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    Home > Active Ingredient News > Antitumor Therapy > Professor Zhao Hui from Shanghai Sixth Hospital: Bone pain is an important signal for tumors, and explore the future of healthy aging of bone metastasis and chronic disease

    Professor Zhao Hui from Shanghai Sixth Hospital: Bone pain is an important signal for tumors, and explore the future of healthy aging of bone metastasis and chronic disease

    • Last Update: 2022-03-06
    • Source: Internet
    • Author: User
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    ▎Editor's note from WuXi AppTec Content Team: Worldwide, the population over the age of 60 has exceeded 1 billion and will account for nearly a quarter of the global population by 2050
    .

    As the process of global aging is accelerating, "healthy aging" has also become the common future focus of all countries around the world
    .

    In the topic "Healthy Aging", WuXi AppTec's content team will talk to the world's most influential experts on aging, and present readers' thoughts from different perspectives such as science, medicine, public health, economy, and society
    .

    In this interview, Professor Zhao Hui, Chief Physician of the Department of Medical Oncology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiaotong University, will share the common problems of metastatic bone tumors in cancer patients and related bone health management, as well as the future trends of tumor prevention and treatment innovation.

    .

    Zhao Hui, doctoral tutor of Shanghai Jiaotong University School of Medicine, chief physician of Shanghai Sixth People's Hospital affiliated to Shanghai Jiaotong University, presided over more than 10 projects of the National Natural Science Foundation of China, provincial and municipal level projects, and published nearly 50 SCI articles.
    Main research direction: transfer Bone tumor, tumor metastasis microenvironment, the application of artificial intelligence in medical big data to promote early screening and early diagnosis, and multi-dimensional promotion of tumor prevention and treatment In the context of an aging population, what aspects of tumor prevention and treatment are worthy of attention? Prof.
    Hui Zhao: With the aging of the population, the incidence of cancer in China is also increasing year by year
    .

    China's 2018 statistics show that the incidence of malignant tumors increases with age.
    The elderly over 60 years old are the high-risk group of tumors, and the incidence peaks at the age of 80
    .

    The top five cancer mortality rates among Chinese elderly are lung cancer, liver cancer, gastric cancer, esophageal cancer, and colorectal cancer
    .

    At the same time, we also noticed that the tumor burden in China showed a different trend from international data
    .

    Taking the recently released U.
    S.
    2022 cancer statistics by the journal CA as an example, cancer incidence and mortality rates for men in the United States and cancer mortality for women have generally declined since the early 1990s, and cancer incidence rates among women in the U.
    S.
    began in the mid-2010s.
    Stable, with a slight increase in recent years, which may be related to the increase in breast cancer incidence
    .

    Looking at another important indicator, the 5-year survival rate for all cancers in the United States has increased from 49% in the 1970s to 68% in 2017, a dazzling achievement
    .

    Controlling the morbidity rate and actively improving the survival rate is also the direction that China's tumor prevention and control needs to work hard
    .

    This needs to be jointly promoted from multiple dimensions such as national strategy, multi-party collaboration in society, early screening promotion, improvement of treatment techniques and concepts, as well as popularization of popular science and improvement of public living habits
    .

    Taking early screening as an example, a consensus on screening recommendations for multiple cancer types has been formed internationally, including lung cancer, breast cancer, colorectal cancer, prostate cancer, etc.
    , but the focus and challenge is to implement these screening measures more widely
    .

    Early screening and early diagnosis are what we strive to achieve
    .

    However, in actual clinical practice, especially when the Medical Oncology Department of Shanghai Sixth Hospital is characterized by metastatic bone tumors, there are not many common and classic symptoms at the primary site (such as cough and hemoptysis in lung cancer, stomach pain and blood in stool in gastric cancer).
    Most of them come to see a doctor because of bone pain and difficulty in movement after bone metastasis, which also reflects the challenges of early screening and diagnosis from the side
    .

    Getting out of the "Dilemma" of Bone Metastasis Most of the malignant tumor patients are diagnosed at an advanced stage, and bone is one of the common metastatic sites.
    What are the clinical characteristics of metastatic bone tumors? Prof.
    Hui Zhao: Many patients with malignant tumors in China have developed advanced symptoms when they are discovered.
    There are a huge number of patients with metastatic bone tumors and potential patients, and bone metastases from breast cancer, prostate cancer, and lung cancer are particularly high
    .

    65%-75% of breast and prostate cancers and 30%-40% of lung cancer patients will eventually develop metastatic bone tumors
    .

    It is worth noting that up to 20% of patients present with metastatic bone tumor symptoms as the first symptom, including pain, paralysis of the lower limbs,
    etc.

    Metastatic bone tumor is also a prominent problem affecting the quality of life and medical burden of patients with malignant tumors
    .

    Although there is no exact data in China, medical data in the United States show that the cost of comprehensive treatment of metastatic bone tumors accounts for about 17% of the total treatment cost of malignant tumors
    .

    In terms of clinical features, different metastatic bone tumors are associated with bone-related events (SREs): bone pain, spinal cord compression, hypercalcemia, and pathological fractures
    .

    Among them, spinal cord compression and pathological fractures are the problems we are most worried about, which may lead to paraplegia and paralysis of the lower limbs
    .

    In view of these characteristics, how can tumor patients better prevent metastatic bone tumors in the early stage and conduct comprehensive management of bone health? Prof.
    Hui Zhao: First, early screening and monitoring should be carried out for patients who are prone to high incidence of metastatic bone tumors
    .

    Especially in breast cancer, lung cancer, and prostate cancer patients, including those in the mid-term at the time of diagnosis, bone scans and specialized examinations for painful areas can detect metastatic bone tumors earlier
    .

    Second, there is a need to prevent and treat osteoporosis in breast cancer patients and elderly patients
    .

    Breast cancer patients are prone to osteoporosis due to physiological factors and endocrine drug treatment factors, and the prevalence of osteoporosis in elderly patients is also higher, and the bone microenvironment caused by osteoporosis is more prone to metastatic bone tumors
    .

    Third, new concepts are needed to manage metastatic bone tumors in a chronic disease model
    .

    At present, the clinical attention to bone health management of tumor patients is not enough, often when they go to a specialist or a higher-level hospital for treatment, they are already in a very advanced stage, and irreversible damage has occurred, including fractures, spinal cord compression and other problems
    .

    Turning passive into active requires the linkage of hospitals at all levels to jointly realize early and comprehensive management of bone health of cancer patients
    .

    The "Expert Consensus on Clinical Diagnosis and Treatment of Bone Metastases from Malignant Tumors" will be released in 2021
    .

    According to the recent consensus guidelines at home and abroad, what are the main treatment goals for metastatic bone tumors? What are the latest concepts and advances in standardized treatment? Prof.
    Zhao Hui: The main goals of treatment include relieving clinical symptoms, improving quality of life, and ultimately prolonging survival
    .

    The most important of these is the delay and prevention of bone-related events
    .

    Due to the different primary tumors and different systemic treatment measures for metastatic bone tumors, anti-bone resorption therapy should be started as soon as possible for metastatic bone tumors regardless of the primary tumor
    .

    Third-generation bisphosphonates, such as zoledronic acid, have the strongest effect on bone resorption, delaying the median time to first SRE by an average of 2-3 months relative to placebo
    .

    The innovative drug denosumab is a fully humanized monoclonal antibody that specifically targets the ligand of nuclear factor-κB receptor activator, which can prevent the binding of RANKL and its receptor substances and inhibit the activation and development of osteoclasts.
    Reduce bone resorption and increase bone density
    .

    Compared with zoledronic acid treatment, denosumab extended the median time to first SRE by 3-4 months
    .

    Local treatment methods include surgery, intervention, radiotherapy, etc.
    , and there are certain limitations in clinical application.
    There are many types of existing treatment options, and their respective indications are unclear.
    How to integrate and standardize the treatment of metastatic bone tumor metastasis can be achieved.
    The key point is that it is necessary to take into account the individualized treatment plan of patients while standardizing multidisciplinary diagnosis and treatment (MDT)
    .

    Lung cancer is the most common malignant tumor in the Chinese population, and about 50% of them are stage IV at the time of diagnosis.
    Bone metastasis is one of the main hematogenous metastasis sites
    .

    What are the important advances in the diagnosis and treatment of bone metastases from lung cancer in recent years? What are the findings of your team? Prof.
    Zhao Hui: The management of metastatic bone tumors needs to be implemented in the whole process of the treatment of lung cancer patients
    .

    From the perspective of systemic therapy, targeted drugs have been widely used in the treatment of lung cancer patients with bone metastases, including EGFR-TKIs, as well as drugs targeting ALK and ROS; there are also many clinical applications of immunotherapy
    .

    In addition, patients with metastatic bone tumors often require intervention and discussion from a multidisciplinary team
    .

    On the basis of precision treatment, we recommend active biopsy of patients suspected of metastatic bone tumors, the concept of which is no meat no treat
    .

    Secondary biopsy is very important, but it is difficult to obtain specimens of metastatic bone tumors, which can usually only be performed in some specialized hospitals
    .

    At the same time, decalcification and biological information processing of bone tissue are also a major technical difficulty
    .

    The strong acid decalcification used in the past resulted in a high incidence of false negatives and could not accurately reflect the genetic status
    .

    Our team used an improved EDTA decalcification method to try on small bone puncture specimens.
    The results show that the slices of bone tissue treated with EDTA decalcification can better retain its biological information and are more suitable for immunohistochemical analysis and analysis.
    Genetic testing
    .

    In addition, our team has also explored in the field of artificial intelligence
    .

    The judgment of spinal stability is the key to guiding treatment.
    Patients with spinal instability should be treated in time.
    However, the scoring system is highly professional, and many grassroots physicians cannot master it.
    Affect the quality of life and survival of patients
    .

    At present, we have developed a relatively mature software using artificial intelligence, which can automatically give spinal metastasis scores and evaluate spinal stability.
    Preliminary results show that the correct rate of software recognition is equivalent to that of the attending physician in the Department of Medical Oncology, Shanghai Sixth Hospital, and slightly lower than that of the Department of Radiology.
    attending physician
    .

    Our software is also currently the only software in the world for evaluating spinal stability of metastatic bone tumors.
    We look forward to later clinical application and promotion to bring greater help to patients
    .

    What is the most challenging part in the diagnosis and treatment of common metastatic bone tumors? How to solve? Prof.
    Hui Zhao: The main difficulty in the diagnosis and treatment of metastatic bone tumors lies in the variety of primary tumors from which they originate
    .

    In the process of diagnosing primary lesions, missed diagnosis and misdiagnosis are prone to occur, which will seriously affect the quality of life and overall survival of patients, and more research and exploration are needed
    .

    Secondly, the clinical complaints of a large number of patients with metastatic bone tumors are non-characteristic when they are admitted to the hospital, including bone pain and numbness of both lower extremities, which lead to the misalignment of the departments at the initial consultation, which causes delays in diagnosis and treatment in the process.
    Therefore, optimization of diagnosis and treatment is recommended.
    Process is also critical
    .

    Another important issue is that the treatment of metastatic bone tumors is complex and diverse, and it is not only necessary to guide systemic treatment according to the primary tumor, but also to standardize local treatment
    .

    This requires multidisciplinary collaborative comprehensive treatment, grasping the timing of treatment, and avoiding overtreatment
    .

    In the next 10 years, these advances are expected to change tumor prevention and treatment.
    In your opinion, where are the most promising areas for breakthroughs in tumor clinical treatment in the future? What are your expectations for this field? Professor Zhao Hui: From the perspective of the current hot fields, there are three major directions
    .

    The first is immunotherapy, including cell therapy such as CAR-T, immune checkpoint inhibitors such as PD-(L)1 monoclonal antibody, and tumor vaccines.
    A large number of clinical studies under development are making progress
    .

    Second, with advances in bioinformatics, we will be able to classify patients more precisely and thus better guide treatment
    .

    Third, AI assistance will play a multi-faceted role in tumor treatment, including assisting diagnosis and patient management in clinical links, and accelerating the design and screening of drug targets in basic research
    .

    How do you think the industry, the medical community, the patient group and the government should collaborate efficiently to more effectively advance the research and development and diagnosis and treatment in this field? Prof.
    Hui Zhao: On the one hand, from the perspective of clinical trials, the current research and development of drugs acting on classical targets is relatively concentrated, forming a situation in which a large number of similar drugs meet in a narrow way.
    To find a wider range of effective targets requires industry and basic medicine.
    cooperation between the medical community and the clinical medical community
    .

    On the other hand, for patient medical data sharing and privacy protection, how to establish an effective mechanism to find a balance in promoting medical development and patient rights also requires cross-border communication and efforts
    .

    What changes do you think will be ushered in the field of cancer prevention and treatment in the field of healthy aging in the next 10 years? Can you paint a picture for us 10 years from now? Prof.
    Zhao Hui: Thinking about the future, I first hope that all cancer patients can be diagnosed and treated early, and that patients who have already been diagnosed can receive standardized treatment and follow-up management throughout the whole process under full network monitoring
    .

    Second, hospitals at all levels perform their own duties and find their own roles and positions in patient treatment and management
    .

    Third, the empowerment of artificial intelligence can guide us to a clearer research direction and shape a better future of diagnosis and treatment
    .

    With the above-mentioned efforts, although there are still challenges in completely conquering tumors, it is hoped that the survival time of Chinese patients will continue to improve and reach or approach the world-class level
    .

    Disclaimer: The WuXi AppTec content team focuses on introducing global biomedical health research progress
    .

    This article is for information exchange purposes only, and the views expressed in this article do not represent WuXi AppTec's position, nor do they represent WuXi AppTec's support or opposition to the views expressed in this article
    .

    This article is also not a treatment plan recommendation
    .

    For guidance on treatment options, please visit a regular hospital
    .

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