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With the continuous development of medicine, various methods in the field of tumor treatment are blooming, each playing an important role
.
How to reasonably and effectively combine these treatments to form targeted combination therapy, so that patients can better benefit from it, is the direction that researchers are exploring
.
But not all combinations can achieve the effect of "1+1>2"? For example, in patients with advanced lung cancer without EGFR and ALK driver gene mutations, the most common treatment is the use of PD-1 inhibitor-type immune drugs.
When the disease progresses in the later stage, chemotherapy is often used
.
However, some patients are reluctant to give up the previous immunotherapy, hoping to use the combination of immunotherapy and chemotherapy, and feel that the effect must be better than chemotherapy alone
.
Is this really true? The synergistic effect of immunotherapy and chemotherapy In the second-line treatment of advanced lung cancer, the general patient's disease progresses after platinum-containing chemotherapy, and the detection of EGFR and ALK driver gene mutations is negative, and immune monotherapy can be used, such as nivolio Monoclonal antibody, pembrolizumab, etc.
, but the response rate of patients with second-line single-agent immunotherapy is only 9%-14%
.
Regarding the reasons for the resistance of PD-1 and PD-L1 inhibitors, researchers believe that the infiltration of immune T cells around tumor cells is insufficient, antigen presentation is insufficient, or the immune suppressive microenvironment depletes T cells
.
An interesting study showed that if patients were initially treated with immune monotherapy followed by chemotherapy, the objective treatment response rate was very high
.
For this phenomenon, it was explained that after discontinuation of PD-1 or PD-L1 inhibitor drugs, due to the long half-life of these drugs, these inhibitors cause some activated immune cells to exist in the patient for a long time, so After subsequent chemotherapy, these T cells activated by the previous immune drug participated in the associated assist
.
However, there is also a phenomenon that the "immune imprint" left by the patient's previous use of PD-1 inhibitors does not remain for a long time
.
For this reason, the researchers conducted this study to test whether the combination of pembrolizumab with chemotherapy after progression on PD-1 monotherapy is more effective than chemotherapy alone
.
Is it "superfluous" to continue to use PD-1 immunotherapy after progress? This is a phase II clinical trial in patients with advanced EGFR and ALK driver gene mutation-negative lung cancer
.
The patient's disease progressed after receiving one or two chemotherapy regimens, at least one of which contained platinum
.
The use of immunomonotherapy after chemotherapy progression also progressed
.
Figure 1.
Survival with continued immunocombination chemotherapy after progression on immunotherapy monotherapy A total of 95 patients were included in this study, with a median follow-up of 10.
5 months
.
All patients were randomly divided into two groups: patients in the experimental group received the PD-1 inhibitor pembrolizumab in combination with chemotherapy, and patients in the control group received placebo in combination with chemotherapy
.
The median progression-free survival was 4.
1 months and 5.
9 months, respectively
.
The hazard ratio and overall survival were not statistically different
.
From Figure 1 you can't see any separation of the two curves, not much difference
.
Figure 2.
Survival of patients with high PD-L1 expression after progression on PD-1 monotherapy with immunocombination chemotherapy.
To further investigate this issue, the researchers reselected patients with high PD-L1 expression
.
For example, patients with a TPS score of PD-L1 greater than 50% tend to benefit more from immunotherapy
.
This group of patients also benefited better from previous PD-1 or PD-L1 inhibitors, with a clinically assessed partial response time of more than 6 months
.
For this group of patients, the two-year survival rate for pembrolizumab plus chemotherapy was 74%, compared with 38% for the placebo and chemotherapy group
.
From this point of view, patients with high PD-L1 expression will benefit from continued PD-1 combined chemotherapy
.
Enlightenment: How to choose treatment measures after the progress of immunotherapy The conclusion of the above research is: if the PD-L1 expression in tumor tissue samples is greater than 50%, and the tumor lesions are reduced by 30% during immune monotherapy, the state of partial remission lasts for 6 For more than one month, patients will benefit more by continuing to use the PD-1 inhibitor pembrolizumab in combination with chemotherapy after the progress of immune monotherapy
.
Otherwise, the combined PD-1 inhibitor pembrolizumab may not be required, and only single-agent chemotherapy is required
.
Figure 3.
With high PD-L1 expression, subsequent use of immunotherapy will benefit more.
Regarding immunotherapy and subsequent combined treatment measures, there will be more clinical trials and more new discoveries in the later stage
.
You are welcome to search and download the Cancer Degree APP to exchange anti-cancer experience with many similar patients
.
Reference: Hyun Ae Jung, et al.
, Continuation of pembrolizumab with additional chemotherapy after progression with PD-1/PD-L1 inhibitor monotherapy in patients with advanced non-small cell lung cancer: a randomized, placebo-controlled phase II study, Clin Cancer Res.
2022 Jan 31.
Click below to learn more about the selected anti-cancer and anti-cancer dry goods of clinical trial projects-Swipe left and right to see more-
.
How to reasonably and effectively combine these treatments to form targeted combination therapy, so that patients can better benefit from it, is the direction that researchers are exploring
.
But not all combinations can achieve the effect of "1+1>2"? For example, in patients with advanced lung cancer without EGFR and ALK driver gene mutations, the most common treatment is the use of PD-1 inhibitor-type immune drugs.
When the disease progresses in the later stage, chemotherapy is often used
.
However, some patients are reluctant to give up the previous immunotherapy, hoping to use the combination of immunotherapy and chemotherapy, and feel that the effect must be better than chemotherapy alone
.
Is this really true? The synergistic effect of immunotherapy and chemotherapy In the second-line treatment of advanced lung cancer, the general patient's disease progresses after platinum-containing chemotherapy, and the detection of EGFR and ALK driver gene mutations is negative, and immune monotherapy can be used, such as nivolio Monoclonal antibody, pembrolizumab, etc.
, but the response rate of patients with second-line single-agent immunotherapy is only 9%-14%
.
Regarding the reasons for the resistance of PD-1 and PD-L1 inhibitors, researchers believe that the infiltration of immune T cells around tumor cells is insufficient, antigen presentation is insufficient, or the immune suppressive microenvironment depletes T cells
.
An interesting study showed that if patients were initially treated with immune monotherapy followed by chemotherapy, the objective treatment response rate was very high
.
For this phenomenon, it was explained that after discontinuation of PD-1 or PD-L1 inhibitor drugs, due to the long half-life of these drugs, these inhibitors cause some activated immune cells to exist in the patient for a long time, so After subsequent chemotherapy, these T cells activated by the previous immune drug participated in the associated assist
.
However, there is also a phenomenon that the "immune imprint" left by the patient's previous use of PD-1 inhibitors does not remain for a long time
.
For this reason, the researchers conducted this study to test whether the combination of pembrolizumab with chemotherapy after progression on PD-1 monotherapy is more effective than chemotherapy alone
.
Is it "superfluous" to continue to use PD-1 immunotherapy after progress? This is a phase II clinical trial in patients with advanced EGFR and ALK driver gene mutation-negative lung cancer
.
The patient's disease progressed after receiving one or two chemotherapy regimens, at least one of which contained platinum
.
The use of immunomonotherapy after chemotherapy progression also progressed
.
Figure 1.
Survival with continued immunocombination chemotherapy after progression on immunotherapy monotherapy A total of 95 patients were included in this study, with a median follow-up of 10.
5 months
.
All patients were randomly divided into two groups: patients in the experimental group received the PD-1 inhibitor pembrolizumab in combination with chemotherapy, and patients in the control group received placebo in combination with chemotherapy
.
The median progression-free survival was 4.
1 months and 5.
9 months, respectively
.
The hazard ratio and overall survival were not statistically different
.
From Figure 1 you can't see any separation of the two curves, not much difference
.
Figure 2.
Survival of patients with high PD-L1 expression after progression on PD-1 monotherapy with immunocombination chemotherapy.
To further investigate this issue, the researchers reselected patients with high PD-L1 expression
.
For example, patients with a TPS score of PD-L1 greater than 50% tend to benefit more from immunotherapy
.
This group of patients also benefited better from previous PD-1 or PD-L1 inhibitors, with a clinically assessed partial response time of more than 6 months
.
For this group of patients, the two-year survival rate for pembrolizumab plus chemotherapy was 74%, compared with 38% for the placebo and chemotherapy group
.
From this point of view, patients with high PD-L1 expression will benefit from continued PD-1 combined chemotherapy
.
Enlightenment: How to choose treatment measures after the progress of immunotherapy The conclusion of the above research is: if the PD-L1 expression in tumor tissue samples is greater than 50%, and the tumor lesions are reduced by 30% during immune monotherapy, the state of partial remission lasts for 6 For more than one month, patients will benefit more by continuing to use the PD-1 inhibitor pembrolizumab in combination with chemotherapy after the progress of immune monotherapy
.
Otherwise, the combined PD-1 inhibitor pembrolizumab may not be required, and only single-agent chemotherapy is required
.
Figure 3.
With high PD-L1 expression, subsequent use of immunotherapy will benefit more.
Regarding immunotherapy and subsequent combined treatment measures, there will be more clinical trials and more new discoveries in the later stage
.
You are welcome to search and download the Cancer Degree APP to exchange anti-cancer experience with many similar patients
.
Reference: Hyun Ae Jung, et al.
, Continuation of pembrolizumab with additional chemotherapy after progression with PD-1/PD-L1 inhibitor monotherapy in patients with advanced non-small cell lung cancer: a randomized, placebo-controlled phase II study, Clin Cancer Res.
2022 Jan 31.
Click below to learn more about the selected anti-cancer and anti-cancer dry goods of clinical trial projects-Swipe left and right to see more-