metastatic lymph nodes were further reduced (as shown in Figure 3), and then the local field was reduced and increased radiotherapy DT16Gy/8f.  Figure 3.
    Chest and abdomen CT on February 28, 2019 From April 1, 2019 to June 3, 2019, the patient continued to receive two courses of recombinant human endostatin 30mg×7d + docetaxel 140mg (75mg/ ㎡) + Nidaplatin 140mg (75mg/㎡) treatment.

    After treatment, the patient experienced adverse reactions, including degree III leukopenia, degree II thrombocytopenia, and degree I gastrointestinal reactions.

    CT of the chest and abdomen on June 3, 2019 showed a mass-like soft tissue density shadow in the upper right lung, with punctate calcifications in it, with a size of about 5.
    1cm×4.
    0cm, as shown in Figure 4, and the therapeutic effect was evaluated as PR.

    Figure 4.
    The expert profile of chest and abdomen CT cases on June 3, 2019.
    Zhang Yunxia, ​​deputy chief physician of the Department of Radiotherapy, Jiangnan University Affiliated Hospital, graduated from Soochow University with a degree in oncology.
    He has been engaged in tumor radiotherapy since 2009.
    He has rich clinical experience in chemotherapy, targeting, and immunization.
    Professor Zhang Yunxia commented that for patients with inoperable stage III NSCLC, radical concurrent chemoradiation is the standard treatment recommended by the guidelines, but the 5-year survival rate of patients is poor and can be achieved The long-term survival of patients is still a small number.

    In recent years, with the advent of targeted therapy, the prognosis of patients with unresectable locally advanced NSCLC has begun to improve.

    At present, anti-angiogenesis therapy combined with radiotherapy and chemotherapy is a new exploratory model for the treatment of locally advanced NSCLC.

    The HELPER study showed [6] that compared with previous concurrent etoposide/cisplatin (EP) radiotherapy, continuous intravenous pump focused group of human endostatin combined with EP regimen + concurrent radiotherapy greatly improved the survival of patients with stage Ⅲ unresectable NSCLC.
    The overall survival (OS) and objective response rate (ORR) were 34.
    7 months and 76.
    1%, respectively.

    A meta-analysis published by Radiation Oncology in 2020 [7] once again confirmed the good efficacy and safety of recombinant human endostatin combined with radiotherapy (ERT) or concurrent radiotherapy (ECRT) for patients with locally advanced NSCLC.

    The results of the pooled analysis showed that the ORR of patients in the ECRT and ERT groups were 77.
    5% and 76.
    1%, respectively, the median progression-free survival (PFS) was 11.
    2 months and 11.
    8 months, and the median OS was 18.
    4 months and 19.
    6 months, respectively.
    Months, and the adverse reactions are within the controllable range.

     The initial treatment of this patient with stage IIIC unresectable NSCLC was treated with recombinant human endostatin combined with chemotherapy to achieve partial tumor remission; then the patient received recombinant human endostatin combined with radiotherapy and chemotherapy, and the tumor maintained a partial remission state, confirming concurrent radiotherapy and chemotherapy Combining recombinant human endostatin is an effective and safe treatment option for patients with unresectable locally advanced NSCLC.

    Reference: [1] Vrankar M, Stanic K.
    Long-term survival of locally advanced stage III non-small cell lung cancer patients treated with chemoradiotherapy and perspectives for the treatment with immunotherapy[J].
    Radiology and Oncology, 2018, 52(3) : 281-288.
    [2] Toma-Dasu I, Dasu A,Karlsson M.
    The relationship between temporal variation of hypoxia,polarographic measurements and predictions of tumour response to radiation[J].
    Phys Med Biol, 2004, 49(19) :4463–75.
    [3] Seo Y, Yan T, SchuppJE, et al.
    Differential radiosensitization in DNA mismatch repair-proficientand -deficient human colon cancer xenografts with 5-iodo-2-pyrimidinone-2′-deoxyribose[J].
    Clin Cancer Res, 2004, 10(22):7520–8.
    [4] Jiang XD, Dai P, QiaoY, et al.
    Clinical study on the recombinant human endostatin regarding improving the blood perfusion and hypoxia of non-small-cell lung cancer [J].
    Clin Transl Oncol, 2012, 14(6):437–43.
    [5] Meng MB, Jiang XD,Deng L, et al.
    Enhanced radioresponse with a novel recombinant human endostatinprotein via tumor vasculature remodeling: experimental and clinicalevidence[J].
    Radiother Oncol, 2013, 106(1):130–7.
    [6] Yirui Zhai, et al.
    HELPER study: A phase II trial of continuous infusion of endostar combined with concurrent etoposide plus cisplatin and radiotherapy for treatment of unresectable stage III non-small -cell lung cancer.
    Radiotherapy and Oncology.
    2019;131:27-34.
    [7] Shu-Ling Zhang ,Cheng-Bo Han, Li Sun,et al.
    Efficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locallyadvanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1):205.
    *This article is only used to provide scientific information to medical professionals and does not represent the views of this platform14(6):437–43.
    [5] Meng MB, Jiang XD,Deng L, et al.
    Enhanced radioresponse with a novel recombinant human endostatinprotein via tumor vasculature remodeling: experimental and clinicalevidence[J].
    Radiother Oncol, 2013, 106 (1):130–7.
    [6] Yirui Zhai, et al.
    HELPER study: A phase II trial of continuous infusion of endostar combined with concurrent etoposide plus cisplatin and radiotherapy for treatment of unresectable stage III non-small-cell lung cancer.
    Radiotherapy and Oncology.
    2019;131:27-34.
    [7] Shu-Ling Zhang ,Cheng-Bo Han, Li Sun,et al.
    Efficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locally advanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1):205.
    *This article is only used to provide scientific information to medical professionals and does not represent the views of this platform14(6):437–43.
    [5] Meng MB, Jiang XD,Deng L, et al.
    Enhanced radioresponse with a novel recombinant human endostatinprotein via tumor vasculature remodeling: experimental and clinicalevidence[J].
    Radiother Oncol, 2013, 106 (1):130–7.
    [6] Yirui Zhai, et al.
    HELPER study: A phase II trial of continuous infusion of endostar combined with concurrent etoposide plus cisplatin and radiotherapy for treatment of unresectable stage III non-small-cell lung cancer.
    Radiotherapy and Oncology.
    2019;131:27-34.
    [7] Shu-Ling Zhang ,Cheng-Bo Han, Li Sun,et al.
    Efficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locally advanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1):205.
    *This article is only used to provide scientific information to medical professionals and does not represent the views of this platformEnhanced radioresponse with a novel recombinant human endostatinprotein via tumor vasculature remodeling: experimental and clinicalevidence[J].
    Radiother Oncol, 2013, 106(1):130–7.
    [6] Yirui Zhai, et al.
    HELPER study: A phase II trial of continuous infusion of endostar combined with concurrent etoposide plus cisplatin and radiotherapy for treatment ofunresectable stage III non-small-cell lung cancer.
    Radiotherapy and Oncology.
    2019;131:27-34.
    [7] Shu-Ling Zhang ,Cheng-Bo Han, Li Sun,et al.
    Efficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locally advanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1):205.
    *This This article is only used to provide scientific information to medical professionals and does not represent the views of this platformEnhanced radioresponse with a novel recombinant human endostatinprotein via tumor vasculature remodeling: experimental and clinicalevidence[J].
    Radiother Oncol, 2013, 106(1):130–7.
    [6] Yirui Zhai, et al.
    HELPER study: A phase II trial of continuous infusion of endostar combined with concurrent etoposide plus cisplatin and radiotherapy for treatment ofunresectable stage III non-small-cell lung cancer.
    Radiotherapy and Oncology.
    2019;131:27-34.
    [7] Shu-Ling Zhang ,Cheng-Bo Han, Li Sun,et al.
    Efficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locally advanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1):205.
    *This This article is only used to provide scientific information to medical professionals and does not represent the views of this platformexperimental and clinicalevidence[J].
    Radiother Oncol, 2013, 106(1):130–7.
    [6] Yirui Zhai, et al.
    HELPER study: A phase II trial of continuous infusion of endostar combined with concurrent etoposide plus cisplatin and radiotherapy for treatment of unresectable stage III non-small-cell lung cancer.
    Radiotherapy and Oncology.
    2019;131:27-34.
    [7] Shu-Ling Zhang ,Cheng-Bo Han, Li Sun,et al.
    Efficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locally advanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1):205.
    *This article is only used to provide scientific information to medical professionals and does not represent Views of this platformexperimental and clinicalevidence[J].
    Radiother Oncol, 2013, 106(1):130–7.
    [6] Yirui Zhai, et al.
    HELPER study: A phase II trial of continuous infusion of endostar combined with concurrent etoposide plus cisplatin and radiotherapy for treatment of unresectable stage III non-small-cell lung cancer.
    Radiotherapy and Oncology.
    2019;131:27-34.
    [7] Shu-Ling Zhang ,Cheng-Bo Han, Li Sun,et al.
    Efficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locally advanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1):205.
    *This article is only used to provide scientific information to medical professionals and does not represent Views of this platformA phase II trial of continuous infusion of endostar combined with concurrent etoposide plus cisplatin and radiotherapy for treatment ofunresectable stage III non-small-cell lung cancer.
    Radiotherapy and Oncology.
    2019;131:27-34.
    [7] Shu-Ling Zhang ,Cheng -Bo Han, Li Sun,et al.
    Efficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locally advanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1): 205.
    *This article is only used to provide scientific information to medical professionals, and does not represent the views of this platformA phase II trial of continuous infusion of endostar combined with concurrent etoposide plus cisplatin and radiotherapy for treatment ofunresectable stage III non-small-cell lung cancer.
    Radiotherapy and Oncology.
    2019;131:27-34.
    [7] Shu-Ling Zhang ,Cheng -Bo Han, Li Sun,et al.
    Efficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locally advanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1): 205.
    *This article is only used to provide scientific information to medical professionals, and does not represent the views of this platformEfficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locally advanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1):205.
    *This article is only for medical Scientific information provided by people does not represent the views of this platformEfficacy and safety of recombinant human endostatincombined with radiotherapy or chemoradiotherapy in patients with locally advanced non-small cell lung cancer: a pooled analysis[J].
    Radiat Oncol, 2020Aug 24, 15(1):205.
    *This article is only for medical Scientific information provided by people does not represent the views of this platform
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