Clinical Essentials . . . Oncologists should understand: "The "scale and cure" of non-small cell lung cancer

Supplementary note 01 adjuvant therapy for patients with R0 resection after surgery, postoperative adjuvant chemotherapy sequential radiotherapy due to concurrent chemoradiotherapy, especially for N2 patients.for patients with R1 and R2 resection, there was no significant difference between concurrent chemoradiotherapy and sequential chemoradiotherapy.02 it is possible that preoperative chemoradiotherapy for resected patients is not superior to induction chemotherapy, and OS has no obvious benefit. It is not supported for IIIA (N2) patients with preoperative induction chemotherapy combined with radiotherapy, unless in clinical trials.03 the study of int0139 showed that lobectomy was beneficial to OS after neoadjuvant radiotherapy and chemotherapy, but not to pneumonectomy.04 standard anatomical pneumonectomy (lobectomy, bronchial and vascular sleeve shaped) was performed. If the ECoG was high, sublobular resection (segmental resection and wedge resection) was performed.however, lobectomy is not a standard procedure for early stage lung cancer.lymph node principle: 3 + 3 type.05 late First line chemotherapy: platinum containing dual drug regimen: gemcitabine (class I 1A: ecog1594), docetaxel (class I 1a), paclitaxel (class I 2a), liposome paclitaxel (class I 2a); nedaplatin + docetaxel (type 1b evidence); albumin paclitaxel combined with carboplatin (Class III, class 2b) maintenance treatment: gemcitabine (class 2B evidence) (limited to first-line gemcitabine plus platinum and KPS) Note: ECoG 1594: gemcitabine / platinum is superior to purple shirt / platinum in delaying tumor progression.GC。the total remission rate was 22%, PFS was 4.2m.for KPS greater than 80, G continuous treatment can gain survival benefits.the EGFR mutation rate of targeted therapy for lung squamous cell carcinoma was 2.7%. The detection of EGFR mutation, ALK fusion and ros1 fusion (2a evidence) was recommended for patients who did not smoke or were diagnosed with squamous cell carcinoma or mixed adenocarcinoma by small specimen biopsy (type 2A evidence); for patients who did not smoke or smoke less (< 15 packs / year), the detection of driving gene was recommended.targeted therapy refers to lung adenocarcinoma.note: lux-lung8 afatinib can improve the survival of patients with erbB mutation better than erlotinib.the genomic status of immunotherapy squamous cell carcinoma is completely different from that of adenocarcinoma, amplification is very common, and gene mutation load is higher.the expression of PD-L1 was detected by immunohistochemical method in tissue samples; the detection of PD-L1 and TMB in advanced SCC was recommended, and the medication was guided according to the test results.References: 1. Ohe y, Ohashi y, Kubota K, et al. Randomized phase III study of cisplatin plus irinotecan versus carboplatin plus paclitaxel, cisplatin plus gemcitabine, and cisplatin plus vinorelbine for advanced non small cell lung cancer:Four-Arm CooperativeStudy in Japan. Ann Oncol, 2007,18(2):317-323.2.Reck M,Rodriguez-Abreu D, Robinson AG, et al. Pembrolizumab versus Chemotherapy for PD-L1-Positive Non-small-cell lung cancer. N Engl J Med, 2016, 375(19):1823-1833.3.Wang Z, Huang C, Yang JJ, et al. A randomized phase II clinical trial of nab-paclitaxel and carboplatin compared with gemcitabine and carboplatin as first-line therapy in advanced squamouscell lung carcinoma(C-TONG1002).Eur J Cancer,2019,109:183-191.4.Wu YL, Lu S, Cheng Y, etal.Nivolumabversus docetaxel in a predominantly chinese patient poputation with previously treated advanced non-small cell lungcancer:checkmate 078randomized phase III clinical trial. J Thorac Oncol, 2019, pii: S1556-0864(19)30020-6.5.Herbst RS, Baas P, KimDW, et al. Pembrolizumab versus docetaxel for previously treated, PD-L1-positive, advanced non-small-cell lung cancer(KEYNOTE-010):a randomised controlled trial. Lancet,2016,387(10027):1540-1550.6.Rittmeyer A, Barlesi F, Waterkamp D, et al. Atezolizumab versus docetaxel in patients with previously treated non-small-cell lung cancer(OAK): a phase3, open-label, multicentre randomised controlled trial. Lancet, 2017,389(10066):255-265.7. Brahmer J, Reckamp KL, Baas P, et al. Nivolumab versus Docetaxel in Advanced Squamous-cell-Non-small-cell lung cancer.N Eng J Med, 2015,373(2):123-135.8.Fossella FV, DeVore R, Kerr RN,et al. Randomized phase III trial of docetaxel versus vinorelbine or ifosfamide in patients with advanced non-small-cell lung cancer previously treated with platinum-containing chemotherapy regimens. The TAX 320 Non-small cell lung cancer study group. J Clin Oncol, 2000, 18 (12): 2354-2362. This article is authorized by the author to be released by yimaitong. Please do not reprint it without authorization.